It started as a text message on March 20 from a local news anchor. “Hey, Dr. Fincher, I understand you're on the Georgia governor's coronavirus task force. Would you be willing to do a Zoom interview with me for the weekend news?” My response: “Sure, but what's a Zoom interview?”
Little did I know my sudden introduction to Zoom a month before becoming ACP President would become an active metaphor for my year in office during the COVID-19 pandemic. Instead of zooming in an airplane to numerous ACP national and chapter meetings in Los Angeles, Philadelphia, Washington, and Chicago from April to July, and to international meetings around the world, I have Zoomed to versions of all of them on my laptop from home or my office. Some of the new efficiencies of virtual meetings will no doubt remain, but the personal camaraderie and networking of members, leadership, and staff can never truly be replaced by virtual meetings alone. So, my story of Zooming for ACP, Zooming for my patients, and Zooming on the home front is now my Zoom ACP presidency.
Zooming for ACP
ACP staff in the Philadelphia and Washington, D.C., offices have responded swiftly, efficiently, and incredibly to address every aspect of the COVID-19 pandemic. While continuing the ongoing work of the College, our outstanding staff have provided extensive and updated critical information for our members, along with practice and telehealth resources. In the wake of the necessary cancellation of Internal Medicine Meeting 2020, they have created the ACP CME 30 program, featuring a selection of the lectures that would have been presented in Los Angeles. ACP staff at both offices have mostly worked from home for months now, having regular Zoom meetings of their own to continue their important work, communication, and collaboration.
We are all rethinking and deploying innovative strategies to improve how we communicate and create more highly sophisticated virtual/digital educational meetings, committee meetings, and governance meetings. The business of our organization is still conducted, our mission is unchanged, but we have added new ways to address the immediate changing needs of our organization, including the critical needs of our members at every level, from student to PGY-50+.
Since March, every month, these questions have hung over all ACP events and meetings planned for 2020:
- Can we meet in person safely? (No.)
- How do we create vital, effective “virtual meetings”? How will they be the same and, more important, how will they be different?
- How do we keep meetings productive in a virtual environment that is already getting tedious? (After three hours, I seem to become a Zoom zombie—”zoombie”?)
- Do we need shorter, more frequent meetings or longer, less frequent meetings? (It depends.)
- How do we help our chapters recreate their meetings with virtual options that are interactive, compelling, and meaningful?
- What new things can the College do now that we've never done before?
- How do we work smarter, not harder?
- What do we need to jettison in order to focus on new innovations?
- How do we support, encourage, and care for each other?
- What is possible?
I look to our younger members on the Council of Early Career Physicians, the Council of Resident/Fellow Members, and the Council of Student Members to help us take these next momentous leaps toward achieving post-COVID-19 innovations and advances in patient care, in medical education, and within the College.
Zooming in practice and with patients
As the months of the pandemic go by, our outpatient clinic feels like a continuous “zoom” of constantly changing office workflows and staff adjustments to in-person and virtual patient volume, as well as to the ebbs and surges of COVID-19 infection within our community. One of the biggest adjustments has been using the telehealth platform to evaluate patients. In my more rural area of Georgia, digital connectivity has had its share of challenges, with limited broadband or cellular coverage and some patients still with only a landline or flip phone, not to mention those who sometimes need help walking through the steps to connect to the telehealth platform.
Telehealth “Zoom” visits certainly provide a new medium to connect with patients. I have gained new insights into their daily lives as I get a glimpse into their homes and their environments. Sometimes I see my patients in a more authentic state as they don't get “cleaned up” or “dressed up,” interrupting their routines to physically “go visit the doctor.” To my surprise, I have had Zoom visits in patients' homes, cars, and offices, on back porches, in their yards, and at their assisted living facilities. I see their pictures on the walls, the books on their shelves, and often other family members, like a spouse or grandchild, in the background. I have met their pets—dogs, cats, horses, cows, and even a pet squirrel so far. I've been privileged to gain a wider view of my patients' lives on their turf, where they are visibly more comfortable than my office.
Clearly the health care landscape is changing dramatically at the payer level as well. Telehealth, which languished for the past 20 years, is suddenly up and flourishing for outpatient physicians, most of whom have rapidly integrated a new telehealth platform that provides a lifeline for them and for their patients during the pandemic. With pay parity for the equivalent office visit codes based on medical decision making or time, minus the geographic restrictions of patients in rural areas, telehealth is intrinsic to our daily workflows.
The current telehealth flexibilities extended by CMS and private insurers have been critical to ongoing patient care and sustaining internal medicine and other primary care practices. At this time, these decisions are on a 90-day regulatory cycle based on the declared national public health emergency. The first renewal, which had a deadline of July 25, was signed by U.S. Department of Health and Human Services (HHS) Secretary Alex Azar on the afternoon of July 24. Nothing like a deadline to make things happen! ACP continues to vigorously press HHS to continue the current telehealth flexibilities at least through Dec. 31, 2021, with the option to extend them even further and possibly make them permanent.
The telehealth experiences and lessons learned by both patients and physicians during this time will clarify the path forward. The pandemic has provided the impetus to make telehealth a useful, routine tool in the toolbox, allowing us to offer timely care to our patients wherever they need it. The patient care and revenue opportunities afforded by the change in regulatory rules will continue to play a significant role within the U.S. health care system and care delivery models into the near future and beyond. In a crisis, the old rulebooks don't apply. New rules with fewer burdens and more relevance become critical, an important principle as we look toward the post-COVID-19 future. The genie really is out of the bottle on telehealth.
Zooming on the home front
My daughter has just completed her pediatric residency at the University of North Carolina, Chapel Hill. I have watched her grow as a physician and in some ways vicariously relived my own days in training. Through observing her, I am humbled by how the next generation is rising to the occasion to confront these new challenges in health care delivery and education. I am inspired by all the remarkable ways our students, residents, and their attendings are adjusting to the “new abnormal.”
In late May, my daughter got married, and the elaborate ceremony and reception we'd planned became an intimate wedding with immediate family only on the front porch of our home. The event was live broadcasted to extended family, groomsmen, bridesmaids, and close friends and followed by a Zoom cocktail reception with 40 different locations and watch parties from New York to Honolulu, then an intimate catered small dinner at home for those present to celebrate. The disrupted wedding plans we had fretted about for weeks resulted in a simple but truly blessed event. The wedding provided a much-needed joyful distraction and family celebration amidst the chaos of our pandemic lives.
We all have the wonderful privilege of going through this life together with family, friends, and colleagues we love and respect, for better or worse, for richer or poorer, in sickness and in health. We will go forward in this uncertain professional life together as an ACP internal medicine family, working daily for the benefit of our patients, communities, and colleagues.
In the early days of the pandemic, we were under the illusion that the temporary makeshift measures of telehealth, daily use of personal protective equipment, virtual meetings through Zoom, and interrupted travel would last two or three months. Now, at the end of July, the disheartening reality of our prolonged tribulation is finally setting in. Our “new abnormal” will be with us for at least another 12 to 18 months. We've barely begun our trek with COVID-19.
The losses and disappointments of the pandemic seem to keep coming. The loss of lives is overwhelming to even contemplate, especially the closer they get to each one of us personally. Most people now know someone in their own family or community who has gotten COVID-19, been seriously ill with it, or even died of it. We have lost some of our very own internal medicine colleagues, many who were on the frontlines caring for COVID-19 patients, putting themselves in harm's way. In an effort to honor and remember them, ACP has created an “In Memoriam” site, where we can acknowledge each of their lives and their sacrifice. We are profoundly grateful for their service and commitment to patients, even above self.
Much like with my patients, I have also observed our staff and physician leaders through our Zoom meetings. I see the stress and emotional toll on them and our many College members who are on the frontlines of this pandemic. I see the staff as they diligently conduct the business of our organization and go to great lengths to keep us updated with the latest information and keep us connected. I observe my colleagues in their environments, similar to my own, facing new and unanticipated challenges. I see an organization and its membership rising to the occasion to meet the needs of our patients, our colleagues, and our nation in the throes of this pandemic. However, even in this Zoom world, I urge my ACP family to pause and take care of each other, yourselves, and your families. You are precious.
If ACP were a Marvel comic during the pandemic crisis, our nimble dynamic organization with a Zoom motif would be fast and adaptable, yet highly focused, and moving quickly. Displaying their amazing superhuman skills, our Zoom staff, leadership, and physician and student members would be wearing masks (of course) with capes of College green emblazoned with a Z. In reality, all of our ACP team members are heroes, though not superhuman. We all put on our business attire, white coats, or scrubs one sleeve at a time as we go through the pandemic. We are physicians and staff meeting the challenges of a new era. I know because I have seen you through my Zoom meetings.
An oft-quoted proverb proclaims, “If you want to go fast, go alone; if you want to go far, go together.” When the viral dust settles, I know that 2020 will be remembered as internal medicine's finest hour. My ACP family and internal medicine heroes, join me as we put on our masks and white coats and Zoom to the future of internal medicine, remaining always #IMProud.