Telemedicine - Ask Dr. P

The Good Thing That Came Out of the COVID-19 Pandemic

by Pain Doc | Oct 13, 2020 | Telemedicine

Dear Readers,

As you know, it has been a really tough 2020 so far, worldwide.

Here in the U.S. we’re still battling COVID-19; dealing with hurricanes, social unrest from racial conflict; a very divisive political situation, and here in California where I live, forest fires (about 400 burning at the same time at one point) enough to cause air quality warnings far away from the fires.

I know some of you are in Europe, Asia, Australia and the Middle East. I hope things aren’t so bad over there.

But enough of that. We must focus on living and make necessary adjustments to carry on with our lives.

There is an old Chinese saying that goes something like this: From crisis, there is opportunity (forgive me if I butchered it; no insult intended).

For the COVID pandemic, this turned out to be true: millions, if not billions of people all over the world learned that they could do a lot of things that they normally did in person, online. And for those who already did this well before COVID, they learned how to do it even better.

Shopping, buying groceries and sundries, attending school, working, holding meetings, attending church services, getting music lessons, and socializing are just some of the activities people learned how to effectively do online, thanks to being quarantined.

And, in my opinion, the most significant thing people are doing more of online, thanks to COVID: healthcare. Telemedicine, also called telehealth involves using a telephone and/or webcam to communicate with a health professional instead of in person, face-to-face for the purpose of improving one’s health. It also encompasses “consuming” health care content in digital format via the internet such as pre-recorded videos, slides, images, flow charts, white papers, and audio files and podcasts. I wrote about this over five years ago when I decided to transition my practice to a telehealth model.

Telehealth was just starting to gain traction right before COVID, but the pandemic accelerated its acceptance. The need to quarantine and social distance forced doctors and their patients to interact online, and things will never be the same (in a good way). We were hesitating at the edge of the swimming pool and COVID pushed us into that cold water, figuratively speaking.

Webcams, Internet, Wireless Connectivity and Mobile Devices Finally Transform Healthcare

The “planets aligned” for telemedicine, and very soon it’s going to be as common as buying groceries. To me, it’s overdue. I hope that telehealth not only enables healthcare for millions more lives on the planet, it will drive healthcare costs down. The cost savings to hospitals are obvious; and those savings should be passed on to the insured and paying patients. We’ll see if that happens. While I know people are used to tradition, starting from the days of the old country doctor with good bedside manners I think in 2020 and beyond, people are going to be just fine seeing their doctor online for simple and routine visits.

And the implications go beyond the actual care: telemedicine will save time and money on a macroeconomic scale, and will be actually good for the environment in more ways than one: less cars on the road (no need to drive to see your doctor); less electricity and other overhead expenses needed to keep a large building operable, less printed paper, etc.

Telehealth Is Ideal for your Average Doctor Visit

The vast majority of things that cause people to seek a doctor are non-emergency, and lifestyle related. Non-emergency means not life-threatening, or risk of serious injury. Lifestyle related means conditions that are largely borne out of lifestyle choices—high-calorie/ junk food diets; alcohol use, smoking, inadequate exercise, occupational/work-related, etc. and are usually chronic; i.e. having a long history–diabetes, high blood pressure, indigestion, arthritis, joint pain, etc. These conditions can be self-managed with proper medical guidance provided remotely via webcam. I believe that if lifestyle choices can cause illness, different lifestyle choices can reverse or minimize those same illnesses, which can be taught via telehealth.

Then there are the cases that are non-emergency, single incident: fevers, rashes, stomach aches, allergies, minor cuts and scrapes, and things of that nature. Sure, some cases of stomach aches and headaches can actually be something dire like cancer. But doctors know that such “red flag” scenarios are comparatively rare, as in less than one percent of all cases; therefore, the vast majority of them can be handled via telehealth. Besides, the doctor can decide at the initial telehealth session if the patient should come in the office, if he/she suspects a red flag.

A Typical In-Office Doctor Visit

Typically when you go to a doctor/ primary care physician, you are given a list of disorders and told to check off any that apply to you recently—stomach pain, headaches, vomiting, fever, etc.

Then, you are asked a bunch of questions related to your complaint. This is called taking your history (of your condition). The nurse practitioner or doctor may do this.

The doctor may or may not examine you, such as checking your eyes, ears, nose, and mouth; temperature, blood pressure, heart rate, lungs and so on depending on your history and complaint.

The doctor then takes this information and comes up with a diagnosis or two. You may be referred for diagnostic testing, again depending on what you came in for, such as an X-ray, MRI, ultrasound or blood test.

You may get a prescription for medications or medical device, and a printout of home care instructions, and then you’re done with your office visit.

With the exception of a physical examination involving touching and diagnostic tests, everything I just explained can be done via a telehealth visit on your computer. But as technology advances, more and more medical procedures will be performed remotely via a secure internet connection.

I believe that in the very near future, there will be apps and computer peripherals capable of doing diagnostic tests which will allow your doctor to get real-time diagnostic data during your telehealth visit. It’s already possible for blood sugar, body temperature, heart and lung auscultation and blood pressure.

Imagine wearing gloves with special, embedded sensors in the fingertips that transfer sensory information via the internet to “receiver” gloves that your doctor wears, 20 miles away. During a telehealth visit, you can palpate (feel) your glands, abdomen, lymph nodes, etc. and this sensory information is immediately felt by your doctor, as though he was right there palpating and examining you.

Or, imagine an ultrasound device that plugs into your HD port that transfers images of your thyroid to your doctor via the internet.

The possibilities are endless, and it bodes well for global health. Imagine all the people who can be helped, all over the world, via telehealth. It’s truly an exciting time in healthcare.

Telemedicine for Muscle and Joint Pain and Injuries

Every day, millions of people worldwide sustain or develop some sort of musculoskeletal (affecting muscles, joints, tendons, ligaments, bone) pain, whether it’s their low back, neck, shoulder, hip, knee, hand or other body part. If not treated right, it can become permanent or chronic.

Chronic pain, and even acute (recent onset) musculoskeletal pain can effectively be addressed via telehealth (this is the domain of my platform, Pain and Injury Doctor, and it’s my goal to help a million people worldwide eliminate their pain).

Available medical procedures for musculoskeletal conditions requiring an in-office visit such as surgery and cortisone injection are usually not the first intervention choice for such pain. Conservative care is the standard of care for the vast majority of non-emergency musculoskeletal pain and injury–an ideal application for telehealth.

For example, if you were to go to your doctor for sudden onset low back pain, you would most likely be given a prescription for anti-inflammatory medications, if not advised to just take over-the-counter NSAIDs such as Motrin, and rest. You would also be given a printout of home care instructions, such as applying ice every two hours; avoiding heavy lifting and certain body positions; and doing certain stretches and exercises. As you can imagine, such an office visit could easily be accomplished via a telehealth session. No need to drive yourself to the doctor’s office for this.

But what about chiropractic or physical therapy? You can’t get these physical treatments through your webcam. Yes, chiropractic has been shown to be effective for acute and chronic low back pain, but available studies typically don’t conclude that chiropractic for low back pain is superior or more economical than exercise instruction or traditional medical care. Same with physical therapy. However, as a “biased” chiropractor myself, I believe the benefit of spinal adjustments is not just pain relief, but improved soft tissue healing and structural alignment; two things that I believe can help reduce the chance of flare ups/ chronicity.

So get a couple of chiropractic adjustments if you can, but know that you can overcome typical back pain through self-rehabilitation as well (see my video on how to treat low back pain).

Yes, Many Types of Pain Can Be Self-Cured

logo Take a second to look at my logo. It looks like a red cross, but it’s actually four converging red arrows that form a figure of a person showing vitality, with arms and legs apart. The four arrows represent four pillars of self-care that my platform, The Pain and Injury Doctor, centers on:

Lifestyle modification (nutrition, mindset, healthy habits)
Using select home therapy equipment
Rehabilitative exercises
Manual therapy

These are four things that people suffering from pain are capable of doing by themselves, and sometimes with the help of a partner (manual therapy). All of the Self Treatment Videos on Pain and Injury Doctor incorporate these four elements of self-care (some are still being produced as of this writing). Isn’t this more interesting than a bottle of Motrin?

Conclusion

I will close with this: research shows that when patients are actively engaged in their healthcare, they tend to experience better health outcomes and it’s not hard to figure out why. By participating in your own health, you have “skin in the game;” i.e. you are invested in your health rather than being passive and wanting health to be “given” to you by a doctor through medicine or treatments. Mindset is what drives behavior, and those who are passive about their health are the ones who pay no attention until it’s too late—they don’t eat healthy; they don’t exercise enough; they voluntarily ingest toxins (junk food, alcohol, and smoking) and engage in health-risky behaviors. For many health conditions, by the time the primary symptom is noticeable, the disease has already set in; for example, onset of bone pain from metastasized cancer; or the first sign of pain and stiffness from knee osteoarthritis.

Being actively engaged and invested in one’s health will pay huge dividends in one’s quality of life, and longevity. So, in order for telemedicine/ telehealth to work for you, you need to have this mindset. You have to “do the work.” I can show you clinically proven self-treatment techniques to treat common neck pain, but they obviously won’t work if you don’t do them, and do them diligently.

Self-care for managing musculoskeletal pain is a natural fit for the telemedicine model of health care, which made its world debut this year. I’m excited to produce content that can help you defeat pain, without visiting a doctor’s office. I’m especially excited if your are one of the millions of people who don’t have health insurance or access to a health professional, and I am able to help improve your quality of life by showing you how to self-manage your pain.

If there is anyone you know who can benefit from this site, please share. Take care.

Dr. P

How Do You “Do” Health Care?

by Pain Doc | Feb 6, 2017 | Telemedicine

The Evolving Paradigm of Health Care

Health care. It’s one of those things that’s talked about regularly that carries sub-conscious assumptions.

I’d like to ask you today, “What does health care mean to YOU?”

You might say:

“Health care is being able to see a doctor whenever I need to, for a health-related complaint.”

Ok, fine. Let’s say you do. Now what?

You may then further elaborate, “Being able to ask the doctor what is causing the problem and what I need to do to get it fixed.”

Ok, you’re talking about getting a diagnosis and prescription. You ask the doctor about that nagging symptom, and he or she explains that it is being caused by a virus. Your doctor then writes a prescription and prints out a pre-written information sheet about your condition, which includes things you should do, and hands it to you and you are discharged.

That’s great. It’s reassuring to have access to a doctor whenever you are ill.

But, given all the tools that are available these days, was a doctor really necessary? Could a lower-cost nurse sufficed? Some RNs and Nurse Practitioners are very knowledgeable in disease signs, symptoms and treatment.

And did you know that there are some pretty accurate apps and websites (WebMD, ShareCare) that could have provided the same information to you in minutes, for FREE?

And, how much a month are you paying in health insurance to have this access? For my family, it’s $1,500/month and we’re all pretty healthy. Is it worth it?

My point here is that the old model of out patient service is getting a lot of challenges in this age of technology and big data access. It is time for people to start questioning how they wish to utilize, or “do” health care.

Another valid question is “Should this be called “sick care” instead?

After all, in this scenario the person seeks out the doctor AFTER the condition is already there; after he is ill or stricken with the malady.

So yes, a better description of this service is “sick care.” But although it’s a more accurate term, sick care sounds negative (which it is) compared to the term health care. When you hear the word health it evokes positive images like strength, energy, vitality and longevity. So don’t expect to see hospitals, doctors and insurance companies extolling their sick care services.

The Three Paradigms of Health Care Today

Returning to the questions “What is health care?” and “How should I use or do it?”, here’s another thing to consider:

Do you really need to take medicine, get a shot, see a physical therapist or get surgery?

Ok, in some cases you do; usually emergency cases like heart attacks and stroke.

The first paradigm of health care, which we’re all familiar with is having some procedure done to you by a medical professional. This is passive health care, where you receive it passively and includes taking medicine, getting surgery, and having therapy done on you.

The second paradigm of health care is the doctor or professional instructing you what to do to get well or for prevention; i.e. prescribing home care or lifestyle modification routines.

This is a big improvement from the first paradigm in the following ways:

(1) it gets you involved in your health, which trains you to be more responsible for your health and not reliant on a doctor;

(2) it is less expensive because you are in the doctor’s office less; and

(3) it is likely to be more effective and safer than visiting a hospital or taking medications.

Diet, exercise, home care strategies and other lifestyle modification interventions have a bigger, direct and longer-lasting impact on your health than medicine or passively receiving ongoing therapy (for a pain condition) such as physical therapy and chiropractic.

Medicines typically work by altering or “jury-rigging” your physiology to counter the symptoms you are experiencing, which gives the “illusion” of health. This is not natural, and there is almost always blow back by your body; i.e. side effects, some which create more problems (such as how taking Aspirin for pain can give you ulcers; or how taking too much Ibuprofen can cause renal failure).

Ongoing chiropractic or physical therapy is almost as bad, because anything passive risks your body becoming dependent or addicted to it, which again leads to blow back in the form of weakness and reduced coordination of muscle and joint systems.

Finally, the third paradigm of health care is when YOU get involved in researching your condition thoroughly, and then getting instruction on how to resolve your health condition from legitimate sources.

Now, this paradigm gives you the most freedom, but it also has some drawbacks. You need to learn how to differentiate between legitimate websites and the extreme ones. Health is an art as well as a science, so there are gray areas and some people are known to take excessive liberties in their writings about health.

Traditional medical websites obviously have an “allopathic medicine” bias. This is good in that the information is usually backed by research (evidence-based medicine), especially when on reputable, authoritative sites like Cleveland Clinic and Johns Hopkins.

(However, in recent years I have seen WebMD warm up to natural medicine; i.e. herbs and traditional natural remedies; although they are careful to use non-committal words and phrases such as “…may be helpful” and “…some anecdotal cases show that herb x reduced pain..”)

But the traditional allopathic websites are not as in-depth into alternative health favorites such as nutrition, herbs and things like electromagnetic therapy and grounding.

Then there are the alternative health websites. These sites are usually written by bloggers; some of whom have credentials (unfortunately, you will have to verify it yourself by doing internet research) and some who do not– just health enthusiasts who read other sites and report on them. Be more cautious about the information you get from these sites. That’s not to say that you can’t find useful information on some of them; some are really good despite being written by non-doctors.

Alternative health websites fit in better with this third paradigm of health care by virtue of the nature of alternative health, which essentially IS about implementing lifestyle modifications to achieve health from within. Things like diet, nutrition, herbs, exercise, breathing, meditation, massage, stretches, and using safe, energy emitting devices to enhance your body’s healing.

Fix chronic pain at home using nutrition, lifestyle modification and techniques used by physical medicine professionals.

ShareCare

Online medical consultation with real doctors.

Cleveland Clinic Online

Online medical consultations and prescriptions by real doctors.

WebMD Symptom Checker

Interactive symptoms checker and medical report and recommendations.

Mercola.com

The world’s largest natural health care website featuring articles on wellness, prevention and the dangers of common medical interventions.