April 21, 2020

The brave new world of telemedicine

And back to the accidental plague diaries I go. The local numbers for metro Birmingham are flattening. UAB and the Birmingham VA have weathered the storm without a major disaster and now the conversation has shifted to how to start thinking about opening things up again while keeping both patients and staff safe. The people at the top calling the shots in both institutions seem to be making cautious and wise decisions with the ability to backtrack if necessary so we’ll see how it goes. I have to give kudos to our governor as well. She has not jumped on the bandwagon of Trumpist conservative Republican southern governors who are running around trying to force things open prematurely for political reasons. She came out today and stated lifting her closure orders is going to be done based on recommendations from scientists, epidemiologists and the department of public health. From what I can tell, the rather odd laundry list of things opening soon in neighboring states has more to do with moving people off of unemployment programs for tax and political reasons than it has to do with any sort of orderly transition based on societal need. Nail salons? Massage studios?

I have a feeling when patient care opens up on an outpatient basis for a return to face to face visits, there are going to be some major changes in patterns of who comes in and when and why. I think video calls are here to stay. There are still a lot of technical glitches but those are going to get worked out over the next few months. It will probably work fine for some sorts of routine follow up but not for everything (and I still have no idea how to do a decent physical via telemedicine. Nothing looks right to me on screen. The VA has been using a lot of telemedicine to get specialty care to rural areas and is way ahead of the curve so I may be doing some of my rural house calls via nurse carried iPad or some such in the not too distant future. Something else I’ve notice is that my hypochondriacs (every doctor has a collection of people that are always ‘sick’ or have new symptoms that must be addressed or are worried about this or that) have gone dormant. When I’ve called them up asking them how they’re doing, they’ve all been fine and stable and without complaints (for the first time in a decade or more). I haven’t quite decided why this is. They may have finally realized what sick really is and have started to understand that they really are relatively well or they may be so scared of visiting a health facility for fear of coming into contact with an infected person, that they’re going to be well unless something is actually seriously wrong. I have a feeling doctor/patient dynamics are going to come out on the other side of the Covid 19 crisis somewhat changed and maybe, with people less interested in accessing health services they don’t really need, those changes may be for the better.

I attended a virtual cocktail party this evening via Zoom. A bunch of folk from the opera chorus got together, each with his or her glass of wine or cocktail. ( I was enjoying a peach hard cider I bought on a whim on my last grocery run). No one has quite figured out the etiquette of virtual gatherings yet but it was good to see everyone, even in a Brady Bunch gathering of squares on my laptop. There’s something not right with my laptops and zoom. On one I can get video and no audio and on the other I can get audio and no video. I settled for the video and also dialed in on my phone for the audio portion. A little clunky but it ended up working. Fortunately, I’ve had some practice with on line social life, even before video was even possible. When Steve was sick and I had a couple of years when I couldn’t really leave the house much other than for work, most of my connections were through email and chat boards and some of the friends I made that way have remained friends for lo these twenty years. (You know who you are.) Just another one of my life experiences that seems to have readied me for this particular moment in history.

There’s a new Facebook group that’s sprung up in the last month for gay male doctors. I don’t know why there wasn’t one before but apparently, given the current social conditions, the time was right, and it’s now up to nearly 5,000 members. The majority are American but there are a few European, Australian, Middle Eastern, and South African thrown in. Despite a tendency of the well built and good looking to throw in some pictures more appropriate for Tinder, it’s interesting to see how much has changed in the last couple of generations. When I was in medical training, there was no one out in medicine. I take that back, there were a few openly gay men in HIV medicine which at the time was in its infancy. Everyone else was pretty strictly closeted whether student, resident, or faculty. I understood the lesson, if I wanted to be successful in medicine, I had to be closeted and play the part society expected. Therefore, no real dating or bonding or getting to know my tribe. I also had no role models for how to live an authentic life in my chosen profession. It wasn’t until I met Steve in 1989 and he let me know in no uncertain terms that if we were going to be together, the closet was not an option, that I came out. Steve came out in the early 60s while still in high school, pre Stonewall and had fought for respect and recognition his whole adult life and he wasn’t going to retreat one step.

The late 80s and early 90s and the cultural changes associated, spurred in part by the AIDS crisis, led to a weakening of some of the barriers and traditions in the medical field and more people started to come out and demand to be recognized. By the time I finished my training, there were one or two out residents in every class and a few of the faculty began to publicly acknowledge what everyone had suspected for years. UAB, being in Alabama, was somewhat lagging when I came here in the late 90s. To my knowledge, I was the first member of the medical faculty recruited as an out individual (everyone else having been closeted until after they got the job), I don’t think they quite knew what to do with me and Steve but they wanted me and my skill set so I got the job. Someone made the right decision for here I sit, 22 years, two husbands, and thousands of patients later. As I look at all the eager young faces in the gay physician Facebook group, internists, pediatricians, radiologists, surgeons, pathologists and so many more, I’ve come to the conclusion that enduring some of what I endured was OK. My generation broke the glass walls and that’s allowing there generation to flourish. They may not recognize the work that was done or the sacrifices that were made but the results make it all worth while. A new generation gets to live up to their full potential and not ghettoized into stereotypical roles.

And so, as Samuel Pepys would say, to bed…

Stay well, stay safe, and wash yo damn hands…

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