(Note: Dr. John Hearnsberger provided his eighth coronavirus update Sunday morning at First United Methodist Church of Nashville.)
HMH continued its lockdown for the 6th week. We have had no overflow of patients to the surgery suite this past week. Currently there is no suspected case hospitalized, and both wings are open for regular admissions. However, I’ve recently learned of a suspected COVID-19 being held in the ED for admission, so the personnel are currently preparing for this admission. Due to testing turnaround, we have had only two elective cases in surgery this past week. We have tested patients and do have more elective procedures beginning Monday. We have a backlog of cases, so the number of elective procedures should increase in the ensuing weeks. Some patients may choose to wait until the pandemic subsides before scheduling an elective procedure. In many instances this is perfectly acceptable, but this is a decision that needs to be made between the doctor and patient. Many businesses across the state are reopening—all with restrictions. The cartoon on the editorial page [DG] this morning read, “The good news, is we are reopening. The bad news is, we don’t have enough healthy employees to run the plant.”
Here are the latest COVID-19 statistics for Ark. this morning.
1. Total cases—3,372.
2. Deaths—72 [Dept of Health]. 73 [ADG].
4. Positive tests—3372.
5. Total tests—51,582.
6. Negative tests—48,210.
7. 73/75 counties are affected. Howard Co. cases remain at 13 with 13 recoveries. I do not know the results of the testing done in Nashville this past Thursday—how many tests were done and were there any positive. I do know one of these patients tested Thursday was hospitalized, but had a negative test result. HMH has tested a total of 253 patients with 13 positives. There has been a downward trend in Arkansas cases per day since the peak on April 21.
Many changes, often drastic, have taken place in our daily lives since this pandemic began. Some events we hope resume in a timely fashion, such as sporting events, school attendance, and church services. Some changes may linger for a long time as working from home, video conferencing, and personal efforts to prevent spread of infectious disease. Will new technology change daily activities as we know them? Will we have virtual classrooms and virtual football games?
One concept that is here to stay is telemedicine. Telemedicine has actually been around as long as the telephone. The phone rings— “Hey doc, I gotta sore throat. Can you call me in something?” “Sure. I will do it now.” This notion implies that both doctor and patient know each other, and the doctor has knowledge of the patients health and medical conditions so that he is able diagnose and treat by means of a phone call, with little chance of making a mistake or doing harm—“First, do no harm—“ Technological advances have skyrocketed. You Facetime with your grandkids, why not your doctor?
When I served on the Arkansas State Medical Board, the Medical Practices Act defined a doctor patient relationship as one that occurred during an in-person, face to face meeting. Telemedicine did not follow this guideline. Later, telemedicine, as defined in the Telemedicine Act of 2017, is—“The use of electric information and communication technology to deliver health care services.” Furthermore, a professional relationship had to have been established by a prior in person meeting, or the doctor had sufficient knowledge of the patient’s medical condition to provide appropriate care. The old school, doctor-patient relationship that existed for decades, and was the gold standard in developing a relationship that was essential for diagnosing and treating a patient, has now been thrown out the window during this pandemic. An executive order issued by Governor Hutchinson in March suspended a face to face exam required to establish a professional relationship. A doctor could establish a professional relationship with a patient using any technology deemed appropriate, including a telephone, with any Arkansas citizen to diagnose and treat. This was done to minimize the number of patients in doctors’ offices waiting rooms, hoping to decrease the spread of the coronavirus. Is this good medicine—?
There is no doubt that telemedicine plays a vital role in the delivery of health care today. The best example I can give you today for HMH is tele-radiology. All of our radiology procedures are sent over the internet to Hot Springs Radiology. We have an in hospital radiologist one day a week when “hands on” technique is required. This is a good service. We participate in the stroke program with UAMS where real time consultation, using video monitors via the internet, is obtained so a neurologist can help assess and treat a patient with an acute stroke. This has been life saving! Arkansas Children’s Hospital, as others, has a telemedicine program. Physicians in our community are increasing telemedicine capabilities during this pandemic.
Here are other examples where telemedicine could be used today. Photographic microscopic tissue samples can be sent to any reference pathology lab for review. Obstetricians in tertiary care centers can review ultrasounds of high risk pregnancies from rural areas all over the state. A cardiologist in Little Rock could view a real time ECHO done at our hospital. The list goes on—
My position on the ASMB then, and my position now, is this technology is here to stay, and will only get better. And who knows what advances and capabilities 5 G will bring! We as physicians, physician regulators, third party payors and law makers must learn the appropriate and efficient use of this technology.
No doubt about the convenience of a doctor visit from your kitchen table or bedroom vs. driving minutes or hours to your doctor’s office. But just as we are carefully and scientifically developing treatments for the coronavirus, we must carefully analyze telemedicine in a similar fashion, to be certain that care delivered in this manner is safe, appropriate, and cost effective. Will an audio-visual exam replace “laying on of the hands”? “First do no harm—“
Sunday school by Zoom. Working from home. Teleconferences. Home schooling and virtual internet classrooms. Social distancing with personal protective equipment. A virtual Kentucky Derby and Super Bowl? Is this the future? Maybe so, if the Coronavirus is with us for another 18-24 months as some are predicting.
Medical science continues to work on vaccines and treatment. There is more evidence today that Remsdivir, although not a cure, can shorten the duration of symptoms for COVID-19 for 4 days, and production of this drug is ramping up. In contrast, Tamiflu will shorten flu symptoms for about a day.
Now during this global pandemic and economic downturn, go out into the world and treat everyone you meet like you want them to treat you. [Masterson]. In other words, “Do unto others—“ And don’t forget to wash your hands before you do it!