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Monday, May 4, 2020

COVID-19 AND DOCTOR VISITS

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Through telehealth, you may continue to visit your doctor from home

One of the first casualties of COVID-19 was normality, and that included routine doctor visits.

Appointments made late in 2019 were suddenly canceled in 2020 as doctors’ offices and hospitals faced the same social contact issues as the general population. The dilemma was how to treat sick people if you must stay six feet away?

Doctors and hospitals could not wait for a government decision, so they expanded some of the technology applications that had been introduced over the last decade and mobilized their own solutions.

It has been sort of like the response of the United States to the bombing of Pearl Harbor. The entire nation suddenly realized that there was a new normal, that things would not be the same, and that it was up to everyone to make the necessary changes for survival.

So, to a greater or lesser degree, Americans adopted social distancing, wearing latex gloves as a new fashion statement, and appearing in public masked like bandits in the name of personal health. Medical personnel struggled to find the PPEs to make their regular human interactions safe, while the wheels were set in motion to get health care up to speed even amid what was being called a global pandemic.

In the local area, the major medical centers quickly let their communities know that medicine was not cancelled because of illness. Some elective surgeries were delayed for a time, but even some of those are beginning to make their way back onto hospital calendars. New visiting rules were instituted for hospitals, masks became the fashion look of the day, even temperature checks of people entering medical buildings became common.

Amid these adjustments, health care began a ramping up to “wartime” footing. Both Christus and Willis-Knighton systems announced virtual visit service and offered patients the option of “seeing” a doctor from home. They even offered screening tools online for people concerned about their exposure to the virus.

Two terms that have become more common are telemedicine and telehealth. Telemedicine generally refers to using technology within the medical profession, more professional to professional. Telehealth refers to doctor-to-patient interaction.

Dr. Aaron D. Martin, MD, MPH, is director of telemedicine for Children’s Hospital and LSU Health in New Orleans, and he’s no stranger to technological health care; he’s been practicing it for some time. The technology has developed over several years to improve urgent care delivery.

Martin noted that other doctors had to make a quick change. “As far as doing the day-today ambulatory care, the low acuity care, there wasn’t a lot of people doing that.”

Part of the problem for doctors was they might not get paid for some of those visits, which were not in-office. The Centers for Medicare and Medicaid Services issued a specific waiver which mandated that physicians could charge for their services in a telehealth setting because of the unique nature of the coronavirus situation. “With the waiver that went out saying that everyone would reimburse for virtual visits as well as phone calls in many situations, it really opened up the doors for everyone to try,” according to Martin.

At the heart of the matter were two issues: Would patients agree to the new way of seeking medical care, and would doctors adopt it? Given the lack of medical safety options presented by COVID-19, “both of those fears were put front and center, and everyone had to face it,” Martin said. “And it’s universally just been loved by everyone. When I started, we were onloading different specialties every month, and once you get somebody willing to try it, they realize this really is kind of cool.”

Patients realize they can stay home and get the same care they would have received for non-acute issues they got when driving to an office without risk of exposure to the virus. On the doctor’s side, Martin said, “The physicians start looking at their schedules and realize, 30, 50, I’ve had some docs say, 100 percent of my visits could be done right from the patients at home [resulting in] the same care they were getting before. Docs are usually a little slower to come along. But they end up still saying the same thing at the end.”

Martin stated doctors learn in medical school that 80 percent or more of diagnoses can be determined simply by the patient’s medical history. He said studies have indicated some of the old school diagnosing talent doctors exhibited had been suppressed given the availability of modern testing like CT scans and blood studies. “Many times, labs and imagery can skew your intuition, what you’ve been trained to look at closely in diagnosing things,” Martin said.

He described the differences in the new technologies as matters of degree. “The complicated telemedicine is the high acuity telemedicine. This is like tele-stroke or tele- ICU type stuff where you have actual software platforms that are used to monitor patients in their rooms, zoom in on their IV fluid rates and things like that. That can be very complicated.”

What is becoming more common, he said, is getting care to people at home, so they’re not coming back and forth to the hospital or a clinic and preventing the spread of COVID-19.

“It works really well. It doesn’t require a huge technology jump. I’ve walked many grandmothers through it who have been able to figure it out. I’ve worked Spanish-speaking people through an interpreter to figure it out. Once they’ve done it once, they get over that fear, and they tend to like it.”

So, is this going to be the new way of visiting your doctor? “What’s going to happen is [telehealth is] going to persist. That’s our plan and our intentions going forward. We’ll whittle down those things that are more appropriate to be seen in person and those things that can stay virtual will stay virtual,” Martin predicted.

“We have this huge spike right now, and that’s going to go down as restrictions are lifted appropriately. But there will always be more telemedicine now than there was before.”

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