Beyond the Needle - A Physician's Guide to Increasing COVID-19 Vaccination Rates

Physicians’ Reflections & Moving Forward After the Pandemic – Part 2 of 2

• I-VAC & Illinois Academy of Family Physicians (IAFP) • Season 2 • Episode 2

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The conversation continues.  Dr. Corinne Kohler, Dr. Marian Sassetti, and Dr. Christina Wells reflect on the evolution of the pandemic in the past year.  They share their experiences and engage in a discussion about how we, as a community of healers, can collectively move forward.
 Meet the Faculty

Topics include:

  • How practices have changed - both in day-to-day activities clinical activities and long-term  
  • Ways to incorporate technology to improve patients’ overall health
  • Impacts from COVID on stress levels and mental health for patients and clinicians 
  • Ideas to we keep momentum going to incorporate these "crisis management" principles currently in place

 Objectives:

  • Discuss how clinicians can use technology to improve patients’ overall health and wellness 
  • Introduce ways to approach patient visits more holistically, rather than strictly problem-centered
  •  Identify resources and options to help people with behavioral health issues

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Dr. Corinne Kohler (00:00):

Welcome to another podcast of Beyond the Needle. Today we're talking about changes and challenges our practices have had with the advent of COVID and the ongoing period. I'm here today with Dr. Christina Wells and Dr. Marian Sassetti. I am Dr. Corrine Kohler. I am a family practice physician who is currently retired from a federally qualified health center, also affiliated with the Carle Illinois College of Medicine here in Champaign, Urbana. Dr. Wells?

Dr. Christina Wells (00:31):

Hi, I'm Dr. Christina Wells and I work currently at a federally qualified health center. I'm also an assistant professor of clinical medicine at the University of Illinois.

Dr. Corinne Kohler (00:44):

Dr. Sassetti?

Dr. Marian Sassetti (00:45):

I'm Marian Sassetti. I'm a [inaudible 00:00:48] family doc. I work at an independent private practice, Lake Street Family Physicians. We're just to the west of the west side of Chicago. I'm also an assistant professor in the department of family medicine at Rush.

Dr. Corinne Kohler (01:04):

So now that we're in our third year of pandemic and COVID, I'm sure we've all seen changes in our practice, both on a day-to-day and more long-term changes. I know for us, the advent of telemedicine and different ways of patients accessing care has certainly changed for our clinic. What have you seen, Dr. Christina Wells?

Dr. Christina Wells (01:34):

I think one of the biggest changes we've also seen is the introduction and evolution of telemedicine. It definitely was something never had occurred within our practice prior to COVID. And I will say that even in my clinic now, most of my visits are now in person, but the ability to be able to incorporate telemedicine has been important for follow-up visits and just for times where patients just could absolutely not get into the clinic. And so I think telemedicine has been one of the biggest things that I've seen incorporated into my practice during the COVID pandemic.

Dr. Corinne Kohler (02:21):

Do you feel like it has actually increased access for your patients to access their healthcare provider by providing the telemedicine?

Dr. Christina Wells (02:31):

I definitely think it has increased access and, like I said, I still do a majority of my visits still in person, but there are sometimes I've had patients who for mobility issues, transportation issues, daycare issues, caregiver issues, whatever it may be, they have been able to do a telemedicine visit. And so I think that it definitely has improved access to some extent and lifted some barriers to access that we have seen in the past.

Dr. Corinne Kohler (03:08):

Dr. Sassetti, how have you seen that affect your practice?

Dr. Marian Sassetti (03:12):

Oh, it's now essential. It's interesting how that happens, isn't it? You know we went from paper charts to electronic charts. I don't think televisits are ever going to go away. It was introduced because of COVID, but now I would say it's hard to estimate, but at least a third of my day is spent on tele visits. Often it's just a patient's preference. There aren't mobility issues. They just prefer it.

(03:35):

I would say the other thing that's happened is I can keep people home that I am worried about coming out and make sure that they have a blood pressure cuff, their diabetes, ability to check their blood sugar and O2 sat has become, a saturation machine, has now also become part of the toolkit that I ask patients to get if they can afford it.

(03:55):

We have also noticed a dramatic decrease in no-shows and then probably as we'll talk about cultural shifts, I have noticed that the reluctant young person, the teenager who didn't feel like coming in, the parent can get them up on a televisit to talk to me, and I've really welcomed that as a way to get the reluctant patient to show up and at least have an inroad to talk to them.

Dr. Corinne Kohler (04:19):

I think having the flexibility of how we interact now with our patients in general is definitely a positive, not just because we don't want patients coming out, but as you said for other reasons. I personally love doing my ADHD follow-up visits with the child in the home, as you can really see how those interactions work and such like that. So I would hope that telemedicine is here to stay. I think the industry as a whole has learned reimbursement.

(04:53):

It's definitely improving. I think getting our staff to buy into. Offering that as a visit was something that was challenging and difficult. And in general, I think some of the staffing changes because if you're doing telemedicine, you don't need as much hands on in the clinic. So it certainly has shifted sometimes who's in the clinic, when they're in the clinic and has made all that challenging. What have you seen Dr. Sassetti, with how that might have affected your practice?

Dr. Marian Sassetti (05:25):

Well, two thoughts. I want to say it's helped me be a better healer sometimes when I can actually... I joke with a patient that I see them in their natural habitat, but it really is. I get to see health risks, especially in my elderly or immobilized, in my mentally ill patients. You can really... well, not all the time, but sometimes get a glimpse as to the challenges that they're living with. So it's helped me too, and I'm guessing that all of our colleagues have seen that benefit of where you actually see what somebody is doing in their own home, what the potential risks are, getting their medications where you just say, "Okay, go grab those bottles and let me see what you're taking." I've had a few patients literally hold the bottle up to the camera, where they can't pronounce the name of it. They went to see the cardiologist, they're not sure what the drug is, that kind of thing. So tele visits is helping me, and I think probably many healers who are using it.

(06:16):

The second issue as far as staffing, we didn't seem to have a problem. One of the benefits of COVID was the remarkable change in the way my staff viewed work, and we were able to very collaboratively see people change. Okay, today I'm at the front desk, but then I'll be putting patients in, that kind of thing.

(06:35):

So from day one where we did kind of crisis management, maybe we could talk about that. We really saw our staff was beginning to understand that they needed to be very flexible with what they were willing and able to do. Patient accommodation was number one through a hundred for us during this crisis and they were really willing to get people in on televisits versus in person. It also meant less work for them. Very often, as you alluded to, getting a patient up on a televisit meant much less work as far as rooming a patient and all the rest of it. So for us it was fairly easy and it kind of dovetailed into a wonderful thing that happened in our practice because of COVID, which was the ability to look at each other and say, "We are all in this together. How can each of us help?" There was very little reluctance among my staff to quote, do someone else's job. They all just pitched in and I think we're seeing the benefits of that continue on many other issues and topics as we go forward.

Dr. Corinne Kohler (07:38):

Dr. Wells, your thoughts?

Dr. Christina Wells (07:40):

Yeah, I think I've had a little bit of a different experience. None of our staff is actually remote, so all of our staff has been in clinic, in person on a daily basis and whatever we are doing in terms of telehealth is taken care of from the office setting, from the clinic setting. So we haven't really seen much in terms of differences in how staff or clinical flow has gone in terms of telemedicine. Yes, with the telemedicine visits, it does take less time in terms of having to room the patient. But, in general, our clinic flow has been pretty consistent throughout

Dr. Corinne Kohler (08:32):

And in our clinic. I know some of our providers did some of their telemedicine visits as a block and then they could work remotely offsite if needed or they could change, and that helped sometimes even free up some clinic space and make some more flexibility definitely for that.

(08:51):

So another really positive thing that I noticed coming out of this whole pandemic is a teamwork approach where rather than working more as individuals, really working as a team, doing crossing, [inaudible 00:09:06] tasking and realizing that everyone is important, from the person that answers the phone to the person that opens the door, to the person that calls the pharmacy, whatever the task is, it's not just one person.

(09:21):

So Doctor Sassetti, you mentioned patients have things like BP kits in their toolkit and O2 sats. What have you seen in terms of maybe remote monitoring? Do you do more of that? Is there a change or a shift in how we use even some of our smart watches and such like that and how maybe patients either collect data or share data? Have you seen that change?

Dr. Marian Sassetti (09:50):

Absolutely. And our cardiology colleagues kind of taught me how to do that remotely. I was actually surprised that they were able to monitor so many of my patients. And now Medicare, as you probably are aware, will pay for a scale, a blood pressure cuff. We've played with getting them to pay for an O2 sat machine. I've written it as a prescription. I think sometimes it does. I need more data on that. So I'll tell my patients, "Take your temperature, take your blood pressure, if you have an oxygen saturation machine, please take that."

(10:18):

At the beginning of the respiratory season this year, even when I didn't have a topic pertaining to COVID or respiratory illness, I said, "By the way, moving into this respiratory season, I think it's a good idea that if you can afford it, please get an oxygen saturation machine." Most of the time, I have priced them out, they are somewhere between 25 and $30. Phrase it that way, we're very sensitive to finances, but insurance companies will pay for the other modality.

(10:45):

My patients feel very empowered. They show up, they've got their list. Very often they'll have written it out. Again, it goes to that collaborative process, "I've got this. This is my body, this is my data, I'm going to share it with you." And it's worked out exceedingly well. People have not been resistant to taking it up.

(11:03):

They also have been taught just gather every pill in your house, put it in a bag, and when Dr. Sassetti talks to you, she's going to want to know, or my nurses will do that as they prep a patient for a televisit. They'll ask them to take out every pill and go through it. Sometimes that's a little time-consuming if we've just done that three months ago, but it's worked out, I would say exceedingly well. I think it's a giant positive in my practice and I see it being so going forward.

(11:30):

And we talk a lot about the elderly, but follow up for those babies who are ill, the febrile babies, that kind of thing. Seeing a sick kid on a televisit, waiting that five days after you've seen them in office, very important. The young parents feel very reassured that I'm able to see the babies on a televisit. I get to see what they're doing. It's all net positive for me.

Dr. Corinne Kohler (11:53):

That quickly brings up for me that rash follow-ups are very easy to do our televisits too. So Dr. Wells, what have you seen change maybe in your patient toolkits and how they interact?

Dr. Christina Wells (12:06):

Yeah, I think that this is a place that will continue to make telemedicine better and better, and I think one of the ways is also to be able to see how we can get more devices covered for patients, like patients who are Medicaid, who may not be able to afford these devices. But I have had some patients who had COVID and could manage their oxygen saturation at home, and I've had some patients who check their blood pressure and things at home.

(12:43):

I will say that there are some limitations in terms of patients, again, being able to afford the devices because a lot of times it's not covered by insurance that my patients are having. But I think that this is an area of opportunity in telemedicine where we could really expand the information that patients can provide from home to their providers if they had access to these devices. So I think it's a really, really important tool that hopefully we'll be able to expand on in telemedicine over time.

Dr. Corinne Kohler (13:24):

So what other positive or challenging aspects have you seen in terms of practical clinic? We talked a little bit about the telemedicine, and I know in our practice we've had some remote employees, both nursing and administrative, and certainly our call center has moved remotely. What other changes have you guys seen in terms of practical clinical aspects?

Dr. Marian Sassetti (13:48):

This is Marian. Definitely a flexibility for our staff to have a hybrid or totally remote. So we have triage nurse almost totally remote at this point, and we have a billing person who's partial. I could go through it, but the hybrid idea. And then we love to practice what we preach. We're family centered. When people have crises, we like them to be home with those kids when they can. It's worked out. We're on the cusp of exploring even rooming patients remotely. So if we have somebody remotely who could room a televisit, that would be great. We haven't done that yet, but we're exploring it.

(14:28):

And I think our staff, again, because in the beginning of the crisis it was very clear we were all into the... you're going to get tired of me saying it, but there was this cultural belief that if we all chipped in and did our part, my office manager has no problem doing front staff phone answering. It's remarkable. There's just an idea that we're all in it together and the patient care, and the patient outcome is what matters. So there isn't really hard boundaries between anybody's job, and we're incredibly grateful that this crisis invited that forward.

(15:05):

I do think as a staff cohesion issue, this crisis like many others do, brings out the best in people. I saw very little of the worst, to tell you the truth. We are going forward with that notion that at any time there might be a problem and you've got to pitch in. We don't really, I don't want to say allow or disallow, but we really don't like the notion of these siloed skillsets. In our office people share tasks, so whatever needs to be done gets done, and I think it increases morale.

Dr. Christina Wells (15:36):

I'll add to that too, that we have in the specific clinic that I work in, a very good teamwork mentality, so that's been beneficial. As Dr. Sassetti, you mentioned, Dr. Sassetti, our nursing staff actually does do those telehealth intakes over the phone. So that's beneficial that the nurse will call the patient or the MA will call the patient and do the intake over the phone. Of course, there are some things that they cannot do, but the things that they can do over the phone, they'll get that done. That's beneficial to me as a provider when I come in having that information already beforehand.

(16:18):

Some of the things also though, that have evolved in our clinic. In the beginning we were doing a lot more testing for COVID within the clinic, but now that patients can test at home, that has alleviated us from having to provide that service as frequently. But then patients can, if they know that they're positive, then they can schedule that telemedicine visit to discuss their current COVID symptoms, and then we can alleviate patients from having to come into the clinic and expose other people. So that's been something that has been beneficial as well.

Dr. Corinne Kohler (17:02):

And I think that carries over to other respiratory or infectious illnesses also, when I can have the influenza or upper respiratory patients call in, especially for follow-up, even as you said, rashes, hand, foot and mouth. There's a lot of those that at least we could maybe do some of the initial and keep the highly infectious patients out of the office. You've mentioned, Dr. Wells, about we're doing less COVID testing in the clinic. What have you seen this past year with how your practice has incorporated the changes in vaccines and the fact that we've added the pediatric vaccines and now the boosters, and how has that impacted your clinic flow or or has it?

Dr. Christina Wells (17:49):

No, that's definitely been an evolution as well. In the beginning and in my practice, we had special days where we would do COVID vaccines, so maybe on Tuesdays it might be adults. And then as we started to get the pediatric vaccines, we would have those on separate days. So on any given day when a patient came in, if it wasn't the day that we had designated to give that particular vaccine or a vaccine by a particular manufacturer, then we weren't offering it.

(18:22):

But as we evolved over time, then we started to, one, we resorted to only having one manufacturer of the vaccine in the clinic just to make it easier for staffing. And then we put it as a part of our routine practice so that if it's an adult, if it's a child, as child vaccines have been incorporated, then they can get them on any day that they're coming into the clinic rather than having to come on special days. So that has been a good evolution in building vaccines into our routine daily practice.

Dr. Corinne Kohler (19:00):

Dr. Sassetti?

Dr. Marian Sassetti (19:02):

Yeah, same. I think I had alluded to what a delight that was early on when we moved from the clinics. We had designated COVID clinic days and we were isolating. They had a separate entrance into our office and all the rest of it. Again, a beautiful evolution, and we only had our RNs doing it. Then our RNs were teaching our MAs, and now again, I keep talking about it, but how fun it is to just tell my staff she needs DPT and the COVID and it's just done. Nothing. No feathers rattled, nothing. It's just truly part and parcel of good healthcare, good preventive healthcare.

(19:39):

Our patients are, for the most part, accepting it. In fact, I think they accept it better when I say, "Look, it's part of keeping your baby healthy. It's part of keeping us healthy." We unfold it into the whole language of prevention. You get your COVID, you get your DPT, you get your flu shot, and your rate of getting ill or certainly dying from these diseases is dramatically reduced and it's a beautiful thing.

(20:02):

I think our staff loves folding it in, our patients appreciate it, and we just keep going forward and as Dr. Wells is alluded to in a previous [inaudible 00:20:12], the next pandemic is coming. We've got to get it figured out. How do we keep getting something new and unfolding it into general preventive practices.

Dr. Corinne Kohler (20:22):

So as we've talked a little bit about incorporating the vaccines and making it part of the well child and the daily care just like we do with offering influenza vaccine during influenza season and such like that, have you seen a change in utilization of healthcare, especially over the past year? You have telemedicine with all this flexibility. Do you feel like there's been uptakes, decreases? How do you think that has affected? We'll start with you, Dr. Wells.

Dr. Christina Wells (20:53):

Well, I think that although we have had more flexibility in how we deal with healthcare appointments in terms of adding telemedicine, I think that there has still unfortunately been not the same in terms of healthcare utilization. I know that even over the last year, I haven't seen as many children coming in as before, especially during times of school physical seasons. And so I think that we still have a ways to go on how we help patients come back into accessing healthcare even more and how we better utilize our telehealth visits.

(21:44):

But I think that there is still something that maybe we need to be exploring about people's utilization of healthcare and maybe there are other factors like social determinants of health that are impacting, again, people's abilities not only to come in person, but also to access telehealth services, like having a working telephone and other responsibilities that people may be dealing with that still may impede them from being able to engage in telemedicine as well.

Dr. Corinne Kohler (22:20):

Dr. Sassetti?

Dr. Marian Sassetti (22:22):

Absolutely. Again, I talk about just like any crisis, what we see is we all default to our most comfortable and familiar. When my patients have managed this crisis, many things have fallen to the wayside. Definitely a lot of chronic diseases that got worse, a lot of... not so many children who didn't get their boosters, their vaccines, except for children just not coming in for routine evaluations, their yearly physicals. Interestingly, they'll have gotten the flu shots or something at Walgreens. And I have to say again, I'm a big fan of what are the invitations during crises. I can't tell you the number of patients who have come in and been like, "I've been bad doc and I'm sorry." Or "Boy, I really haven't been good. I know you're going to be upset about it."`

(23:08):

Which is funny because I'm never upset, but that's their language. And I say, "Look, you're here. That's what matters." It's also been a fabulous opportunity for me to say, "Look, we're here about keeping you healthy and trying to get you to enjoy some quality of light. Missing a physical isn't a big deal. Here's the deal. Were you still exercising? Were you eating right? All the rest of it." And it's really this nice opportunity to say you didn't hurt yourself because you didn't come and get a physical. You are your own advocate. What were you doing during this time? And for a lot of us, me included, we gained weight during COVID and I've got endless numbers, especially women, but other people coming in, "I gained weight. I feel bad. I was trying my best." And I say, "That's right. We were all trying our best. Here's the most important thing."

(23:52):

And I think it's the language that both you, Dr. Kohler and Dr. Wells were talking about. We keep talking about these opportunities to build loving connections where we remind patients what exactly it is we're doing here. Is it filling out, the checking boxes about who got a physical and all the rest of it? Or is it really about empowering our patients to see themselves as their best advocates for health? It's an opportunity to say, "Here's what you did well. Even though you didn't see me, your blood pressure looks great, all this other stuff." If their blood pressure doesn't look great, I'll say, "Do you think that was from stress?" And I haven't had a single person say no. And I know it's from stress because crises cause blood pressures to go up. Crises cause stress reactions in our bodies. So it's another opportunity for me to talk about... my language is our bodies are smarter than we are.

(24:43):

Our bodies know you're under stress. How do we talk about stress reduction? Even though they came in for their physical, the conversation leads to these kind of things that I believe personally over all these years are the biggest, best topics for us to be talking about. So long-winded answer to, yes, it's definitely changed. I think it also shows us the challenges we have about getting our patients in, reminding them how powerful they are. Try to get rid of this language around, "I've been bad, I'm not a good person, I'm not a good patient", and reminding them how resilient they are and propping that up because they're going to use it at the next crisis or the next problem their families have.

(25:23):

Especially our young people, which I think we're going to get into, but our young people who haven't bumped up against a lot of problems and now are. It's really important to start that whole language and create these safe spaces around even just coming in when they've missed a physical or two.

Dr. Corinne Kohler (25:41):

I really like how you approach your visits with not only problem centered but a more holistic approach and bringing in the stress and the lifestyle and such like that, which I think is highly important to all of us as family physicians as COVID has kind of become part of our more mainstream a little bit more, as I say here, to stay. How do you feel like that has affected things like stress and maybe mental health access, especially in the pediatric population. Dr. Wells?

Dr. Christina Wells (26:16):

Yeah, I think that definitely over the past year and a half, I've definitely seen increases in persons coming in with issues or concerns around mental health. And those persons have been young and old alike, but definitely younger than I had pre-COVID. The wonderful thing about my clinic is that we have placed a huge emphasis on behavioral health. And so in each of our sites we have an LCSW where we can do warm handoffs and we can have the patient talk with them to do some brief counseling. So that's been very beneficial and it's definitely an asset to the practice that I'm a part of. And so I know all practices are different, but it's definitely important because more people are experiencing burnout. Even healthcare providers. We're experiencing burnout as well as mental health challenges.

(27:19):

And so being able to recognize that, acknowledge it, and not stigmatize it as some bad thing, but acknowledge that we all go through things and then how do we deal with it in appropriate ways and get the help in appropriate ways? And so definitely seeing more of that and the need to have more of this integration within our healthcare system and interdisciplinary integration where we provide different services, one of which may be mental health.

Dr. Corinne Kohler (27:54):

I definitely see that as a positive change having come out of this whole pandemic, being more aware. And again, especially in the pediatric population, as we all are aware of remote learning versus in-person learning and some of those challenges and how our different practices have addressed that and have provided resources. What about your practice, Dr. Sassetti. How has that affected your clinic?

Dr. Marian Sassetti (28:22):

Well, it's actually a massive topic for us, and it's one of my interests both personally and professionally. To be more concise than I usually am, let me just say that I have never seen the amount of mental illness and the severity that I have seen and the age groups affected. I hate to share, but it is the truth that now I have my youngest patient who has attempted a suicide is eight years old.

Dr. Corinne Kohler (28:49):

That's really difficult to know that our children, that we're seeing that much crisis. And I think part of it is, I know for us, we've been kind of isolated from some of that. Sometimes that's just been dealt with because they've gone off inpatients such like that. And it's not been maybe as well incorporated into our family medicine routine. And now these patients are coming back to us so we're following up on them and we're seeing them more, hopefully, as a cohesive unit and not just fragmenting their care.

(29:19):

So in the awareness of this, maybe that's the positive that will come out of some of that.

Dr. Marian Sassetti (29:26):

I get choked up. But so I had shared that the youngest patient was eight years old who had attempted suicide. And then on the other end, I had a grandmother during a televisit where the scribe... I have a scribe in the room, actually started weeping. And all three of us were in tears by the time she finished telling me... well, actually the reason for her tele visit was that she wanted to know if I could quote, put her in the hospital and put her to sleep so she wouldn't have to bear witness to the suffering of her grandson who took an electric cord and tried to commit a suicide in front of her.

(30:01):

So these are the extremes of what we are seeing, and certainly they are the extremes in my practice. But it highlights a huge shift, and I know worldwide it's happening. We are understanding that young brains that aren't completely developed until they're in their twenties are absorbing a lot of negative energy, a lot of the social isolation and becoming mentally ill, severely sometimes, but a lot of anxiety. There's a statistic that says we are now seeing three to 400% increase in the rise of adolescent and pediatric mental health challenges.

(30:36):

So in my practice, unfortunately, I don't have what I think is just a visionary progressive piece, Dr. Wells, is to have embedded right in your practice a mental health provider. So we are overwhelmed and just incredibly frustrated with the inability of so many of our patients to access mental health providers, so we're taking that on. It's causing enormous burnout and frustration and sadness on my part and the part of our young staff because my personal family history, I have a skillset that so many of my partners don't and I'm watching my young partners really, really struggle with great sadness and sorrow trying to meet this challenge. It's not going away.

(31:18):

I think that some very forward thinkers in our country have begun to understand this is now yet another issue that they have to grapple with. And I think many of us are aware that there's a national movement to embed mental health providers in schools, which could only be a positive. So we haven't seen the end of this. I think it's peaking, but I really want to emphasize that we have to help each other through this and help our patients.

(31:45):

One of my favorite phrases is, "Say it out loud." I'm thrilled you said it out loud. It takes courage. Sometimes I'll tell parents who are really, really worried about their children, "I'm not worried about your son. Young children who can say out loud that they need help are light years ahead at the kids who go up in the room and close the door." So asking for help, role modeling it, telling people how courageous they are and how much you admire the fact that they were able to say out loud that they need help is part of the way we need to start talking to encourage patients to come in.

(32:18):

But I wish I had answers for not having a great number of open psychiatrists and mental health providers. I think many of us should be aware, if we're not, of DocAssist, the program through the University of Illinois where you can get a psychiatrist on the phone. I think that's magnificent. It's helpful. It's not all the way to having an available slot, but it's very helpful and we need to be grateful for those docs who staff it. I wish they had better news. I don't, but again, we're all in this together and we've got to help each other, especially our young providers who it might be the first time they're encountering suicidal young people who are severely mentally ill.

Dr. Corinne Kohler (33:00):

Going forward, do you see some of these changes, especially some of this, like embedding the behavioral health in the clinic and such as changes that will persist? Or do you feel like these might be things that will not continue once we're past our current crisis? I know for the clinic I worked in, we have had, hadn't embedded behavioral health probably since early 2000s, so we had it for adults, but adding it for the pediatric population or shifting how we access the pediatric population has definitely been a change. Dr. Wells, what do you see going forward?

Dr. Christina Wells (33:40):

Yeah, even in our clinic, we had started to focus on behavioral health before COVID came about. So definitely we just utilized it a lot more as we saw the aftermath of COVID. And so I think that this is going to be a shift of this behavioral health integration. Hopefully, we can have this more and more to be integrated in our different practices as we see the need for it. And so I think it is going to be something that hopefully will continue to evolve and grow. I think the other thing, as Dr. Sassetti was talking earlier, is us realizing our own need for support as healthcare practitioners and our own vulnerabilities and being able to, one, recognize those in advance, get help when we need it, and also be able to share with our patients our own struggles.

(34:40):

I think sometimes we are viewed as superhuman, and that leads also to our own burnout, which is what we've seen also during the pandemic. And so I think focusing on mental health amongst not only patients, but also providers is going to be important as we move forward.

Dr. Corinne Kohler (35:01):

Any additional thoughts on that, Dr. Sassetti?

Dr. Marian Sassetti (35:05):

I've got a gazillion additional thoughts, but for this podcast, I would just say I think that there are various cultures, populations, even male/ female divides down how accepting we are or are not of conversations around mental health. I think the pendulum is swinging wildly and I'm thrilled with that. But I think we do need to be sensitive that there are people who it's easier for them to say out loud they need help. And that's all I say. Just say out loud, you need help. You don't have to say, I'm mentally ill or I'm depressed, or I just need help.

(35:39):

And sometimes I'll use the expression again, you've heard me say it, our bodies are smarter than we are, but why do you think you have this abdominal pain? Why do you think you've been getting these headaches? What do you think is going on? Tell me about what your stress levels are like.

(35:52):

People will talk about stress. They won't talk about mental illness. And I think that's one of the inroads that I've begun to use. Again, I have age as a positive on my side. I have been on people's journeys for many years and I know that they're safe. Teaching their young providers how to create those safe spaces is important. And I think they're learning very fast and they need to and they want to. They're tired of doing the million dollar workups for chest pain when it's really a stress-related kind of thing. So I think we're moving in the right direction. It's all welcome.

(36:24):

And I think we have to help each other and the conversations cannot stop. I think there'll be a time when we look back in history and we'll say "What? Lake Street Family Docs didn't have a social worker on staff, but the FQHC clinics did? What the heck were you guys thinking?" It will be that important to providing good preventative wraparound healthcare. So I think we all just need to keep our eyes on this as a major player in health and wellbeing of ourselves and our patients and our communities.

Dr. Corinne Kohler (36:55):

So in a little bit of summary, I'll start with you, Dr. Sassetti, what would you still say are the biggest practice changes and challenges specifically maybe related to COVID over the past 12 to 18 months?

Dr. Marian Sassetti (37:10):

I would say the biggest positive is, of course, the vaccine, and of course the commitment to prevention. Big picture stuff that all of us have engaged in, whether it's bench work scientists to my front staff, all the way up to my senior partners, the vaccine and how we have been strategizing and how we have used every skill available to us, every resource available to us, how we have come together and problem solved around getting a clinic up and running to getting it embedded. I think it's just called forth the best in every person that I've intersected with around the vaccine.

(37:53):

I think the worst parts of the last 18 months have been the divisiveness and the willingness to be divisive. I think that's upset me more than anything, is this willingness to look at each other and just be angry and hostile. And again, to look at our marginalized patients and kind of shrug and say, "That's too bad." I think that was one of my greatest sorrows. And one of the toughest things in my practice is acknowledging how resource heavy many of us are and what we have to do to make sure that's spread evenly across. I don't have all the answers yet, but it's certainly there. That is powerful in our practice at Lake Street Family Physicians.

Dr. Corinne Kohler (38:39):

Dr. Wells?

Dr. Christina Wells (38:42):

Yeah, I think on a general level, I would say that we did a okay job of learning how to respond to crises, but I would say that though we did it more of in a reactive fashion. And so I think as we move forward, our challenges will be to how do we implement processes that are consistent, that will help us to meet the future challenges that we may face. If we remember quickly, this is not the first pandemic. We had the the flu pandemic of 1918. And so as we think about these different things that have happened over time, is really coming together and forming processes that are going to be consistent in our healthcare systems that will carry us through whatever pandemic we may face, knowing that we'll have to make tweaks here and there, but some processes that we can follow all along the way.

(39:44):

And so I think we've done a good job in our response. I think we can give ourselves a pat on the back, but also knowing that we will also always be needing to continue to grow and evolve in how we deliver healthcare to meet the needs of the communities that we are providing care for.

Dr. Corinne Kohler (40:05):

Thank you very much for that concise summary, Dr. Wells. I think we can all agree on that and certainly as we have provided some resources and links for some additional information and thoughts on the subject on this. Please send us any comments you have on this podcast and join us for our next session of Beyond the Needle. Thank you for being with us.

 

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