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Francis Koster: Telemedicine could stop invisible calamity

By Francis Koster

We have two health care calamities unfolding before us — one visible, the other not yet.

The first you at least know something about — COVID-19. As of Jan. 14, one in 15 Americans (24 million) have been diagnosed with COVID-19. Of these, around 4 million survived but are suffering after effects ranging from brain fog, lung issues and sexual dysfunction. Another 380,000 Americans have already died from it.   

Experts predict that the number of dead will grow to over 500,000 by April 2021, even with an aggressive vaccination campaign, because around one-third of Americans say they will not take the vaccination at all.

This is only the visible part of our national tragedy. 

The second (still invisible) crisis is caused by the fact that out of every 10 Americans six have a “chronic disease” — things like heart disease, diabetes and kidney disease. These do not heal. They do get worse over time and must be carefully managed for as long as you live.

In normal times, chronic disease is managed by regular doctors’ office visits. However, the Centers for Disease Control and Prevention has reported that due to the COVID-19 epidemic around 40% of American adults have either delayed or avoided routine and chronic disease related medical care. This includes visits to doctors’ offices by patients with chronic heart, lung and brain issues, which have dropped considerably. So have emergency room visits; for example, Seattle-area hospitals reported half the normal rate of emergency room visits by patients concerned they were having a heart attack. Some portion of those who did not go to the emergency room did in fact have a heart attack and survived and need to be carefully medically supervised or they will suffer early death.

We need to figure out how to help the more than half of all Americans that have chronic diseases but are afraid to go to a medical facility due to fear of COVID-19 infection.

One solution may be the use of telemedicine, also called “virtual office visits.” At a scheduled time, the health care worker calls the patient via computer or cell phone, and a face-to-face visit is held which can result in steps being taken to control the chronic disease. This is not suitable for a patient whose circumstance is changing rapidly — they need a face-to-face office visit.   

There is one specific population that video visits could make a big difference for — older men. In America, life expectancy for men is about five years shorter than for women. At age 65, for every 100 surviving American women, there are only 77 men still alive — and most of those have chronic illness. The challenge is that one in four of all Americans (and more men than woman) over 65 are not online. So, the people most in need of careful medical attention for chronic diseases but are not going to the doctor are millions of mostly older, mostly male, not technically savvy and/or don’t have the needed electronic equipment.

So what can you as an individual do to help your older loved ones get the medical attention they need safely? 

First you help the patient who has not been to the doctor in a long time locate someone to set up the technology for a video connection. This technical helper (your grandchild?) does not need to be in the room during the visit, but they do need to be able to make the connection happen using the doctor’s software. (Things like FaceTime and Skype cannot be used because they do not have enough medical privacy.),  

Then you lovingly nag, nag, nag until a video call appointment is scheduled.

During the visit you can also use the same tools the nurse used during your last in-patient visit such as a blood pressure cuff or blood sugar monitor, which you can order from Amazon, Walmart or Target. The doctor can get real time data to use during the call to help them guide the patient.

You have the resources in your family or neighborhood to protect your older friends and relatives from increasing harm caused by a disease you already know about, and know how to fight. All you have to do is make two phone calls. First, get an appointment for a video visit, and, second, get your grandkids or neighbors to help you set up the technology.

It will benefit both the young and old — and you.

Koster, who lives in Kannapolis, spent most of his career as chief innovation officer in one of the nation’s largest pediatric health care systems.

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