Julie Maxey-Allison | 10th Street
|G. Stuart Mendenhall, M.D.,
Department of Cardiology,
Scripps Memorial Hospital—La Jolla.
Courtesy Cardiac Arrhythmia Associates.
JMA: Working as a cardiologist, in our time of COVID-19, what, now, are your “on call” hours?
GSM: At Scripps Memorial - La Jolla we have delayed all elective or non-emergency procedures to minimize exposure or transmission of the coronavirus in the hospital, in addition to keeping facilities, rooms, ICU beds and ventilators free in the event there is a surge of COVID-19 patients requiring hospitalization. Unfortunately, there have been a few doctors who have exhibited symptoms of the disease and have been immediately removed from clinical service.
I have been asked to cover other shifts frequently, and fortunately I have had no symptoms. Despite being a sub-specialist, now I have been helping with general cardiology. If there is a need, I may function as a floor medicine doctor or staff the intensive care unit. Many of us have been going back and familiarizing ourselves with modern ventilator modes, which have changed since I was in residency!
JMA: Are you working virtually more frequently?
GSM: All office visits are now virtual visits “unless” the patient requires and requests to be seen in person and is under 70 years old and of low risk for COVID-19 complications. All patients over 70 are seen virtually and do not have the option to come in for routine checkup except for urgent procedures that must be done in person, or in an emergency. Face to face visits in my field are often to reprogram a pacemaker, which can only be done in person.
JMA: How often do you meet in person at your office? For a first meeting? Only if necessary?
GSM: Medicare and most insurances have relaxed the previously existing requirements for reimbursement for remote visits. Before the COVID-19 crisis, an established patient-doctor relationship had to be existing, as well as other requirements. Now we are able to do the majority of visits over the phone or a consumer video-chat solution such as FaceTime or Skype. Prior to the physical distancing guidelines I did not use telemedicine to any significant amount other than remote monitoring of devices. Since the coronavirus has spread I have now been doing essentially all visits as telemedicine.
With pacemaker and defibrillator patients, there are limits to what can be done remotely, and reprogramming of the device is not available. This generally is not a limitation of the technology, but a design to limit danger in the event of security breach, device compromise, or unexpected interruption in communication.
JMA: Are your patients tech savvy enough or do they have to go through a learning curve? It is easy? Who helps?
GSM: For patients that do not have a smartphone or are unable to use video features, we use the regular old telephone. However, do not underestimate the usability of modern interfaces and willingness of octogenarians to use video chat! Many have a family member help connect for them.
JMA: What have you seen in your medical community that is most gratifying?
GSM: People have continued to work in the face of potential danger, and we have generally had good outcomes. The nurses and staff have continued to put themselves at risk caring for suspected and confirmed cases, in addition to the staff who clean and stock the rooms for all of our patients. Hardworking individuals must be acknowledged for their continued dedicated efforts all the time, not just during a crisis.
JMA: How has your involvement in this crisis changed you as a physician?
GSM: I think, and hope, that physicians are quite level-headed and equipped to deal with the potential number of critically ill patients under worst case scenarios. The number of asymptomatic patients is yet to be reliably ascertained. If high, this would paradoxically be reassuring, as there are likely many individuals who have already been exposed and developed an immunity after no or mild illness. This would determine the pattern of spread looking forward.
JMA: How can Del Mar support the work of medical professionals?
GSM: Doctors like to see patients living healthy lifestyles — if I could put myself out of business, I would! Unfortunately time stops for nobody, and after a while even the most well-managed bodies may be in need of medical services. Keep healthy, stay active, eat well, and listen to reliable medical advice, not rumors. Good habits decrease the burden on the medical system for all. But any time you need us, we are right here for you.