What Is A Complete Physical?

Hi everyone! I’m feeling a little prickly today because I have been fired. No really, I got fired recently by a husband and wife who were angry I didn’t do certain tests with the husband’s physical.

Turns out their last physician performed certain tests during their physicals that are not recommended, and this particular couple is of the opinion that doing a test is always better than NOT doing them.

So since I declined (with an explanation) to do these tests they felt I was not a good doctor.

It seems to me that these two are not the only patients who don’t know what a “complete physical” entails. Let’s talk about it!

A “complete physical” or “wellness exam” is an opportunity for your doctor to go over your entire medical history, update your chart with things that have happened since the last visit, and make sure your medication and allergy lists are correct.

Your primary care doctor is the one who keeps all these things up to date. This is why it’s important to have your physical every year. If you get sick or need to see a specialist, your primary care doctor is the one folks will ask for records.

Your physical should include an examination and a discussion of your screening needs. Your doctor should make sure your vaccines are up-to-date. And you should go home with guidance on eating healthy, vitamin and supplement use, exercise, and harm reduction measures like using condoms with sexual activity, moderation in alcohol use, wearing your seatbelt and bike helmet, and wearing sunscreen.

For women your visit should review whether your Pap test and mammogram are up to date. Yes, your primary care doctor does Pap tests. You may need a bone density test based on your age and risk factors.

For men, there should be a discussion of prostate cancer risk and current screening recommendations, which are a little controversial. The current recommendation is NOT to screen men unless they are Black or have a father or brother with prostate cancer.

Both men and women should have their colorectal cancer screening recommendations reviewed. There are several options including colonoscopy and Cologuard, depending on age, family history and previous screening results. And both men and women should have labs ordered periodically to check blood sugar and cholesterol.

That’s a lot! So what is NOT included in a complete physical?

Urinalysis – Except in pregnant women, screening urinalysis has little or no value. It is common for a perfectly healthy person to have a small amount of protein or blood in the urine. Screening will turn these findings up and result in anxiety and additional testing. However, if someone has a strong family history of kidney disease, or has high blood pressure or diabetes, testing may be valuable.

EKG – Again, EKGs are an imprecise tool. It is common for patients with perfectly healthy hearts to have minor abnormalities on their EKG. This again leads to anxiety and unnecessary additional testing. If one is concerned about their heart risk, you can ask for a coronary CT (coronary calcium score). This is a much better measure of heart risk as it measures the amount of plaque in the coronary arteries.

These two tests are the most common inappropriately-ordered tests done with a wellness visit. The complete physical is a very valuable tool in keeping you as healthy as possible. You should definitely get one every year. Just be aware of “extras” that may cost more and don’t add to your care.

Want more information about appropriate testing and treatment? Please see the American Board of Internal Medicine’s Choosing Wisely site and app. Yes, there’s an app for that!

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Dietary Anthocyanins And Inflammation

When you were a kid did your parents tell you to eat your fruits and veggies? Have you been told that red, purple and blue fruits are healthy to eat? They’re right – because of dietary anthocyanins.

Credit: ProHealth.com

The anthocyanins are a group of flavonoids, pigments in fruits, flowers, plant leaves and seeds that have powerful antioxidant and anti-inflammatory properties. There are a lot of studies that have looked into the effects of dietary anthocyanins on obesity, inflammation and other metabolic markers of health.

In 2016 it was estimated that nearly 40% of American adults were obese. In 2018, 30 million Americans were KNOWN to have heart disease. Almost 650,000 Americans are newly diagnosed with heart disease every year. Dietary change is key to addressing obesity and heart disease. Diabetes and heart disease are not skyrocketing because we’re deficient in metformin and Lipitor, for Pete’s sake. It’s because of what we put in our mouths. Every. Day.

What sorts of foods are we talking about? Red cabbage, blueberries, blackcurrants, mulberries, cherries, black elderberry, black soybean and chokeberry contain a variety of anthocyanins. Foods that have red, purple and blue colors are incredibly healthy to eat because of these powerful antioxidant and anti-inflammatory pigments.

A group out of Korea published a very good review of the literature on the effect of anthrocyanins in the diet. Turns out eating foods containing anthocyanins reduces a number of markers of inflammation and metabolic illness, such as C reactive protein, LDL cholesterol, leptin, glucose, tumor necrosis factor, insulin and triglycerides. Eating these foods also down-regulates genes involved in weight gain and obesity.

We can do a lot with diet to impact our risk of obesity, diabetes, heart disease and other illnesses. Decreasing animal foods and saturated fat, sodium and salt in the diet and increasing fruits and vegetables, dietary fiber and other plant based foods are good steps in the right direction.

When you’re picking fruits and vegetables, pick red, blue and purple ones so that you’re getting lots of dietary anthocyanins!

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Tug-Of-War: The Work-Home Balance Dilemma

I’ve been talking to a lot of patients recently who have been struggling with finding the right work-home balance for their families.  Especially with COVID and so many parents working from home, it can be very hard to juggle everything.

Let’s face it:  work is necessary.  For the family to survive someone has to earn an income.  Many people also find their work very fulfilling and a source of great satisfaction.  However, finding the right balance between your obligations at work and your obligations to your family is often tough.

When I have patients struggling with the stress of juggling home and work, I ask them to do two things.

First of all, I validate their dilemma and ask THEM to do the same.  It is normal to find it difficult to be pulled in two directions at once.  On the one hand, spouse and kids and household tasks are very important.  On the other hand, like I said before, earning an income is critical.  The person has to give themselves permission to feel stressed!

Especially working moms.  The women’s liberation movement has taught girls and young women that they can have it all.  They can have happy kids and a close, loving marriage as well as a fulfilling career.  While this is true, it is a VERY hard juggling act, and usually something has to take a backseat.  Working moms feel the stress very acutely and need permission to acknowledge they CAN’T do everything and to ask for the help they need.

The second thing I ask patients to do when they are struggling to make sense of their work-home balance is to make some lists.  List their priorities.  What are all the things that are important at work and important at home.

For instance, at work they might list priorities of getting a promotion, getting a raise, expanding their company’s sales force, or helping to open a new branch.  Entrepreneurs in particular must make priorities because if it’s YOUR business it’s pretty easy to let it overwhelm the rest of your life.

At home a person might list being home for dinner every night, scheduling date night regularly with their spouse, or taking one of the children to swim lessons or band practice.  Everyone’s priorities are unique.

Once the priorities are listed it’s easier to see where they might conflict.  For instance, committing to being home for dinner every night would keep you from working evenings.  A job that requires you to travel regularly might interfere with family activities.

Ultimately the balance of work and family is an individual and personal one.  There is NO right answer and the solution YOU choose has to be right for your situation.  Being open and frank with your spouse is very important because (as in my house) when one spouse works a lot, the other does most of the heavy lifting as far as the household tasks go.

Love, support, understanding and humor can be great tools to help smooth any rough spots in finding the right balance.  It’s never easy, but it’s definitely worth it!

QUESTION:  What struggles have you had in finding a balance between work and family?

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Back To School With COVID-19

It’s that time of year again, with one big twist.  Have you got kids going to school this fall?  Me too!  We’re shopping for school supplies and clothes and shoes just like everybody else.

Of course this is not a typical year.  Schools are wrestling with the best and safest ways to get kids back to school.  They need to balance academics with health and safety for students, staff and teachers too.  Plans are changing, sometimes on the daily, and it seems like the complexity rivals the invasion of Normandy.

Are your kids ready to go back?  Are they doing online schooling, in-person schooling, or a hybrid?  Whatever your plans, there are a number of things you can do to set your kids up for success this school year!

Good Sleep

Did your kids get off their school sleep schedule this summer?  Don’t worry, if they did you should have plenty of time to get them back on-track before school starts.

Elementary school children need about 10 hours of sleep per night.  For instance, if the kids’ bus comes at 7:30 AM they will likely need to get up between 6:30 and 7:00.  So bedtime should be about 8:30 so that they were asleep by 9.

You will want to give plenty of time to adjust a child’s sleep schedule.  Move bedtime by no more than a half-hour per night, every few nights, to let your child adjust.  If they’ve become accustomed to sleeping in, start instituting a set wake-up time.  In the adjustment period if they seem tired let them take a short nap.

There are plenty of things to adjust to in the first few weeks of school.  Fatigue and sleepiness and battles over going to bed and waking up are things you just don’t need to deal with.

Even if you’re doing online learning, children (and adults!) still benefit from the routine of set bedtimes and wake-up times.  Our child’s school will have remote-learning students attending classes live through two-way livestream, so even if we decide to do the first quarter remote he will still need to be up and ready before first bell.

Doctor’s Visits

Are your kids playing sports this school year?  While sports schedules are still up in the air, it’s a good idea to get their sports physicals out of the way.  The physical is good for a year and is covered by health insurance.  Make sure to bring along any medication administration forms (for asthma or other meds your child will need to take at school).

If your child will be heading into kindergarten or 7th grade, they will need vaccines prior to starting school.  You should have gotten paperwork from the school already if your child is affected.  Remember that although your rising 7th grader is required to have the DTaP, the meningitis and HPV vaccines are also recommended at this age.

I get a lot of questions about the HPV vaccine and dove a little deeper into that topic in this post.  Please discuss the vaccine recommendations with your child’s doctor in detail.

After the 7th grade shots, your child will be done with tetanus shots until after college (unless she hurts herself, gets bit by a dog, etc) but she will need a meningitis shot booster at age 16.  Other than annual flu shots those are all the immunizations your child will need.

Nutrition

If you’ve gotten off track this summer with healthy eating, now is a good time to re-evaluate things.  Getting (back) in the habit of eating a good breakfast each morning NOW will reduce hassles later.  If constant grazing on snacks has become a problem, taking steps now to reduce between-meal snacking will help your child make it from breakfast to lunch without getting too hungry or cranky.

There are a number of supplement options to support your child’s immune system, which is important every year but especially now.  A good multivitamin provides basic support.  Chewables should not have artificial colors, sweeteners or added sugar (check here for my recommendation).  Vitamin D is very important as it seems COVID disease may be milder (and other illnesses like influenza as well) in patients with normal blood levels.  A good probiotic, combined with a diet rich in fiber from fruits, veggies, beans and whole grains, supports good digestion and immunity both.

COVID-Specific Issues

There are a number of things unique about this school year.  The first and most obvious is the need for masks.  Small children will likely have trouble wearing masks for extended periods, but starting to introduce them at home can make it easier.  Making it a game, letting them choose their masks and wearing them for progressively longer periods at home will make the transition to wearing them at school go smoother.

For children who will be learning remotely, we have to make sure they stay connected with friends at school.  This may mean video chats to play games and just talk and laugh.  Outdoor games with friends like Frisbee, throwing a baseball, riding bikes and other activities can be done safely while maintaining physical distance.  Our children need their friends, their mental health depends on it.

From a health standpoint, heading back to school can be stressful.  With a little planning your youngsters can transition into the school year happy and healthy.

QUESTION:  What back to school health concerns do you have that I didn’t discuss?  I can always talk about them next week, LOL!

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Best Exercise For Weight Loss

You probably know people like this. I certainly see plenty of them in the office! Cara is a lovely woman who is about 60 pounds overweight. EVERY time she comes in I ask how she is doing with her diet, and what she is doing for exercise. And EVERY time she answers “Dr. Jen, you know I hate to exercise.

The last time she was in she asked me, “OK, I’m tired of us having the same conversation over and over. If I have to exercise, I want it to work! What’s the BEST exercise for weight loss?”

After I gave her kudos for acknowledging that exercise is important, we had a short conversation that boiled down to this. The BEST exercise for weight loss is this.

The one you will ACTUALLY DO!

Before you (figuratively) throw rotten tomatoes at me and tell me that answer is a cop-out, stop and think. How am I supposed to know what is the best exercise for YOU? I don’t know your likes and dislikes. I don’t know what joints give you problems and if you hate to sweat or if exercise-induced asthma makes anything more than a rousing game of frisbee a challenge.

What I told Cara was that if she hates to exercise it’s because she hasn’t tried them all yet. She needs to keep trying out types of exercise until she finds one that she loves. She needs to find one that she loves so much that she would do it if it were bad for her!

Before you laugh – I have patients like that. I have high school athletes that love soccer so much they will play with a broken foot. I have wrestlers and swimmers that will fight me over time off for a strained shoulder. And don’t get me started on elbow injuries in Little League pitchers.

They will play even injured. Even though it hurts. Even though it endangers their health. So I hold people like that up to the exercise haters and say “There is a sport or a leisure activity out there that you will love so much you will do it through pain. You just have to go find it.”

Here are three suggestions for finding your fitness passion. Movement is good for you – it lifts your mood, decreases joint pain, decreases heart risk AND helps manage your weight.

Join a League

One of the best ways to enjoy a fitness activity is to schedule time to do it with people you like. There are lots of rec-league activities out there, some cater to beginners, and all are much more fun than working out solo.

If you played basketball in middle school, find a basketball pick-up league at the local rec center or community center. Hiking clubs, cycling clubs, all sorts of groups and clubs are out there. Go find one!

Take a Class

Trying something new is a great way to shake up your fitness routine. Take horseback lessons. Join a Zumba or kickboxing class at the gym. Find a martial arts studio. Take ballroom dancing lessons with your spouse or sweetie.

There’s something to be said for spending a little money. If it’s free, there’s no urgency to attend classes or show up for a lesson. If it costs money, there is some value to it.

Grab a Buddy

Exercise is more fun with a friend! You’re less likely to blow off a workout or game or practice if you have someone meeting you or waiting for you. An accountability partner is a good strategy to increase the likelihood you’ll stick to your plan and meet your goals.

Exercise has many benefits. These include

  • increasing metabolic rate
  • burning more calories
  • boosting mood
  • increasing muscle mass
  • improving balance and reducing risk of falls
  • improving bone strength and reducing fracture risk
  • reducing heart risk
  • improving glucose tolerance
  • improving digestion

What are you waiting for? Go play! Have fun 🙂

QUESTION: What do you like to do for exercise?

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Masking For COVID-19 Prevention

I have been wearing a mask every time I leave my house to do anything other than exercise outdoors for the last 2 months. It’s hot. It makes my nose itch. The skin on my face gets tight and irritated. Why do people pay money to have their faces steamed as a facial treatment?!

I don’t like wearing a mask. But. If everyone wears a mask, it will save lives. There is good data supporting universal masking for COVID-19 prevention.

Researchers at Texas A&M and UC San Diego looked at epidemiological data and how the outbreak responded to different control strategies. They found that the strategy that impacted the outbreak the most in both Italy and New York City was universal masking.

China was confusing because they implemented everything at once. Social distancing, stay-at-home, contact tracing and masking were all started at the same time. In Italy and New York City, however, masking requirements were instituted some time AFTER the physical distancing requirements. This makes it possible for researchers can see the relative contributions of these measures.

It turns out the single measure that made the most difference in bending the curve was universal masking. The curves representing the outbreaks in Italy and New York City were identical, including the bend that occurred when masking was instituted. The lockdown/stay-at-home orders in Italy and NYC occurred right at the beginning of the outbreaks and may or may not have impacted the outbreaks’ course.

Credit: www.pnas.org

COVID-19 is a respiratory illness. It is transmitted by aerosol primarily, not by contact. Masks decrease the production of aerosols by catching droplet when the wearer breathes, coughs and sneezes. The virus particles are very very small, too small to be stopped by tightly woven cotton or other fabrics. However, the virus isn’t shed by itself. It’s shed in droplets of mucus that ARE large enough to be stopped by the fabric.

A second benefit of masking is it decreases people’s tendency to unconsciously touch their faces. Hand washing, use of hand sanitizer and disinfecting commonly touched surfaces like light switches and doorknobs decrease contact transmission. But even if you do touch a contaminated surface like a doorknob, you have to touch your eye, nose or mouth in order to get infected.

Recommendations from health authorities like CDC and WHO change based on the latest and best information. In some cases recommendations change quickly and are contradictory. This is simply because the state of understanding of COVID-19 is new. New research findings are coming out so frequently that it is hard to keep up.

We (and the health authorities) are doing the best we can with the information we have. When we know better, we do better. However, the data is coming pretty clear that universal masking for COVID-19 prevention is an important measure.

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Tanning Beds And Skin Cancer

Summer is coming, and so now I’m starting to see teenage girls coming in abnormally brown. There’s a lockdown, you can’t travel, and it’s Cleveland. I know you’re not laying out in the backyard. If you’re tanned, you’ve been in a tanning bed.

For twenty years I’ve been talking to patients and parents about the dangers of tanning beds. The most important risk (although not the only one) is the link between tanning beds and skin cancer.

The good news is that indoor tanning is becoming less common. Educational and public service programs seem to be raising awareness of the dangers. However, millions of adults still use indoor tanning beds every year, increasing their risk of skin cancer.

Credit: CDC.gov

There is good news about tanning bed use in teens. It is clear from surveys that use among teenagers is going down as well. But it is still obvious that tanning bed use is problematic in young women and teens.

Indoor tanning increases the risk of melanoma skin cancer by 15% after only ONE session. Use before age 35 increases the risk by 75%. The damage is cumulative, the more it is used the higher the risk.

If tanning is so dangerous, why do people do it? There is a lot of misinformation about indoor tanning out there. Tanning salons promote questionable health benefits and minimize the risks. Tanning beds often provide very high UV exposure, sometimes as much as 15 times the exposure one would receive from the sun.

One of the misconceptions is that indoor tanning is a “safe” tan. Young women in particular believe that a tanning bed is less dangerous and can provide a “base tan” before being outside in the sun. Research is clear however that the tanning process requires DNA damage. Whether one is tanning indoors or outdoors, it is NOT safe and increases the risk of skin cancer.

The only known benefit of UV exposure is the production of vitamin D in the skin. However, the level of UV exposure received in indoor tanning is complete overkill for vitamin D production. Vitamin D supplements are much safer and more effective for getting to a normal blood level of vitamin D.

Both indoor and outdoor tanning increase the risk of skin cancer, but tanning beds are much more dangerous. Wearing sunscreen, sunglasses and light-weight light-colored clothing, avoiding sun exposure during peak hours and taking a vitamin D supplement is the best approach to protecting your skin AND your health.

QUESTION: Do you use tanning beds?

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3 Best Ways To Survive Quarantine

Raise your hand if you are TIRED of quarantine. (Yes, that’s my hand waving in the air too…) We’re all managing, but are we really thriving? I think we’re all just waiting for life to get back to normal. Feels a bit like the end of pregnancy, if you ask me.

It’s uncomfortable and you don’t really care WHAT happens, as long as SOMETHING happens. And you know perfectly well that “old normal” is loooooooong gone, but you just are so eager to have it over with that you can miss some of the magic.

Everyone seems to have advice on how to make the best of this Great Pause. I have three suggestions of the best ways to survive quarantine, how we can come out of this situation better than when we went in.

Rest

One thing that really characterizes our culture is HUSTLE. We are SO busy that we rarely get the time to stop and take a few deep breaths.

Well the hustle is done for now. Rest assured, it isn’t done for good, but for this period we are forced to do less, to take a break. Take advantage of this time.

Sleep. Really commit to getting 7-8 hours of sleep at night, if at all possible. Do things just for the joy of them, without guilt. Work crossword puzzles or read a book or take long bubble baths. Binge a good Netflix series.

Rest. Take a break. It’s OK, the world can clearly take care of itself for a minute. You can take care of YOU.

Connect

One other thing that characterizes our culture in America right now is lack of connection. We work all day but don’t really know our coworkers. Our kids are in day care, school, after care programs, we don’t spend much time with them. Our siblings and parents and friends are even lower on the list.

Make a commitment to reach out to someone you’ve lost touch with. Call your parent or another older adult EVERY DAY just to say hello and check on them. It means more than you know. Play with your kids. Ride bikes. Learn how to play Magic or Pokemon or Dungeons & Dragons. Teach them your favorite recipes. (Christmas cookies in May? Sure, why not!)

I’ve heard it said that our kids someday may not remember much about fear and death, masks and hand sanitizer, not being able to go to the movies or the mall. But they might very well remember this was a time of pillow forts and board games, cooking and playing outside, going for walks and just hanging out with the most important people in their lives. You.

Learn Something New

If you are REALLY bored, look online for something new to learn. There are lots of community colleges offering courses online. Many museums are offering virtual tours for free. DuoLingo, Babbel and other language-learning apps make learning a new language fun. Start a blog. Take it from me, I’ve learned more from writing this blog than you have!

Life will get busy again very soon. Those on leave or unemployed will go back to work as the economy lumbers back to life. In this time before the hustle starts again, it’s great to rest, to cocoon with your people, and to work on YOU.

QUESTION: What has been your coping strategy for this quarantine period?

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Vitamin D and COVID-19

Wintertime in Cleveland really sucks. Snow. Cold. Gray skies. Did I mention snow? Colds and flu. This year’s winter has really taken the cake, though. COVID-19 has shut down the world, it seems.

I’m finding it really fascinating to read some of the explosion of research about COVID-19. Researchers are furiously trying to figure out what distinguishes those who are prone to more severe cases of this illness from those who have only mild symptoms.

A number of risk factors have emerged. Some are obvious, like diabetes and chronic lung disease. Others are making the medical community scratch their heads, like hypertension.

Recently a protective factor has emerged: vitamin D. It turns out that those with mild cases of COVID-19 are more likely to have normal vitamin D levels than those that have more severe cases or who are critically ill. What’s the link between vitamin D and COVID-19?

We know that vitamin D is important in supporting immune function and decreases your risk of getting colds and flu. Where does vitamin D come from, anyway?

Vitamin D is made in the skin in response to UVB light from the sun. UVB is blocked by clouds and by the atmosphere, so exposure is low in the winter in the higher latitudes and during the rainy season in the tropics. People with darker skin (such as people of African and Asian descent) make less vitamin D in their skin with a given amount of sun exposure.

There are not many dietary sources of vitamin D. Most dairy milk in the USA is fortified with added vitamin D, but there is not much in there. Most dairy milk is fortified to 100 units per cup. Given that it seems most adults need 2000-4000 units of vitamin D every DAY, you definitely can’t rely on dairy milk to get what you need.

So we’re left with supplementation. The best way to make sure you’re getting enough vitamin D is to have your doctor check a blood test. Current guidance is that your level should be around 50 to be optimal.

Black, Hispanic and Asian Americans have higher morbidity and mortality from COVID-19. Older adults have worse disease. These groups also generally have lower blood levels of vitamin D. I don’t think this is a coincidence.

If you can’t get to your doctor to get tested just now, that’s OK, you can definitely add a vitamin D supplement. Click here to see which one I take and trust for my family.

There is a lot of fear right now surrounding the COVID-19 pandemic. Making sure you are getting enough vitamin D every day is a simple thing that will help improve your health and support your immune system, and may help reduce your risk of a severe illness if you do contract COVID-19.

QUESTION: Do you take a vitamin D supplement every day?

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How To Have A Successful Virtual Visit

This is a really weird time in America. Everyone is staying at home. Restaurants and bars, museums, malls, zoos, movie theaters, parks and playgrounds are closed. Hospitals are empty of “elective” cases like knee replacements and spine surgery. At the same time, in many areas the health care system is completely overwhelmed by COVID-19.

Doctors’ offices are empty of patients. My practice is only seeing patients online. I have unfortunately gotten pretty comfortable doing something I never wanted to do – the virtual visit.

virtual visit

I was taught in medical school and residency that good medical care requires an examination. You can’t come to a reliable diagnosis if you can’t examine the patient. For over 20 years that has been “reality” for me.

Now I can’t examine anyone. It is extremely uncomfortable for me as a physician to have to diagnose someone’s illness based only on their symptoms. To know why someone is coughing without being able to listen to their lungs and heart is very difficult! To diagnose a UTI without checking a urine specimen is tough!

The very real danger is in overdiagnosing. Treating the earache caused by a viral infection with fluid in the ear is fairly simple, and doesn’t need antibiotics. However, if I can’t see the eardrum, I’m tempted to treat with antibiotics “just in case” it’s a bacterial ear infection. Antibiotics are potentially dangerous and only useful in certain cases.

But virtual visits are where it’s at right now, and they are safer for my patients, for me and my staff, and for all our families until the risk of this infection has subsided to some sort of “new normal.”

So how can you make sure that, if you need to do a virtual visit with your doctor, it’s as safe and effective as possible? Here are a few pointers:

  • If you are vomiting and unable to keep food or liquids down, or have chest pain or shortness of breath, you will likely need to be seen in the office, urgent care or ER. If you are severely sick you probably should bypass the virtual visit altogether and get checked out in person.
  • Do the visit on a laptop or desktop computer, not your phone or tablet if possible. Interfaces are more glitchy with the smaller electronics. (Also, your doctor doesn’t really want to look up your nose which is what happens when your phone or tablet is on your lap!)
  • Make sure your computer has the webcam, microphone and speaker (or headphones) all enabled.
  • Make sure you are not sitting with your back to a light source, like a lamp or brightly lit window. The light should be in front of you, behind the computer, so the light falls on your face.
  • You should have a home blood pressure meter available to take your blood pressure and pulse and show it to the doctor. If you have a known history of high blood pressure you need to have one of those, it’s a good time to get one. They’re available at your drugstore or on Amazon.com. Wrist meters are not as accurate as the ones that go on your upper arm.
  • While you’re ordering medical supplies, make sure you have a thermometer to take an oral temperature. The forehead scanners used in hospitals are very expensive – oral thermometers are cheap and accurate.
  • I love meeting your pets and your kids (and seeing what you’ve done with the place!) but please make sure they’re not going to be disruptive of the visit.
  • Be aware of and understand the limitations of the visit. There is an inherent risk of a missed diagnosis which is larger in a virtual visit (because there is no physical examination) than in an in-person visit.

I have high hopes that we will be able to start seeing patients in the office again soon. But the virtual visit probably isn’t going to go away. There are instances when it makes a lot of sense. Mental health follow ups. Reviews of lab results. Stable blood pressure follow ups when the patient has a reliable home blood pressure meter. (In fact, some of my patients would be better off having their BP checks at home!)

In this super weird time the virtual visit is what I would consider a necessary evil. We need to make sure we’re doing everything possible to make your online visit as safe and effective as possible.

QUESTION: Have you had a virtual visit with your doctor? Was it a good experience?

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