Healthcare Archive

Because medical exams are invasive, and because many people have experienced some form of trauma and may be uncomfortable with aspects of the exam, healthcare providers should approach care with consideration for what patients may have experienced.

Here's what you need to know so you can see your doctor without leaving home.

Remember when "virtual" doctor visits became available a few years ago? Being able to chat with a doctor on a video call instead of an in-person office exam was novel, but it never caught on as a mainstay of treatment.

That changed in the spring of 2020, when the pandemic hit and telemedicine rocketed from novelty to necessity. "At Massachusetts General Hospital and Brigham and Women's Hospital, we did 1,600 virtual encounters across the system in February. In March it was 89,000, and in April it was 242,000. That's the kind of growth we're experiencing," says Dr. Joseph Kvedar, a dermatologist with Harvard-affiliated Massachusetts General Hospital, senior advisor for virtual care at ­Partners HealthCare, and president of the American Telemedicine Association.

Ask the doctors

Q. I'm considering using a telemedicine provider. Is there anything I should be aware of before I make my appointment?

A. The good news is that insurance coverage has expanded recently, due to the COVID-19 pandemic, which has allowed many people to access telehealth services who weren't able to in the past. Telehealth services can take many forms, from live video consultations to remote patient monitoring. But you should use some caution when taking advantage of these services to ensure that your privacy is protected.

Asking some simple questions can help you determine what medical research to pay attention to and when to wait for more information.

Every day there's something new in the world of medical research, and sometimes the results conflict. Eggs are good for your heart, or not. First surgery is advised to repair tears to cartilage in the knee, then nonsurgical options are favored. Do this, not that, for better health. For many women, all this information is a little confusing. When should you change your health habits, and when should you wait for more information? How can you tell the difference?

"It can be difficult for the consumer to know what research study is preliminary at best and in need of replication, versus a study that should cause you to change your life," says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School and chief of cognitive and behavioral neurology at the VA Boston Healthcare System.

Because the very nature of recovery support involves face-to-face interaction, whether in support group meetings or dispensing medication, it is at odds with the need for social distancing during the COVID-19 crisis, creating barriers to receiving support and maintaining recovery.

News briefs

In the old days, doctors would make house calls; that rarely happens today. However, a new kind of "house call" is in the works: in many cities it's now possible to receive hospital care at home for certain conditions. Such "home hospital care" programs are gaining in popularity. A randomized controlled Harvard study published online Dec. 17, 2019, by Annals of Internal Medicine suggests that the home hospital model of care is less expensive and leads to fewer readmissions than in-hospital care.

Researchers studied about 90 people who'd been diagnosed in the emergency room with infections or flares of heart failure or breathing problems. Half of the people were admitted to hospitals, and the other half were enrolled in home hospital care. The home hospital care group received visits from doctors and nurses, intravenous medications, and video monitoring. People in the home group had 38% lower hospital costs than those in the hospital group, they were more active during care, and they were readmitted to the hospital within 30 days after their care less frequently (7% vs. 23%) than those in the hospital group. Home hospital care is not appropriate for everyone. "If someone is too sick or is in need of advanced procedures, their care may be better delivered in a traditional hospital," says Dr. David M. Levine, the study's lead author and an internal medicine specialist with Harvard-affiliated Brigham and Women's Hospital. However, if you have an illness that needs constant monitoring and treatment for several days — in other words, it can't be done in a doctor's office — yet it also doesn't require advanced procedures or constant and intensive nursing care, the home hospital care model may make sense. "If the home hospital model were offered to a member of my family, I'd encourage them to do it," says Dr. Levine.

Research we're watching

Doctors have been overprescribing opioids for chronic musculoskeletal pain, according to a December 2019 study in The Journal of Pain. Researchers looking at data from a survey conducted between 2007 and 2015 found that doctors more often prescribed pills, either non-opioid or opioid, rather than physical therapy, counseling, or other nondrug interventions — a practice that is directly at odds with what experts now recommend, including those in the CDC Guideline for Prescribing Opioids for Chronic Pain. At their first visit with the doctor, people were most often prescribed non-opioid painkillers (40.2%) or opioids (21.5%), followed by counseling, nonpharmacological treatments, and physical therapy. Study authors say this shows there is room for improvement through education. However, it's worth noting that the time period studied (2007 through 2015) preceded much of the recent work and advocacy aimed at reducing prescriptions of opioids.

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Do a thorough assessment to make sure equipment is safe.

Your doctor or an occupational therapist may recommend that you use some kind of medical equipment, such as a walker, electric scooter, cane, lift chair, or shower chair. Such equipment can help you maintain your independence or continue living at home. But what if your insurance won't pay for an item or if you need a spare? For many people, the solution is gently used equipment.

Bargain hunting

You'll find used medical equipment in consignment shops and thrift stores, and through online classified ad sites (such as Craigslist). The deals are substantial: you may find a used electric wheelchair (that retails for $2,500 new) for a few hundred dollars, or a used power lift chair ($500 new) for just $75.

Talking about sexuality with a doctor can be uncomfortable. If you identify as LGBTQ+, it's important to find a doctor who is attuned to the specific needs of the LGBTQ+ community. This can make getting proper care easier.