Wondering what's going on with your doctors' offices and clinics?

How are you supposed to see the doctor or other care provider if you're also supposed to #StayAtHome?

What even is #telehealth?

Let's talk a bit about what's going on in outpatient medicine during #COVID19.
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You've heard a little (though probably not the worst parts) about what our frontline #healthcareworkers are experiencing. It’s harrowing at best, and in reality, it's a complete crumbling of our healthcare system to take optimal care of its patients and its workforce.
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What you may not be hearing as much about in the media, but will affect every one of you, is what’s happening with clinics and outpatient care.

Because almost everything has changed.
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I speak for myself, and my statements do not reflect that of my organization, and the experience that I am having is not unique to my organization.

#COVID19 has upended clinical care as we know it, and it’s important that we talk about this.
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You still need medical care. I still need medical care. We all still need our medical care.
If you had chronic conditions prior to COVID19, you still have those same chronic conditions. Acute conditions will still happen.
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People will still get appendicitis. They will still get heart attacks and strokes. The rashes will keep happening, depressive episodes and anxiety attacks will still occur (even more so now), other infections and cancer won't stop, and on and on.
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The mild acute care needs will still occur.
The severe and life-threatening conditions will still happen.
Non-COVID medical emergencies will keep happening.
The chronic disease maintenance will still need to take place.
The chronic disease flares won't stop happening.
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What to do? How does our #healthcare system take care of all the non-COVID19 healthcare concerns that will continue to happen, during the time of #COVID19, when we are all trying to simultaneously practice #socialdistancing to #flattenthecurve?
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Overnight, medicine has had to adapt.
Overnight, we have had our entire profession and workflow upended, and we have had to reimagine EVERYTHING.

We have had to do this while doing our best to remain physically distanced.

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Healthcare organizations and clinics have had to determine how we going to best take care of our patients, in the safest manner possible, that will not inflict harm upon them, the workforce, our families, or the public at large.
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None of us trained in this.
None of us were prepared for this, or ever practiced this.
We have not had simulations or trial runs.
We don't learn about this in medical school.

We are, quite literally, creating this as we move through the #coronavirus pandemic ourselves.
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There are dozens, if not hundreds, of emails a day addressing policy/protocol updates from our clinical departments, our organization, our hospitals, our medical societies, our public health departments, etc.
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If you are part of leadership, you are actively working on creating these policies and protocols, which are updated almost daily as circumstances change. There are local, state and federal policies within which all of this takes place and must be compliant with.
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We must keep up with the science: the #SARSCoV2 virus itself and updated guidelines and literature that are coming out an unbelievably fast past from our doctors, researchers, consensus groups and expert panels, sorting through fact vs fiction.
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For social distancing to work properly, we must all engage and commit to it. Clinics are finding the safest solution to provide care while still trying to keep as many people at home as possible.
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This means postponing all non-essential & non-urgent care to either a later date, or ideally, to be managed via #telehealth, aka #telemedicine.

So let's talk a little about that.
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Telehealth has been around for a long time, and it’s mostly used a way to provide care to remote areas that don’t otherwise have adequate access. It's getting its moment in the spotlight now, and it’s about time.
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If we are to truly improve access to care in this society full of disparities, we must fully adopt and invest in telemedicine as an effective means of care delivery.

COVID19 has forced us to come to terms with this reality.
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The urgency of the situation has led to fast-track loosening of restrictions that were in place prior to COVID19.

For ex, HHS has eased HIPAA restrictions on platforms that can be used to deliver real-time video care, meaning we can now use certain methods like FT and Skype./19

Yes, Facetime and Skype! Can you believe it?! We couldn't do this before due to privacy concerns, but those are lifted for the time-being.
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@CMS just announced approval of audio-only (telephone visits) to be considered as appropriate means to deliver care.

A variety of #telehealth and #telemedicine vendors have been stepping up their game and helping with waiving fees to their clients.
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Also, @zoom_us and @Webex have been instrumental, both for delivering telehealth as well as to keep operations running.

Meetings, conferences, continuing trainee education, etc...

It’s been truly fascinating to see what can be done when *we have no other choice*.
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What does this mean for you as a patient? Good new and some not-so-good news.

The good news is that many healthcare organizations are doing everything they can to figure out how to take care of their patient populations and getting innovative and flexible with these mechanisms.

We are learning how to provide #telehealth in real-time. We are learning about the nuances in phone vs video vs online communication.
We are learning about how this affects patient billing and costs.
We are learning what works and what doesn't.
And we need to do it fast.
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Every day we don't get our patients care is one more day that those patients may experience harm by not getting care.

Every day patients don't get care for their medical conditions is one more day those patients may end up going to the overwhelmed emergency rooms.

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I'll be honest. I wasn't sure how well I could provide care over the phone or over a video.
The entire art of medicine is being with your patients. Seeing them face to face and having meaningful connections.
But these aren't normal times anymore.
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Being able to provide care to a patient over the telephone or a video virtual visit, while allowing them to remain at home and alleviate their concerns about breaking #socialdistancing, has been crucial in our fight, as doctors not on the frontlines, to help save lives.
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Most patients have been immensely grateful to still get care and not put themselves or others at risk, and the providers are grateful for the same.

And there are some other benefits too.
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Other benefits include saving them time and money to not have to come into the office and helping our planet by keeping cars off the road.

Have you heard that China can see blue skies for the first time in...forever?
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Though these other benefits may not seem as relevant now, they are still important, and will become more relevant once we get past this pandemic.

But the process has not been without its challenges.
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The not so good news is that there will be moments of being uncomfortable and being inconvenienced.

1. It’s new, and with any new process means growing pains, trial and error, and a whole lot of headaches early on as we all trudge through this learning curve together.
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This is very uncomfortable, for all parties involved.

2. Having to either postpone non-essential and non-urgent care or address these care concerns over telehealth may be inconvenient, and often not ideal.

Is face to face medicine the best? Yes, most definitely.
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Nothing can truly take the place of the doctor-patient interaction that we are familiar with and we know is at the heart of medicine.

As a #dermatologist, there’s hardly an adequate replacement for being able see and touch a rash to help with our diagnosis.
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But, is that the best thing for us right now, as we fight a pandemic that requires as many of us as possible to remain physically distanced and confined so that we can flatten the curve?

Most definitely, the answer is no.
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You've heard how social distancing works.
For us to truly get ahead of this, one of our main strategies is to keep people at home.

Particularly when we know that asymptomatic carriers can drive the spread.
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It is hard for us as patients to be told we have to put off non-urgent or non-essential care, or to interact with our providers in a contrived and impersonal manner.

I completely get it. Because I'm a patient too, not just a doctor. And so are my kids, my husband, my parents.

It’s also hard for us as providers to learn all these systems overnight, deliver care in ways that we don’t often prefer, and be in positions to say no, we just can’t do that right now. We just aren’t used to that. Not as doctors, and not as a society.
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Believe me when I say this has been one the most challenging experiences of my career, & definitely a time of unprecedented uncertainty for all of us.

I know how hard this is for you as a patient. That has kept me up at night. It's why we've been working 24/7 to figure this out

Additionally, there are entirely new systems of billing that we have to learn, which often can vary with different insurance carriers (thanks US Healthcare System).

Couple that with managing all the COVID19 chaos and you have a whole world of upside-down-ness.
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At the beginning, I said almost everything has changed. So what hasn’t changed?

What hasn’t changed is the “why”. The “why” is what brought us here to healthcare, and it’s what keeps us here even through our darkest hours. The “why” is YOU. YOU are our purpose and our mission.

Taking care of you and your loved ones, and all the people around you, and all the people around us, are what keeps our wheels turning, our pulses beating, our minds thinking, and our bodies moving, despite the confusion, the fatigue, the uncertainty. This will never change.
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You have always been the reason and will always be the reason. You are at the center of it all, and for that, we will have a life after Corona.

It will be a changed life, a new reality. #COVID19 has changed us permanently.

It has left deep scars, and continues to wound. /41

But I truly hope some things will finally be better than they ever were before. I truly hope some things will finally change.

This virus has blown open all of the frailties of our society.
But what it can never do is take away the spirit of who we are.
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As doctors, nurses, trainees, technicians, clerks, therapists, receptionists, volunteers, & all the other #healthcareworkers, we are scared right along w/you.

But we've also got you. We will walk through this dark tunnel with you.
It is going to be hard. Impossible at times.

I want to end this by letting you know how much we are all thinking of you. And trying to do our best to figure this out. Please know that, and know that we don't want to do anything that will jeopardize your health.
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There will be an end to this dark tunnel. There will be a light at the end. I know there will be.

And at the end of this dark tunnel, we will still be there, waiting for you.

Much gratitude for reading.

I couldn't end on 45, so here is #46.

Stay as well as possible, my friends.
Stay home, stay safe, and call on each other.
We need each other to get us through this.

End. 46/46
#COVID19 #COVIDー19 #medtwitter

@alisadoc1 @RyanMarino @tnicholsmd @AlexAndersonMD @uche_blackstock @arghavan_salles @DrHowardLiu @sarahkendzior @AmyOxentenkoMD @JulieSilverMD @tamisawyer @ASlavitt @janevandis @TheRealDoctorT @JJcolemanMD @LeahHoustonMD @cmclymer @mochamomma @ETSshow @moorehn @ElizabethEThorp

Yikes, I’m not sure if that’s good or not !