(lighthearted music) - Hello, and welcome to Journal, I'm Steve Kendall.

Besides all the other issues during the pandemic, it seems that for a number of reasons, many people are not getting their annual preventative screenings or taking care of current health issues until they become at risk situation.

Joining us talking about this, is Dr. Robert Palmer, M.D.

Independence Health General Surgery at Wood County hospital.

Dr. Palmer, thank you for joining us today on the journal.

- Thank you very much.

It's great, great opportunity to be able to speak to today.

- Yeah.

And, one of the things as I said with all the other things that have revolved around the pandemic, of course there was concern about ongoing medical situations, whether as we've talked about in the introduction.

Just the normal routine medicine that goes on under a more normal set of circumstances and then of course surgeries and other things.

But, that's become an issue because as we mentioned some people have put off or delayed becoming involved in their normal medical routine.

So, talk a little bit about that and how that's affected your practice and what you do at Wood County Hospital.

- Sure, absolutely.

You know obviously for most of us, I'd say majority of us, this is our first pandemic.

So it's really kind of a unique environment for all of us to be interacting in whether it's, you know, our daily routine with our families and friends all the way to our medical care.

The one thing with medical care that I think is very distinct very different is that people still get sick.

You know, routine medical stuff continues to happen whether it's appendicitis, gallbladder issues a variety of, of just kind of general health ailments that continue regardless of the pandemic.

The issue that we have with this is that a lot of people have a lot of fear instilled in their daily routine at this point.

They're afraid to go out.

They're afraid to go to the store.

They're afraid to interact with neighbors, friends, family, and healthcare is no exception to that.

We have seen a variety of health conditions that, that otherwise can be managed fairly routinely that have that oftentimes present in a very delayed fashion potentially for some very dire consequences for patients in terms of outcomes.

Also in terms of what we're able to be able to offer patients from a therapeutic standpoint.

This can be as simple as, you know, hypertension blood pressure issues that aren't managed appropriately because people aren't going to their doctors to get their medicines refilled.

Again, in my specialty things like appendicitis and gallbladders and diverticulitis which is a fairly common condition involved in the colon that, that people present because they're afraid to come to the hospital in a very delayed fashion.

And, and it is, it is really, really affected, you know how we manage those patients is affected how long they are subsequently in the hospital, potentially laid up as far as recovery and also again for what we're able to do surgically.

So we sometimes have to do a much more invasive procedure than we otherwise would have done if somebody came in earlier.

- Now, and, and when you, when you've been confronted with that situation as we've gone on, what have you been able to do in terms of reaching out to patients, trying to encourage them to come in on their normal schedule given the fact that they are and especially I'm assuming to people were especially reluctant to go into medical facilities because they were concerned that they might encounter someone with, with COVID-19 there.

I mean, so were you able to reach out to patients and try and give them information and say, look, you can't just keep putting this off.

How did you approach the patients who might have been reluctant to, to come in and talk to you?

- I think that one of the biggest things that we as healthcare professionals can kind of reach out to patients with is to emphasize that, you know, from a medical standpoint, this while, while this pandemic and the contagion is, is all kind of a new phenomenon for a lot of people.

this is really what we deal with on a daily basis.

You know, we, we practice a septic technique.

We practice, you know, with masks on and while we have expanded that to wearing masks the majority of the day, you know we're kind of experts in, in, you know, this, this kind of environment.

we screen patients and I think patients when they go just about anywhere at this point, whether it's to your kid's basketball games, they all get screened with temperatures.

You know, we do some pre-screening on the phone to make sure that the patients and our staff are safe, so that we're not inadvertently, you know, having any sort of, you know, exposure of people have a risk factor for that.

We do have other options to be able to at least hopefully engage patients from a, from a more indirect route but still be able to hopefully provide the quality of care that they deserve.

And one of the things that has kind of expanded in the last six to nine months has been telemedicine or telehealth visits.

So, we have patients that, you know, obviously we need to see in the office to be able to do a physical exam but we have patients that just have routine questions and it can be even as, as extensive as looking at a wound over your phone and being able to say, all that's nothing to be worried about.

Or, hey, I have a bug bite and this looks infected, what do you think?

So, we can have indirect interaction with patients and be able to make sure that they feel safe but they also need to understand that again this is what we do on a daily basis.

And, and, and, and we're very, very thorough about how we screen patients.

We want to keep our patients safe.

We want to keep our staff safe.

We want to keep our hospitals safe.

So, that's what I emphasize to the patients when they come.

I think the worst thing that we can do is, is to try and discourage patients, you know, or, or or instill fear in patients that, that, you know the hospitals while, while we can, you know, while we try and keep people out of hospital, you know, as reasonable as we can, that they are in a safe environment.

We're taking every precaution in these facilities to make sure that patients are safe.

- Yeah.

And, and the reality probably is, or is that, the hospitals as you mentioned, your protocols have always been aimed at providing the best environment the safest environment under, under normal circumstances.

So, this has just been an extension of that to provide that additional layer and additional protocols to deal with this.

So actually medical facilities are probably among the more safe places to have gone during this versus some of the other areas that people might've encountered in their daily lives.

- Absolutely.

There's no question.

- Yeah.

Now, when you, when you talk about telemedicine, of course that's based too a little bit on how the access that people have and their ability to navigate through the technology.

Can you guys, as you're, as you're talking with patients help them with that a little bit?

So if you're, you're dealing with one of your patients you can kind of get them through the technology barrier if they have one?

- The, the technology barrier, as long as somebody can receive a text message is print, and then they have some sort of, you know, iPad or computer with a with a video monitor, they should be able to interact fairly easily.

There are a couple of, of apps that are out there now that, that are very, very user-friendly.

Basically what happens is, is that our medical assistants or nurses will reach out to a patient at a, you know, we have predestined times just like we'd have for regular appointment.

And what they do is they get the basic health information make sure that all their medications and everything are up to speed or up to, up to, up to speed and accurate.

And then what they then do is they send a text message to your, to their phone.

All they have to do is click on that text message and, and it puts them in a virtual waiting room that we can then click on and then we can interact just as we're interacting right now.

It's, it's really, I think it's been a very unique opportunity for us as physicians.

We've expanded it even into some of our calls on the weekend, when nobody's in the office being able to reach out, if somebody has a question we can actually bring them right up on our phones.

They're all encrypted and secure so that nobody's can, you know, and it doesn't save conversations or anything else like that.

So it's all HIPAA compliant but it allows us to really interact with patients and our ultimate goal with all this is to, again, if we can keep people out of the hospitals, if we can keep people from out, be roaming out and around when they don't necessarily need to be, that's ultimately a, you know, a plus to being able to interact with people with telemedicine.

- Yeah.

Great.

Well, we'll be back in just a moment a little bit more with Dr. Robert Palmer, from the Wood County Hospital here on the journal on WBGU-PBS.

Thank you for staying with us here on the journal.

What we're talking about, preventative medicine that's been delayed and routine medicine and of course, surgeries and other medical activities that have been postponed or put off by patients because of their concern about the pandemic.

And we're joined by Dr. Robert Palmer, M.D.

Independence Health General Surgery at Wood County hospital and also by Dr. Brad Everly, M.D.

Family Medicine at Wood County Hospital.

And Dr. Everly, we'll start with you.

Talk a little about the fact that, you know, there is some concern that people have been putting off routine screenings, routine medical maintenance, which of course postpones your abilities diagnosed to some degree.

And then, then the concern that down the road a few months from now a year from now, we'll see an upsurge in things that, that could have been dealt with right now because people have put it off.

We're going to see that.

Is that a concern that you have right now?

- I would say absolutely that's a concern.

I guess the first point that I would make to the audience that's watching is that, there is a high degree of safety.

There, there are legitimate concerns with COVID.

However many measures have been put into place in hospital systems and outpatient laboratory testing facilities to really mitigate that risk and comparing that to the risk that you would have going out, filling up your tank at a gas station or going to a grocery store.

There's actually very little risk for these patients to come in and get their screening tests done.

And so with, with that point being made in my practice there's been quite a few patients who have put off screening tests and ultimately had diagnoses that were much more serious than otherwise would have been had they been caught earlier.

- Yeah.

And when you talked with those patients when you were able to finally get them in, what did they give you reasons as to why they hadn't come in sooner, why they were concerned?

What were their, what were their worries about about seeing you on the normal schedule?

- Well, just to give a salient example here.

I had a patient just recently who came in, who had felt a lump in her breast and not had a mammogram in over a year because of fears for going in and being exposed during close proximity to other patients.

And it was mainly just a fear for exposure to COVID.

And unfortunately, in this case it turned out that she have a breast cancer.

The fortunate thing is after we made that diagnosis it turned out that it was not metastatic and it was treatable at the stage that it was caught in.

However, that's somewhat the exception to the rule and people that are delaying their screening tests and given the size of the lump that we felt in this woman's breast.

I had a very sinking feeling and fear that it was going to be metastatic and more devastating diagnosis than it actually turned out to be.

So my fear with the audience is just making sure that they're not falling into that same category, by delaying these screenings and ending up with more sinister pathology that's more difficult to treat at later stages.

- Yeah.

And, and Dr. Palmer, you, you mentioned that in the first segment too that those are your concerns that patients will delay and then the, your ability, your capabilities to deal with the issue that now is presented itself will be compromised by that delay.

- Absolutely.

I think that, you know, certainly in the more advanced disease process becomes the more limited some of our options become as well.

You know, my biggest fear is that, that from a pandemic standpoint obviously we have a very serious health crisis right now.

I think that this, unfortunately for most of us in the healthcare profession will continue well beyond this.

And we will eventually beyond COVID or at least have things contained from that standpoint but we'll still be dealing with the ramifications of all these other health issues that have potentially been delayed or, or ignored for a period of time.

So my, my concern is our big health crisis again will continue into the future beyond our, our pandemic.

- Yeah, well, it's an interesting point because we'll once we get over the, the pandemic, we'll probably as we as human beings normally do we'll sort of relax and go, okay, everything's fine now.

And the reality is the concern will be, we'll see basically what we can almost implied as a pandemic of delay of, of other things that have happened because of the delays, the fears that people had about being treated during the pandemic.

So we'll, we'll see another surge and other almost a epidemic of delayed diagnosis and delayed circumstances because of that.

Dr. Everly, when we were talking with Dr. Palmer too that, obviously in your practice which is family medicine you're seeing a broad range of patients and a broad range of, of things that present themselves.

Are you also doing, reaching out in terms of new ways to kind of contact your patients, try to get them back in to do the things they should be doing?

- Absolutely.

That's one of the things that having electronic health records makes it a little bit easier because, we can search through data and see who is missing their, their routine screening testing and it allows us to create callback lists for these patients to remind them of what they're due for.

So, we are actively reaching out to patients and reminding them that they're due for clinical follow-up or laboratory testing or colonoscopies, et cetera.

- Yeah.

And, and I guess one of the, I guess if there is some good news out of this, which there is, is that it has encouraged us to try maybe in more extensively some of these newer ways to, to distribute medicine ,to contact patients, to interact with patients as opposed to simply, simply being face-to-face with them.

- Yeah.

The, the option for telemedicine, which is a not a new practice tool but has become a lot more common with the pandemic allows us in cases where the patient really needs just needs counseling on preventive medicine to do those by computer or over a smartphone.

And we can do that counseling and order tests that many of which they don't even need to leave their house.

As an example, you can do colon cancer testing or screening rather without actually leaving your house, doing certain testing.

It's not quite as good as a colonoscopy but it's better than no test at all certainly.

- Sure.

Yeah.

And, and I guess that's the, that's the advantage too that we have is that there is other other parts of this technology that allows you said to do more things at home versus having to come into an office or to a facility to get that done.

As, as you look at at what you're dealing with right now, are you seeing, are you, are both of you were able to encourage people to come in and do things are people starting to get more comfortable with ,with doing the things they should be doing as opposed to maybe a month or two ago?

- To answer that, I would say I'm in a unique situation.

I live in a, or I should say a practice in a very small community.

In that community, I'm the only physician and patients by and large look to me for guidance on whether it's safe to come into the office and whether it's safe to do these tests in a city the size of Bowling Green or larger city like Toledo.

I think that because there is a little more fear because there's a higher population density it is more difficult to convince those patients.

But the fact of the matter is, and I'll say it one more time that patients are actually very safe going into these facilities and getting blood work drawn, going in and getting mammograms completed.

Those facilities have taken extraordinary measures to make sure that the environment is clean and that safety measures are in place.

So, I think you could make a very strong argument that you're actually safer in that environment than in the public at a grocery store or a gas station.

- Yeah.

Okay.

Great.

Well, we'll be back in just a moment with more about preventative medicine and making sure you're doing all your routine screenings on, on the normal schedule here on the journal in just a moment we'll be back in just a moment here on WBGU-PBS.

Thank you for staying with us here on the journal.

Our guest for this segment is Dr. Brad Everly, M.D.

practicing Family Medicine at Wood County Hospital.

And we might also say Wood County Hospital but you're practicing in a small town and you are the only physician in that town.

So, kind of a unique situation as well.

So, talk a little bit about that.

And then I guess to one of the things that is of a concern is the follow-up to routine screenings and things like that that also can get lost in this unfortunate pandemic set of situations but talk a little about how you've been dealing with this in a small town because that's a different environment than a larger city as you related to in the previous segment.

- Well, practicing in a small community does give me the little bit of latitude to be the sole piece of advice.

And it also gives me the latitude to get to know patients on a much more personal basis, which in some ways makes it easier to know if somebody does have Corona virus, who they may have been in contact with.

And it puts me at the forefront of essentially contact tracing and making sure that we're limiting the spread of disease which is much more difficult to do in larger cities.

So, I think that there's a higher degree possibly of trust that I see from patients in my practice than you may see in a larger city.

- Sure.

Yeah.

Because your, your facility is, is I'm assuming smaller than it would be if you went to a hospital, that sort of thing.

And.. - Absolutely.

- Therefore people are more comfortable in a more personalized setting in that case.

So that's, yeah, that's, that's very good.

We touched on it briefly, but there is some concern that besides just the routine screenings that have been put off and normal appointments and things of that nature that even after that, the follow-ups to those routine screenings, those other pieces that are also very significant are also can be, can be lost in this as well.

So talk a little about your concern about that.

- Well, with chronic diseases.

So, for example, things like chronic kidney disease, congestive heart failure, COPD, these are illnesses that need regular follow-up in order to make sure that they're not deteriorating over time.

And we have seen a significant number of people essentially out of fear of coming in and being in contact with exposure to Corona virus, not coming in for their routine followups.

And the unfortunate thing in these situations is these patients generally speaking feel completely fine until things really start to deteriorate.

And at that point there's a much higher chance that they're going to end up being hospitalized or have severe complications.

So the irony of that is they're fearful of coming into the office where there's very minimal exposure to Corona virus, and then deteriorate to the point where they end up in the hospital where there is significant exposure potentially.

So, I'd like to stress the importance of, even though you feel fine, if you have these chronic illnesses like diabetes or heart failure, you do need to have your routine follow-ups with the physician in order to make sure that you do continue to feel fine and that things don't deteriorate.

- Yeah.

And, and that's an interesting point you make that because of this you actually increase the potential for, as we've talked about a more significant intervention required by you or other doctors.

And at the same time, also increasing your exposure to the very thing you were concerned about that prevented you from coming in for your normal procedures and things.

So, it's ironic that it actually then sort of doubles back on you in that regard as far as the patient is concerned.

- Yes.

And the other thing to consider for the patients is the extraordinary cost associated with that.

An office visit to a primary care physician usually is a very lower, sometimes no cost.

Whereas if things deteriorate to the point that we have to hospitalize the patient we could potentially be talking tens of thousands of dollars in medical bills.

- Yeah.

And, and, and, and on top of that too, as, as you've mentioned earlier too, that you're also then at some point, if you have a surge of people because they've delayed either routine screenings or follow-ups whatever it might be, that, that will also then put more pressure on the system a few months from now a year from now because of all of the delays that have taken place in the last eight or nine months.

- Absolutely.

In terms of the overall cost of healthcare.

I think that, as long as people are getting their routine screenings and having the routine follow-ups for control of chronic diseases, that, that is absolutely the one thing that we can do to control the cost for the patient and the expense when things do get out of control, skyrocket, skyrocket's exponentially.

- Sure.

Yeah.

Okay.

Anything else you'd like to add?

We've got just a short time here that, that people should really be aware of and what's the best thing they can do in this circumstance.

And just sort of once again remind people of the right thing to do right now given all of the things that we're going through medically.

- I suppose the last point that I would make is just to reiterate the routine screening tests should not be something that there is fear for going in and getting it.

So, as an example, colon cancer screenings colonoscopy would be considered the gold standard by testing like Cologuard, can be done in the privacy of your own home and is generally covered by most all insurances.

So there's absolutely no exposure because you quite literally don't even have to leave your home the test kit ships to your door and ships back to the lab.

Things like laboratory testing to monitor for chronic disease states or for prostate cancer screening, it's a laboratory draw.

And the way that labs are set up now you'll be the only patient in the lab at the time.

And those measures to limit the exposure to other patients have been put in place.

Mammography very similar.

You would end up being the only patient there at the time because of the measures that are in place to prevent exposure to others.

So, at this point, there is really nothing for patients to be concerned about in terms of exposure.

So, I would encourage them to speak to their primary care physicians about what testing they are due for.

And then go in and have that testing done so that we can do our best to make sure that diseases are caught at early stages and addressed at a point where it is either curable or easily manageable and that it doesn't get out of control.

- Yeah.

Okay.

Great.

Well, Dr. Brad, Everly, thank you so much.

Practicing family medicine, Wood County Hospital and a small town here in Wood County.

So we appreciate you taking this time to talk with us today about the concerns that you have for just the routine medicine that we have a tendency to overlook right now.

You can check us out at wbgu.org.

And of course you can watch the journal every Thursday night at eight o'clock here on WBGU-PBS.

We'll see you again.

Next time on the journey.

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