By  John M. Rayhack, MD

Today is 4-27-20. I am in private practice in Tampa, Florida. I have been in a wrist and hand surgical practice for 36 years – academic for 7 years, solo for 29 years. It has been five weeks since my last day of elective surgery on March 19^th. Accepting the inevitable shut down, I quickly decided to look for the positive changes that could come from the serious challenges posed by the Coronavirus pandemic. I immediately signed up for doxy.me telemedicine based on the very helpful ASSH listserv discussion. I asked my IT guru to add the direct link to my web site. I was impressed with his  acknowledgement that I needed to quickly adapt to a new medical approach. Within hours he even upgraded all the laptops to permit my office staff to access the medical database from their homes. Teamwork was immediately evident in our medical community.

 I felt sorry for my RN surgical circulator at the outpatient surgery center who was now functioning essentially as a respiratory therapist due to the crisis and I quickly realized that any inconvenience to my solo practice life schedule was nothing compared to the risks and stresses posed by the direct care of sick patients by my colleagues.

Telemedicine has been enjoyable and fruitful. For older individuals or individuals with older computers, I quickly resorted to face time due to the ease and familiarity with this technology. How much easier it was to foster face-to-face contact and I found the telemedicine interview with a new patient remarkably quite personal. Android phones posed a problem, I would just do a phone conference. Thankfully, HIPAA rules were eased.

Going forward, I hope we can permanently initiate a signed patient document: “I authorize expeditious communication between medical professionals for my benefit acknowledging that these communications might not be HIPAA compliant.” I asked myself, just how critical is the confidentiality of a wrist or hand problem? For example, it is so much more important to be able to effectively communicate with an infectious disease colleague when we do not have to be so worried about disclosure of a name or telephone number. The key is to get the patent seen and treated for a newly cultured Mycobacterium avium.

 My office practice quickly ceased within two weeks except for a few fractures that I reduced and splinted. A dorsally displaced proximal phalanx fracture that I might have pinned was now treated with a closed reduction held with a thermoplastic orthosis so that I could clearly confirm the reduction and then held in a short arm fiberglass cast. Why didn’t I think of that two-step approach before? Necessity is the mother of invention.

 Switching gears…extra free time at home was pleasurable. I was surprised by the enjoyment of not having to be some place at a specific time. I could tackle some home projects and found that very relaxing because of the feeling that I now had “more time.” I reflected on the financial drain for some physicians of an immediate cessation of revenue generation, and promptly realized that a younger doctor in his or her prime is much more dependent on revenue generation. For them, I knew this could be a very stressful time and I felt compassion for my fellow surgeons and medical colleagues.

This is an unprecedented time. This crisis will promote more innovation: 3D printed nasal swabs for home testing, expedited vaccine production, convalescent antibody treatment, multiple user ventilators, more responsible social interaction, PCR saliva testing, and more reliance on the production of our own pharmaceuticals, to name a few. Maybe there might  even be a societal epiphany recognizing that taking responsibility of our own personal health is crucial and beneficial financially and health-wise for the good of all.