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Category Archives: Medicine
VIDEO: “IS TELEMEDICINE THE FUTURE OF HEALTH CARE?”
The coronavirus pandemic has overwhelmed hospitals, physicians and the medical community. That’s pushed telemedicine into the hands of providers and patients as the first response for primary care. Telemedicine isn’t new to the medical community, however it hasn’t been embraced due to insurance coverage, mindset and stigma. Here’s how it works and what it means for the future of health care.
COMMENTARY
The safety and convenience of Telemedicine have been amply illustrated by Covid 19. It’s place in the future of Medicine would seem to be assured.
Once the epidemic is over, however, some sticky details, waved away by fiat during the early days, must be addressed.
Will Payment parity be allowed by the Health insurance companies (And Medicare) be continued? Will cross-border Practice still be allowed by the states. Will more Doctors modernize? Will lawyers (and litigious patients) restrain themselves?
Stay Tuned!
—Dr. C.
DOCTORS CALL: “CHRONIC COUGH – DIAGNOSIS AND TREATMENT” (MAYO CLINIC)
On the Mayo Clinic Radio program, Dr. Kaiser Lim, a Mayo Clinic pulmonary and critical care physician, explains chronic cough and how it can be treated.
COMMENTARY
If you have had a cough for more than 8 weeks, the good news is that you don’t have Covid 19. The bad news is that you need a Medical evaluation, tests and imaging to find out what is going on.
COUGH is not a disease, but is a manifestation, a SYMPTOM of a disease.
Your Primary Care Doctor will do a Medical History, an examination and a chest X-Ray which may allow her to DIAGNOSE what disease or problem Is causing the cough, and allow her to treat it.
If you continue to cough, you will be referred to a specialist, such as an Allergist or a Pulmonologist. ENT (sinusitis) and Gastroenterology (GERD) are 2 other medical fields often involved.
Usually blessed relief comes when Chronic Cough is properly diagnosed and treated, but a few Patients continue to suffer, challenging the best of medical care. 2 of my friends continue to cough after Medical School Level evaluations.
Nature continues to hide some of her secrets from Medical Science.
—Dr. C.
THE HEALING POWERS OF YOUR POSITIVE ATTITUDE
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
From “Do Not Go Gentle Into That Good Night” by Dylan Thomas
My brother recently sent me a video featuring a confident man with a famous last name and a winning message: You beat Covid by fighting it. I would like to comment on several recommendations in his inspiring speech.
It is usually best to approach a problem with a POSITIVE ATTITUDE and a PLAN (1). This is particularly true with the ravages of old age (my area of expertise). Memory loss? Try to memorize poems. Balance loss? Practice standing on one leg. However………….
One person’s good experience is not a medical study. Medicine calls it a testimonial. This applies to my individual experiences as well. Going forward, I will be recounting many personal experiences with common diseases and conditions. Be careful about applying my solutions to your condition.. EXERCISE CRITICAL THINKING.
Be especially careful not to equate fame with medical expertise.
Mr. Cuomo’s result, if indeed the outcome was changed by his efforts, was most likely influenced by a powerful PLACEBO effect (2) which can be associated with striking outcomes, as we know from countless inspiring testimonials of “hopeless” cancer and other terminal conditions.
Even if we KNOW a treatment is likely due to the placebo effect, it remains effective. I don’t believe I’m doing harm with my speculations.
A couple of generations ago, confidence in doctors was much greater than it is now. We had fewer effective treatments, but surprisingly good results. As medical information of various quality proliferates and medicine loses prestige, it it is losing a valuable tool. Still, we have the placebo effect.
Mr. Cuomo was fortunate to have a good, positive doctor, and to believe in him. Positive affect is powerful.
FEVER is not the virus incarnate, but the bodies RESPONSE to the virus. Fever survived the culling of evolution because it confers a survival advantage, and is helpful.(3) Viruses replicate less rapidly at higher body temperatures.
I always told my patients: “ if you are stuck with the infection, enjoy the fever”. Of course high fevers, above 104 degrees F should be reduced.
I’m not sure that Covid patients should hold their breaths to “fight the virus”, although the length of time you can hold your breath is a good measure of breathing difficulty. Blood CO2, the main driver of dyspnea (shortness of breath), must not be allowed to accumulate. The accompanying hypoxemia (low blood oxygen ) is not desirable either.
I agree with most of the advice quoted by Mr. Cuomo. Lying on the back has proven dangerous in severe Covid. Taking deep breaths (even if painful) will help keep the alveoli (air sacs) expanded. Change of position is important for the same reason, and adequate fluids, including water, is always beneficial.
So educate yourself as much as you can about your condition. Pick out the best doctor you can find (the subject of a future opinion piece) and place yourself in her care. Enjoy a sense of relief and confidence. Even physicians need the objectivity and support of their own doctor.
Finally, armed with a positive attitude, make the most of whatever placebo effect you are accorded.
—Dr. C.
TELEMEDICINE: 80% OF PEDIATRIC PATIENTS SEEN REMOTELY AT JOHNS HOPKINS CHILDREN’S CENTER
From Johns Hopkins Medicine (April 30, 2020):
“A lot of our pediatric divisions are now seeing 80% or more of their patients by video or telephone,” says Hughes.
The Children’s Center’s preparations for the virus and the disease it causes, COVID-19, were unwittingly sparked by pediatrician Helen Hughes and her early work in telemedicine outreach for pediatric subspecialists. In 2018, she spearheaded development of a telemedicine collaboration with the Talbot County Health Department on Maryland’s Eastern Shore.
The goal was to ease the burden of long treks to Johns Hopkins’ Baltimore campus for young patients — especially medically complex patients — for follow-up visits. At the time, she said, “This is where the future of health care is headed. Video technologies can allow us to do so many things for our patients without having to see them in person every time.”
The Children’s Center, notes Hughes, had been conducting between zero and eight video visits per month for the past two years. In the second half of March, after the coronavirus had clearly arrived, Johns Hopkins pediatricians and pediatric subspecialists saw 800 patients via telemedicine. That number increased to 1,400 telemedicine visits in the first half of April. Additionally, MyChart users in April jumped to 71%.
Artworks: “The Doctor” – Sir Luke Fildes (1891)
From an article in MedPage Today by Michael C. Luciano, MD:
You often hear about the practice of medicine which, by definition, is the repetition of a skill set to gain proficiency. All the education, hard work, and countless patient visits are part of this practice.
The art of medicine is the application of all this information and skills we learn and relaying this in a humane way to this one patient in front of you, which is the only thing that matters at this moment. I am here for you is what each patient deserves to feel. This, in my opinion, is what separates the good doctor from the great doctor. That skill is innate. Those going into the field for the right reasons have this within them.
ABOUT THE PAINTING
In 1890 Sir Henry Tate (1819-98) commissioned a painting from Luke Fildes, the subject of which was left to his own discretion. The artist chose to recall a personal tragedy of his own, when in 1877 his first son, Philip, had died at the age of one in his Kensington home. Fildes’ son and biographer wrote: ‘The character and bearing of their doctor throughout the time of their anxiety, made a deep impression on my parents. Dr. Murray became a symbol of professional devotion which would day inspire the painting of The Doctor’ (Fildes, p.46). Fildes invented a new setting and characters for his painting, and in 1890 he made several sketches.
One year after Tate’s commission, The Doctor was exhibited at the Royal Academy. Agnews immediately published an engraving of it which sold over one million copies in the United States alone and became one of the most profitable prints made by the firm. The popularity of the painting confirms the popularity of social realism in art at this time, and Fildes was one of a number of artists, including Frank Holl (1845-88) and Hubert von Herkomer (1849-1914), whose paintings of the hardships of working class life were widely reproduced in The Graphic magazine. The Doctor was one of the fifty-seven pictures offered by Henry Tate as a gift to the nation in 1897.
Read more at Tate Museum website
Doctors Without Waiting Rooms 