"Problems of the Mind"
Dr. Liam Burke is a family medicine physician who practices at the University of Massachusetts primary care clinic. He speaks about telehealth and what it means to provide primary care during the COVID19 Pandemic.
-A Big Change-
All areas of healthcare were affected by the Pandemic. From the way we interacted with patients, to the way we interacted with each other, to the way we carried out care.
“The amount of change that needs to be adapted to every single day has been a challenge, despite the many repositories of information that can be accessed…criteria rapidly change, standards have changed, practices have changed and there are emails everyday from the people who dictate these changes. So it’s been challenging. The biggest adjustment is doing things telephonically, or video conference style, wherein you have to have a sense of the patient and their symptoms, and your ability to elicit that, because we’re losing a lot of the clues we used to see in an in-person encounter.”
During the COVID19 Pandemic, insurance companies in the United States responded by allowing for the billing and reimbursement for telehealth visits – visits that would have normally been in-person in the office were substituted by scheduled telephone or video visits between healthcare providers and patients. The situation dictated the rollout of telehealth nationwide on a large scale; to keep patients out of the office if they did not need to be seen in person, in order to reduce risk of COVID19 spread. Though prominently used during the Pandemic (fueled and supported by the ability to bill for these visits), telehealth is not a new concept. Telephone calls have long been routinely used (on a smaller scale) to connect with patients and for follow-up, but now (owing to the Pandemic), healthcare providers could be reimbursed for this patient care service.
“I would say I am pro-telehealth, but not as a panacea or something that would be constant. The idea that certain things which require patient home data such as blood glucose monitoring, we can do reasonably well (with telehealth)…particularly times of infection. So maybe next time there is a high flu rate, every other visit becomes a telehealth visit…My guess is someone is going to be crunching numbers and the efficacy of our treatment based on billing codes…and reduce burden of people having to come in, the expense and time of coming to the doctor’s that people do experience, depending on where people live and where they receive care.”
“(Telehealth) It’s here to stay on some level, but I’m not sure at what depth. But it won’t be going back to what it was 4 months ago, I’m sure of that.”
-Doctors Providing Care from Home-
“(I’m) currently in clinic about 50% of my regular time that I would be normally…the other 50% is telehealth from home to reduce our multiple exposures if someone is to come in and is positive (for COVID). At work, I look professional and at home, I may not…If I’m doing telehealth, it doesn’t matter. If I do video health, I look the part when the time comes.”
Dr. Burke reflects on whether or not telehealth has been a positive or negative change, both in his (as a physician) quality of life and in the quality of patient care.
“I’m trying to decide if my quality of life is better working from home…I would say it is nice – (without a commute) I now have 30 minutes which adds to my personal time, which is nice. And for a fair number of visits, I would say the care is the same, because mostly what we deal with is the problems of the mind, which mostly bear out in thought and questioning. And so I wonder…I think those we’re doing a good job adapting to and being responsive…whereas for other things that are more difficult, such as things that are new – difficult to describe, maybe not. As for quality of life, I like the routine of going to work – I don’t feel like it’s onerous, I don’t feel unprotected – I feel like we’re doing the things that we need to that when I go into work I don’t feel unsafe doing the things that I need to do. I’m being treated fairly and appropriately…and pushed to do the things that I can to reduce patient contact and adapting to these technologies.”
“A fair number of people have been under a lot of stress…this may not be very different for them as an additional factor of anxiety to incorporate into their daily living. There’s the other half where things are worse – due to additional responsibilities such as child care, education of children, not being able to work, and financial hardships that come…In that way, it kind of mirrors what I would expect in any given visit. Can’t say people are having more depression or deeper anxiety, but it mirrors that idea that both incorporation of the new is going well for some and not for others.”
-Primary Care during the Pandemic-
At the heart of primary care is always the prevention of illness and disease. During the Pandemic, these values remained true.
“Primary care in our institution has been supported in many ways and an emphasis to maximize on it and its capacity so that we provide the care that we need to provide. It is not ideal, being thrust into it, but problems arise and they must be solved. Primary care, I don’t know of any that aren’t practicing, or trying to in some way. This is mostly due to telehealth, trying to keep people with acute problem out of the emergency room where the risk of infection is what we’re trying to prevent to help not burden the system. “
Liam P. Burke, MD
Family Medicine Physician
University Campus – Umass Memorial Medical Center