EPtalk by Dr. Jayne 4/9/20

I’ve been reading tons of scientific papers this week, trying to keep up with recent research on COVID-19 while alternating other things I have put off, such as finishing my tax return. I know the deadline has been pushed, but I’m expecting a refund this year so wanted to get things moving.

I enjoyed coming across this decidedly non-COVID article discussing the “Association between lottery prize size and self-reported health habits in Swedish lottery players.” That’s a decidedly niche research set, for sure. In case you’re curious, the question they were seeking to answer was this: “Is unearned wealth from lottery winnings associated with more healthy habits and better overall health?” Looking at over 3,300 individuals up to 22 years after their lottery win, they found no statistically significant differences in long-term health behaviors.

I also took some time for personal healthy behaviors, such as continuing to binge watch “Poldark” and also watching the first two episodes of the new season of “Call the Midwife.” I enjoy its gritty portrayal of nurses in London during the 1950s and 1960s. Although it makes me grateful for the medical technology we have today, it also makes me wonder how things would be if we had a similar national focus on neighborhood-based care, including home outreach. If there’s any good to come out of this pandemic, perhaps it’s a re-evaluation of how we deliver care around the world.

Speaking of remote care options, one of the things I wanted to see at HIMSS was the GlobalMed Transportable Exam Backpack. I was impressed by their exam cameras last year. They have integrated those plus a few more tricks into this bag, including EKG and ultrasound. Apparently its predecessor was a ruggedized briefcase that was used in various capacities, including treating Secret Service agents detailed abroad and enabling communication with physicians in the US. The images obtained with their cameras are better than what I sometimes see with my own eyes in the office, which makes me wonder about using solutions like theirs to augment in-office workflows as well as those in remote locales.

April 12-18 is STD Awareness Week, and a recent writeup made me wonder whether social distancing will have much of an impact on sexually transmitted diseases. I live in one of the US cities with the highest rates of STDs, so a reduction in illness would certainly be welcomed. The article notes that the event used to be the full month of April, but even with the condensed timeframe, the goals are the same — raising awareness, providing education, encouraging testing, and reducing stigma, fear, and discrimination. Stay healthy, folks!

When patients test positive for sexually transmitted diseases, public health agencies have to perform contact tracing. That kind of work has come into the spotlight with COVID-19. I’m hoping some of those technologies can be later adapted for routine use. A group of innovators from MIT and other organizations has created a solution that not only helps with tracking, but also helps maintain privacy for individuals who allow it to use their location tracking data. Patients’ memories aren’t always reliable over time and other countries have made great use of location data, not only for contact tracing, but to enable a return to a more normal level of human interactions.

I was glad to see CMS applying its Extreme and Uncontrollable Circumstances policy for clinicians who aren’t able to submit their Merit-based Incentive Payment System (MIPS) data by the recently extended April 30 deadline. The policy will be automatically applied to those who don’t submit – clinicians will be flagged and receive a neutral payment adjustment for the 2021 MIPS payment year. For those organizations who started data submission but aren’t able to complete it, a separate non-automatic application can also be completed.

For those of you who spend most of the winter checking this graphic from week to week, I think we can safely say goodbye to flu season. Many of my coworkers would give anything to go back to even a bad flu season rather than what we’re dealing with now.

It’s a safe bet that most medical school graduates from the Class of 2020 will receive their diplomas in the mail. My alma mater canceled its commencement exercises weeks ago, even before the first states started going on lockdown. They realized that people were already making travel arrangements and wanted to send a message for folks to stay home. It’s the first time the university has ever cancelled commencement, even with world wars and other conflicts.

They sent out an alumni blast today asking us to send messages to the newest graduates as they carry their brand new MDs into a world that none of us envisioned. Here’s to all the new physicians, nurses, therapists, and other healthcare providers heading into this brave new world. My virtual hat is off to you.

From HIT Girl: “Re: specialists. I am not a clinician, so this might be a doofus question, but how easy or difficult is it for a specialist to work as a generalist? Doctors and nurses are getting sick, getting exhausted, and visibly suffering moral distress. Can specialists be rotated in to take over and let people take some time off to regenerate (or recuperate, if sick)?” This is the approach many healthcare systems are taking, although they are trying to find synergies in what kinds of resources can do which kinds of work. For many subspecialists, such as cardiology and gastroenterology, their underlying training is in internal medicine and they have a lot of knowledge that can be brought to bear in the hospital setting. They might not do as well in the outpatient setting, where we see a broader spectrum of chronic care than what they are used to encountering.

Many physicians are taking online refresher courses to get up to speed before they’re redeployed to other clinical areas. My experience, in delivering urgent care and primary care at the World Scout Jamboree, is that a lot depends on the individual clinician and their training. The subspecialty surgeon with whom I worked had a terrible time treating basic primary care issues such as strep throat, and his continued frustration with the EHR added to his inflexibility and unwillingness to learn. Conversely, the pediatric rheumatologist slid right into adult-ish medicine without blinking and even made a couple of great saves.

Bottom line: your mileage may vary when redeploying physicians. There are some procedures I haven’t done in decades and wouldn’t have any business attempting them regardless of how many videos I watch.

Thank you to all the readers who sent me words of encouragement in response to my recent underemployment. I’m trying to pick up telehealth visits where I can, although the big surge seems to have passed in those as companies have onboarded new physicians in droves.

Several wrote with their own physician stories that could form an administrative hall of shame. One busy primary care doc who expertly transitioned to telehealth saw her schedule reallocated to her partners who weren’t as busy. Others were told to use vacation time to make up for closed clinic hours even though they were willing to see patients virtually. Another office is requiring all the providers to come to the office to deliver telehealth services, citing HIPAA and “place of service issues” as the reason providers can’t operate from their homes. The common theme was poor communication – major changes in how physicians operate probably shouldn’t be delivered via impersonal group text messages.

I appreciate each of your stories about your personal “new normal.” Please keep them coming.

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