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Telehealth in the Age of Quarantine

By: Naomi Zilkha, MD (Telemedicine, Allied Physicians Group)

As a pediatrician, I have always looked forward to the Spring. During a typical year, that’s when the flu season comes to an end, overall illness is down, and the seasonal allergy visits replace visits of high fever and cough. This year March came in like a lion and came out like an entire pride of lions. And although this year April showers will still bring May flowers, the more up to date slogan (according to my 18-year-old daughter) is “April distance brings May existence”. She even wrote that on the whiteboard in my kitchen that normally keeps track of our endless activities. Now it only contains my work schedule and the schedule of her college classes that she started this week from home.

I could never have imagined, in my wildest dreams, that we would be having a pandemic. Every day, it seems there is more stressful news as we all try to navigate this new normal of social distancing. In addition to the constant anxiety that we are bombarded with, from the new information we receive daily.

One silver lining to the COVID-19 pandemic has been the effect on Allied Telehealth. I’m so proud of all the work the whole Allied Telehealth team has done to create such an incredible telemedicine experience that was completely prepared for this type of volume.

To quote Eminem, “Be careful what you wished for, ‘cause you just might get it”. It’s true that I wished that Allied families would want to try out our telemedicine 2.0. Of course, I had no idea what would get them to try would be a pandemic that has so many of us (including me!) quarantined in my own home.

The good news is that all Allied offices can now schedule telemedicine visits during the day, and after-hours telemedicine has expanded to 7 nights a week from 6:30-10:30 pm!  Even more good news is that we are accepting all insurances with zero co-pay during the pandemic. It’s been going so well that we’ve opened our telehealth to non-allied patients whose offices do not offer a similar service!

In March 2020, I saw over 300 of New York’s children via a telemedicine visit, and almost all of them were spared needing an in-person visit.  The response to our scaled telehealth has been great—our patients love the quick, easy, and high-quality care (as I knew they would!)

The visits have been very variable, and I’ve pretty much seen the entire spectrum of ages we see in pediatrics. My youngest patient this month was an 8-day-old, whose parent had feeding questions, and my oldest was a 20-year-old back on Long Island because of college closure.

Overall, the most common visits I saw in March were for fevers and/or coughs. There’s been a lot of talk on the news/social media about what temperature causes concern. However, when I decide if a temperature is a cause for concern, I consider many different factors including the age of the patient. One way you can help me is by taking your child’s temperature before your visit. Rectal temps for our younger kids, and oral temps in our older kids, are most reliable.

After that, if your child has a temperature, I will usually go over appropriate dosages and intervals for acetaminophen and ibuprofen. Once your child reaches 100 pounds, then it’s easy: they get the adult dose of fever reducers. For our younger kids, I like to double-check the dose.

When it comes to coughs, there’s a lot I can tell via a telemedicine visit. One great trait of pediatricians is that we are all are awesome at observation. When a good portion of your patients can’t tell you what is bothering then, honing your observation skills is key. So, when I have any telemedicine visits (even if it’s not for a respiratory complaint), the first part of the exam is to observe how the patient is breathing. I’ve had telemedicine visits that were made because of a different complaint, but I’ve had to send the patient to the emergency room for respiratory distress! Whether your child is a newborn or a teen, I watch how they are breathing, how they are talking, how they are crying. Also, watching and listening to them cough can help me a lot. Although if I had a stethoscope I could tell more, what I look for when I ask a patient to take off their shirt is many things: I am seeing how fast they are breathing, and if they are having trouble breathing, I also look for how they are sitting, and how their mouth is. For patients who can follow directions, I watch them breathe in and out, and sometimes ask them to take huge breaths in and then blow that breathe out like there was a birthday cake right there.

Now that the kids have been in quarantine for so long, most of my visits are much more typical spring complaints: seasonal allergies, insect bites, sunburns, injuries, and many different rashes. Pro tip: if your child has a rash, take as many photos as you can and upload them into the Anytime Pediatrics app. Even though I can see rashes on the live video feed, often it is easier to see the high definition photo on my desktop where I can enlarge it and really look at it well.

One last tip: Don’t worry for a second what you or your home looks like during the visit. I’ve had so many parents apologizing for the way they look, or a mess that’s in the background. It’s not about tidiness in this chaotic world we live in: it’s about bringing you quality Allied medical care right where you are.

Much love,

Dr. Z.

Click here for an update from Allied Physicians Group about the Coronavirus- COVID19 infections in our area.