Can You Heal Me Now? Telemedicine’s Momentum.

Momentum for telehealth is accelerating


Doctor of the future as envisioned in 1925The nation’s ongoing battle to strike a delicate balance between increasing access to quality health care for all Americans and reducing overall health care spending just scored one of its most substantial victories.  In late April, after several months of thoughtful and robust collaboration, the Federation of State Medical Boards (FSMB) ratified a new model national policy: the Appropriate Use of Telemedicine in the Practice of Medicine.

This marks the first time the medical community has unilaterally acknowledged the impact technology has had on the practice of medicine, and the ability telemedicine — or connected health — has to facilitate and improve the delivery of health care.

Let us first put this in perspective.  We all know health care is at a critical juncture.  The implementation of the Affordable Care Act means millions of newly eligible Americans will seek access to an already overburdened health care system.  The nation faces a serious shortage of primary care providers, specialty care is becoming more diversified, and access to care in rural areas is an ongoing challenge.  All of these issues are on the rise.

Technology-enabled care

Enter technology-enabled care.  Real-time video encounters between patients and providers reverse the burden on patients to seek care in a hospital or doctor’s office by bringing health care directly to them, in their home.  At the same time, remote monitoring, sensors, mobile health and other technologies are helping to reduce hospital readmissions, and improving adherence to care plans and clinical outcomes, as well as patient satisfaction.  Connected health tools also support preventative care efforts for chronic care patients and can empower individuals to make positive lifestyle changes to improve their overall health and wellness.

Momentum for telehealth is accelerating at an undeniable rate.  As of March, twenty states and the District of Columbia have passed mandates for coverage of commercially provided telehealth services; 46 states offer some type of Medicaid reimbursement for services provided via telehealth.  A study by Deloitte predicts that this year alone, there will be 100 million eVisits globally, potentially saving over $5 billion when compared to the cost of face-to-face doctor visits.  This represents a growth of 400 percent in video-based virtual visits from 2012 levels, and the greatest usage is predicted to occur in North America, where there could be up to 75 million visits in 2014.  This would represent 25 percent of the addressable market.

Continue reading Can You Heal Me Now? Telemedicine’s Momentum.

Doc-in-the-Box Meets Docs-Outside-the Box

Fortunately, the doctors and staff of Central Coast UrgentCare and IndustrialCare, have great relationships with other healthcare professionals in the Santa Maria Valley.

masthead for Dr. Fred Pelzman's blogBy Fred N. Pelzman, MD


We have all seen patients coming out of urgent care centers and emergency departments with prescriptions for antibiotics that were probably not necessary, and with opiate pain medicines which we are then left to sort out whether they are needed. We have also seen extensive scans and lab tests that we now need to take care of and follow up on, that likely are not clinically relevant.

I’m not saying that in the primary care setting our care is always perfect, efficient, always evidence-based. We have all given antibiotics for a cold (admit it, you know you have), and ordered too many labs and scans because we could.

But these other settings, these alternatives to the primary care office, serve an incredibly important and useful purpose, and can become critical cogs in the healthcare team that we’re trying to build in the patient-centered medical home model.

We know that ideal care requires 24/7/365 access but, as we know, none of us want to be on call 24 hours a day, 7 days a week, 365 days a year.

I recently had a nearly perfect interaction with an urgent care center and the staff who provided care. My patient was seen there urgently late on a Friday night, and they actually followed up with her 2 days later (then Sunday morning) and provided ongoing, and appropriate, care for this clinical situation. Monday morning I arrived in my office and received an email communication from the provider at the center, detailing what had happened, explaining their thought process, and recommending follow-up with me.

For most of us busy primary care providers, after-hours care is usually telephone care. It’s hard for us to come into the office at 12:30 at night when a patient is sick and wants to be seen. There certainly are exceptions to this, where we may come into the emergency department to see a sick patient, but for many things it is nice for patients have an option for walk-in care that is safe, clinically rational, and available.

Wouldn’t it be nice if the urgent care centers and emergency departments became an integrated part of our team, rather than us continuing the sometimes somewhat adversarial relationships that currently exist between these different settings?

What, if anything, does a “near miss” have to do with health and safety?


Reporting a Near Miss Safety Poster“Well, no one died, so what’s the problem?”  I have heard lines like this before and I heard it again yesterday.  What irks me is that the people saying (or reported to have said) these words are often in supervisory or managerial positions.  Some even have a title or function that includes “safety and health”.  The truth is, the absence of injury is not a true measure of workplace health and safety.   And how a “near miss” is reported and reviewed reveals much about the safety culture of a workplace.

I instruct classes and seminars with learners and talk about safety with a lot of workers.  When I ask about their health and safety experiences, they often relate incidents like the following—serious incidents but without injury: The ladder I was on began to slide sideways and I had to jump off.

  • The patient suddenly lost balance and collapsed on top of me.
  • The student I was helping impulsively started the drill press while my eye was next the bit aligning the project.
  • As I pulled out the top drawer, the file cabinet began to fall forward… I was just able to step out of the way before it went crashing to the floor.
  • Someone had sprayed a lubricant in the hallway and I nearly slipped and fell when I stepped in it.
  • The metal plate broke loose from the winch and missed my toes by a fraction of an inch.

The workplaces above are varied:  a paint job on a residential site, a clinic, an industrial education shop in a school, an office, a hallway in a public building, a fabrication shop.  From an outcome perspective, there were no injuries, no lost days due to accidents, no need for doctor’s visits or alternate duties.  Yet, most of us would recognize that what separated the worker from injury in each case was a matter of luck (or millimetres) and not safety.  [READ MORE]

Now, Ignoring Co-Workers is Worse Than Bullying Them


keyboard with red IGNORE keyWe thought being harassed by the office bully was bad, but it turns out that overt harassment is better than having him ignore us completely.

I can barely keep up with the worst offensive actions of the workplace. I’ve written about office bullyingin the past, but a recent study now indicates that bullying isn’t the biggest problem we face. No, it now seems that ignoring creepy Kenny in IT is harder on him than if you just gave him a swirly in the toilet.Researchers at the University of British Columbia’s Sauder School of Businesshave discovered that “ostracism actually leads people to feel more helpless, like they’re not worthy of any attention at all”, even when compared to workplace intimidation. They found that “people consistently rate workplace ostracism as less socially inappropriate, less psychologically harmful”, and therefore “less likely to be prohibited than workplace harassment”. I mean, really, who out there has an anti-ostracism policy in their employee manual? Their study revealed that “people who claimed to have experienced ostracism were significantly more likely to report a degraded sense of workplace belonging and commitment, a stronger intention to quit their job, and a larger proportion of health problems”.

The researchers also looked at a previous employment survey, conducted by a different educational entity. That survey included data on “feelings of workplace isolation and harassment”. They then compared it to turnover rates three years after the survey was conducted. They found that “people who reported feeling ostracized were significantly more likely to have quit.”

There you have it. Creepy Kenny in IT is looking for a job, folks. Someone could save him by showing a little attention, even if that attention involves degrading him just a little bit more. At least he would know he was worthy of the harassment.

Professor Sandra Robinson, co-author of the study, tells us that “There are many people who feel quietly victimized in their daily lives, and most of our current strategies for dealing with workplace injustice don’t give them a voice”. Now apparently that victimization is being extended to those who no one pays any attention to.

As a side note, I love the phrase “workplace injustice”.  We have so many abusive factors today in our world of employment it now has its own term. We aren’t paid enough, we aren’t treated fairly, and we are bullied, harassed, discriminated against and abused. Now we are being ignored. It’s amazing any of us bother to show up at all.

So it turns out we are victimizing people even when we leave them alone. Who knew? And what is an employer to do?


Heat Wave: A Major Summer Killer

En Español

Heat is the number one weather-related killer in the United States, resulting in hundreds of fatalities each year. In fact, on average, excessive heat claims more lives each year than floods, lightning, tornadoes and hurricanes combined. In the disastrous heat wave of 1980, more than 1,250 people died. In the heat wave of 1995 more than 700 deaths in the Chicago area were attributed to heat. In August 2003, a record heat wave in Europe claimed an estimated 50,000 lives.

NOAA weather service heat indexNorth American summers are hot; most summers see heat waves in or more parts of the UnitedStates. East of the Rockies, they tend to
combine both high temperature and high humidity; although some of the worst heat waves have been catastrophically dry.

Additional detail on how heat impacts the human body is provided under “The Hazards of Excessive Heat” heading.

NOAA’s Watch, Warning, and Advisory Products for Extreme Heat

Each National Weather Service Weather Forecast Office can issue the following heat-related products as conditions warrant:

Excessive Heat Outlooks : are issued when the potential exists for an excessive heat event in the next 3-7 days. An Outlook provides information to those who need considerable lead time to prepare for the event, such as public utilities, emergency management and public health officials. See the mean heat index and probability forecastsmaps.

Excessive Heat Watches: are issued when conditions are favorable for an excessive heat event in the next 12 to 48 hours. A Watch is used when the risk of a heat wave has increased, but its occurrence and timing is still uncertain. A Watch provides enough lead time so those who need to prepare can do so, such as cities who have excessive heat event mitigation plans.