Curbside Consult with Dr. Jayne 3/30/20

I’m still getting tone-deaf emails from HIMSS touting the value of Virtual HIMSS. They are also pitching a white paper that I can download to “understand in real time how your patients experience every interaction along the continuum of care; make patient feedback quick, meaningful, and actionable; and protect and improve your market share.” Honestly, with what is coming, I don’t think health systems are worried about protecting their market share. They are either knee-deep in COVID-19 or trying to prepare for it.

The hospitals in my area are busy giving very carefully worded interviews to the press about their stock of personal protective equipment. They usually go like this: “As of today, March 29, we have enough.” Reports from friends who work at those facilities are pretty bleak and we’re not even in a hot zone.

I also heard report that HIMSS isn’t wasting any time invoicing corporate members for their annual renewals, which has to sting for vendors who recently ponied up a good chunk of change to exhibit at a conference that didn’t happen.

I tend to skewer many different parts of the industry, so I don’t want to miss the opportunity to highlight physicians who are behaving badly. States are coping with a burst of prescriptions for drugs that are being used to combat coronavirus, often being written by physicians for themselves or their families. In response, states are requiring physicians to include a diagnosis code on every prescription for the suspect drugs, one of which is azithromycin.

Although including a diagnosis code on prescriptions is a best practice for medication safety, the reality is that many physicians don’t do this unless their EHR is set to require it. Those physicians just going about their business treating strep throat in penicillin-allergic patients are getting pharmacy callbacks, which clogs up the system. Some organizations have flipped the switch to require a diagnosis code for all prescriptions, which is making everyone unhappy.

Bottom line, folks: prescribing unproven drugs for your family in a situation like this one is unethical. If you are doing it, shame on you.

On the positive side, AMIA has announced that its Clinical Informatics Conference scheduled for May 19-21 will now be virtual. The CIC is a must-attend conference for many clinical informaticists who are in the trenches with hospitals and health systems versus being in academic settings. In addition to occurring on its scheduled dates, organizers will share the content with registrants using a learning platform. The CIC has grown tremendously since its inception, roughly doubling in size every two years. I wish AMIA the best in trying to make this new format happen.

Recently my clinical practice has hit a lull as we wait for the surge of coronavirus patients to hit. I’ve gone from delivering medically focused care to delivering care with a more psychological focus. A good number of patients in both my in-person and telehealth practices just want advice and aren’t able to get it from their primary physicians, or don’t have primary physicians to reach out to.

I’m also giving a fair amount of public health advice both in my practice and on various Facebook groups and community forums. Medical misinformation abounds these days, and people are coping with requests to stay at home with some unhealthy behaviors.

Our local high school had to recently close its athletic fields because one of the club football teams called a practice despite a stay-at-home order being in place. Parents drove their middle school children to participate in contact football, which baffles me. Other people are getting together in groups to have social distance tailgating parties, where the six feet of social distancing is just an illusion. Another group of moms got together and backed their minivans up facing each other, then crawled into the back end and drank Starbucks. People are asking me what I think about these practices, and sometimes I struggle to find the right response.

We live in the most connected time in human history. The technology to bring people together while they are apart is amazing. Most of us in the US have ready access to free video calling, conference calls, unlimited long distance, and more. However, people are struggling to feel “close” to people unless they are within a certain physical proximity. Have we lost the ability to have relationships with people unless we are literally face-to-face with them?

Some of my best friends live across the country and around the world, but I can “talk” to them within moments through texting or online messaging. They are literally at my fingertips through the magic of the cell phone. For those people who psychologically must have face-to-face contact, I’m recommending they do it with a single friend and from a distance, rather than mimicking one of the group distancing solutions I’m seeing.

People who are getting together in these groups are missing part of the point about healthcare providers wanting or needing them to stay home. When you’re on the road, you put yourself at risk for accidents, which puts first responders at risk, and possibly healthcare providers. It also puts you at risk – you can give the virus to them, and they can give it to you, since many of us don’t have adequate personal protective equipment.

It’s one thing to go out to get essentials. It’s another thing to go meet up with friends because you’re bored. I strongly encourage people to rethink what they’re doing, especially if they’re under a stay-at-home or shelter-in-place order.

For those of you who might be struggling with this, I have some tips to share from retired NASA astronaut Scott Kelly. As someone who spent her formative years wanting to be an astronaut (specifically, the first doctor in space, but I didn’t quite hit the mark), I have tremendous respect for those who journey to the ultimate frontier. As he says in the piece, “Flying in space is probably the only job you absolutely cannot quit.” Some highlights from his recommendations: follow a schedule, but pace yourself; go outside (safely and prudently); find a hobby; keep a journal; listen to experts; and take time to connect.

As an anonymous blogger, the last one is important to me. I correspond frequently with a few regular readers, and it’s good to have kindred spirits. If you’re not sure who to reach out to, check on a neighbor, reach out to an elderly person in your religious organization, or consider reaching out to someone from work who you typically see in passing but don’t get to talk to regularly. We can all make new connections as well as our existing ones, and you might just find yourself brightening someone’s day in this challenging time.

Those of you who have been reading my work for a while know I’m an avid baker, and one of my favorite prescriptions is for pastry therapy. I didn’t write myself a script for a Z-pack to fight coronavirus, but I did treat myself to a new cast iron skillet complete with Rosie the Riveter. She reminds me that we can do this, and like our parents and grandparents during major world upheavals, it’s going to take all of us to get this done. Thank you to my friends at Lodge for keeping the foundry going and the online orders shipping.

To the rest of you, I leave you with tonight’s pastry therapy offering: the Chocolate Chip Skillet Cookie. I promise it bakes up much better in the 10-inch Rosie the Riveter skillet than it ever did in my trusty 12-inch one. Bon appetit!

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