By HANS DUVEFELT
Life as we knew it and medicine as we had viewed it shapeshifted so dramatically in the past year that it is still hard to believe.
Medicine has started to move from an in-person only profession to one that finally recognizes that clinical assessment and treatment have fewer boundaries than people assumed. A patient of mine with newly diagnosed mastocytosis had a productive first consultation with an immunologist hundreds of miles away right from her own living room.
Efficiency increased when we could handle straightforward clinical issues electronically, even over the telephone, and still get paid. We were liberated from the perverted and miserly view by insurers that services not delivered in person should be free, as if fast food restaurants couldn’t charge for food at the drive through.
We delivered more virtual services to allow patients the safety of staying at home and avoiding lobbies, waiting rooms and exam rooms where airborne particles might linger.
Yet, when a primary care or mental health patient is in crisis or a person with new symptoms needs to be evaluated, a video visit is sometimes not enough. Step by step, we improvised screening protocols, not knowing which would be efficient or relevant as we didn’t know quite how the coronavirus behaved and transmitted.
We had to put in place telephone triage protocols in order to steer potential Covid cases to the most appropriate sites or levels of care. We also had to find ways to promote, guide and support self care.
Americans have widely held the inappropriate belief that conditions like the common cold or a viral gastroenteritis need to be fought or treated. The infinite variety of cold remedies and the overprescribing of antibiotics illustrate the public disbelief that most viral illnesses run their course and resolve without permanent after effects. Many of my patients, for example, don’t seem to know that drugs that decrease nasal discharge can cause mucous stagnation that leads to sinus infections.
Self care is an obvious strategy to avoid overburdening the health care system and in fact to decrease community spread of the Coronavirus. But it is a psychological challenge for many people to see their symptoms for what they are instead of what they could be. A mild case of Covid-19 is less dangerous than a bad case of influenza or a typical pneumococcal pneumonia. Knowing the cause of mild symptoms isn’t necessary unless you decide to risk exposing others to whatever you have. If you hunker down, stay home and use common sense to monitor your symptoms, everyone is safer than if you go out to buy useless remedies or clog up clinic waiting rooms.
It suddenly made less sense to encourage more visits to generate more revenue. It made sense to consider not only our patients and our organizations welfare but also our communities.
Giving video or telephone advice has come into focus and for many emphasized the value of providers and patients knowing each other. The simple fact that it is easier to “read” someone you know than someone you don’t know is often overlooked by system designers and health care entrepreneurs.
Sometimes patients themselves or their family members have an easier time determining that someone is getting seriously ill than a random provider hampered by the limitations of electronic communications.
So, it seems like this pandemic will bring on more of two seemingly opposite strategies: self care and high tech innovation ranging from telemedicine to vaccine development. I applaud all of it.
Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.