MARCH EDITION, VOLUME 2021, NO. 3
COVID AFTER ONE YEAR: THERE IS NO “NEW NORMAL” By Frank Skilling, M.D. We’re a year into the COVID-19 pandemic, and it’s become patently obvious that there’s no going back to the “old ways.” The structural changes I’ve observed within our society are so profound that even if the virus is contained and the pandemic soon ended, I don’t think that there’s going to be a return to “business as usual.” What this will mean for medicine and the delivery of health care is unclear, but I foresee that video patient visits will be used more frequently. There has been a move for many years to institute video consults for patients, but the concerns of the boards of medicine and the insurance payment systems have kept it at bay. For some insurers, it just didn’t seem right for doctors to be reimbursed if they weren’t actually going to touch the patient or talk with them face-to-face. And then there was the problem with licensing boards and physicians being situated in different states. All states are notoriously jealous of preserving their individual licensing. But both physicians and patients have gotten used to Zoom encounters, and no one can conceive of a future without them. Once the Veterans Administration crossed the line, other government agencies will soon follow. The chief of the medicine service when I was an intern in internal medicine (“straight medicine” as it was called without irony in those days) at the University of Miami in the early 1970s was a bright young Harvard Medical School graduate who got into telemedicine early on. Jay Sanders became a proselytizer for long distance examinations and consultations, even before the internet, via television. I got the sense that he was always on the verge of
developing a successful product, and I wonder if Zoom conferencing has improved his success. As an acolyte of the Osler/Harrison medical model for patient interactions, I’ve always been a believer in the face-to-face encounter for being the best method of evaluating patients. One of the things I have enjoyed over the past few years is working with the second-year medical students at FSU. This school, above any other I’ve been affiliated with, stresses the face-to-face encounter and uses standardized patients to allow the students to hone their clinical diagnostic skills in a controlled setting. This past semester, the students were limited to working in pairs throughout the term and performing physicals on each other. For me, it was less than ideal. I told one group that they had to palpate the abdomen of a 60-year-old to get a real understanding of how a belly will feel in a solid patient. However, even a video encounter with a standardized patient was sufficient for some of them to sharpen their diagnostic acumen. One of the instructors noted that this year’s class was doing extremely well academically, which was a surprise to me. But it’s perhaps because they have more time to study during the lockdown without the distractions that previous students had to contend with. Yet, I think that with smart students, the good ones will learn even under the constraints of social distancing and video remoteness. There is no substitute for the face-to-face encounter, but good learners will be successful even under difficult circumstances. I just hope that these types of virtual medical encounters will never become “the new normal.”
CAPITAL MEDICAL SOCIETY 2021 MEETINGS CALENDAR April 20, 2021 Virtual CME (1-Hour) Exploring the Long-Term Consequences of a COVID-19 Diagnosis 6:30 pm
September 14, 2021 Celebration Awards Dinner University Center Club at FSU 6:30 pm See page 7 for more information