EPtalk by Dr. Jayne 3/19/20

I was back in the clinical trenches today. At least in the urgent care world, it was eerily calm at times, although we did see some big rushes at the beginning of the day. People are getting the message to stay home, although some ventured out.

I want to offer some advice for those of you who need to seek medical care. First, this is not a time to take the family. If you need someone to drive you, great, but have them wait outside and not enter the facility. I saw two families today with multiple children in tow, but multiple parents. It would have been better if the second parent, who didn’t participate in the visit at all, remained in the car with the siblings.

Second, look out for your healthcare workers. If you see that something has gone wrong with their personal protective equipment, say something. Although I’m sure the worker in the picture above knows that their forearms are exposed, therefore defeating the point of a gown, maybe they would have done something different if a patient or co-worker had said something.

Third, please do not question why your provider is wearing a mask. We have our reasons, and some are personal health issues. We might also be protecting you from our cough or sneezing since it’s also allergy season. We are healthcare providers and you need to trust us to make decisions for our health and yours. I have had colleagues at other facilities that have been told they can’t wear masks because they’re “panic-inducing” for patients.

Many of your healthcare workers are terrified. If they wear the one crummy mask they have access to and have been wearing every day for a week, give them a break. Maybe they’re just scared because physicians in our area have already been infected.

Last, please think before you complain about wait times. You never know when the team is tied up transferring a critical patient to the hospital or doing another critical task, like starting the autoclave so we can get more instruments sterilized. For those patients who are coming in apologizing for being sick, it’s OK and you don’t need to apologize. That’s what we’re here for.

I was excited to hear announcements that licensure requirements for telehealth are going to be relaxed. The reality, though, is that it is on a state-by-state basis, and not all the states are playing along. I can see patients in Florida and North Carolina as well as the states where I have licenses, but we’re a long way from letting available physicians flex to cover the areas with the most need.

Most of the telehealth visits I’ve done in my off hours have been for routine things. Patients either don’t want to risk going to a physician’s office or the offices are overwhelmed and not keeping up with phone volumes. I handled some medication refills along with sinus infections, urinary tract infections, and pinkeye. These are routine things in primary care and I’m glad to be part of the solution as clinics struggle to cope with their new normal.

CMS has also relaxed telehealth rules for Medicare and Medicaid as far as which visits providers can bill. Medicaid is still subject to state regulation, so that might take time, just as with the state license issue. New federal policies also let clinicians use technology beyond established telehealth platforms, such as Apple’s FaceTime, Facebook Messenger, Google Hangouts, Microsoft Skype, and more .

Speaking of virtual care, I practiced some virtual self-care this week as my cello instructor moved my lessons online. I had to run a cable from my laptop to the router to make it work and we experienced some distortion of the sound when I was too close to the microphone, but it worked out well. I only started playing last summer, so I smiled when I saw this article about two young cellists who played a socially distant concert on the porch of their elderly neighbor. The article mentions that their repertoire included Suzuki Book 1 and Book 2. I’m just finishing the latter, so perhaps it’s time for a concert.

From Cultural Afficionado: “Re: Google Arts & Culture. I was led there by an article about virtual tours of museums around the world for folks who are self-quarantining (is that a proper verb?) While looking over the rest of the site, I found a ‘Spotlight on Shoes’ section that included this story, ‘Amazing Shoes of Turin.’ Enjoy, and thanks for your contributions to HIStalk!” I’ve been enjoying all kinds of virtual adventures as I force myself to take frequent breaks away from scientific articles and other reports about COVID-19. My favorite video is the one of the penguins at the Shedd Aquarium in Chicago, who were allowed to roam the building after it closed to visitors. We need a little levity in times like these, and penguins always get the job done.

From Homeward Bound: “Re: telecommuting. I work for a health plan with about 2,000 employees. The organization had very little telecommuting before this outbreak. This crisis has forced a huge amount of scrambling to get hardware to people who need it, and more importantly, get management to figure out how to manage people they don’t see on a daily basis. It will be very bumpy for the time that everyone is working remotely. Work will get done, but not as much as usual. It will be interesting to see whether the old-school leadership tries to put the genie back in the bottle once we don’t all have to be remote. The lack of telecommuting has been a real negative for recruiting for a long time.” I hope managers are keeping an eye on productivity because they might be surprised. Of course it varies from employee to employee, but some of us get much more done in a non face-to-face situation. I’m sure others have trouble focusing or maintaining the self-discipline needed to work remotely. Lack of childcare is another factor in this situation compared to other work from home efforts, so if productivity dips, I hope they don’t judge too harshly.

It’s time to announce the results of my virtual Shoe-A-Palooza and Sock-It-To-Me competitions. A single champion dominated in both categories — Dr. Nick van Terheyden. In his submission, he notes: “My Scottish Leather Ghillie Brogues. Not for the whole show, but for my now-cancelled Whisky Tasting at the NextGate booth on Tuesday.”

There’s a potential 18-month trajectory for the COVID-19 crisis, so let’s hope we get to see that ensemble at HIMSS21.

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