The New Normal

by Jennifer Ashton, M. D.

  That said, when there’s a pandemic going on in the world, it pays to be able to think like a doctor and weigh the pros versus the cons of going to a crowded, potentially overburdened emergency room where you might be exposed to COVID-19 or a number of other communicable diseases.

  With that understanding, here are some things to consider if and when you or a loved one is thinking about taking a trip to the hospital:

  Call 911 for life- or limb-threatening emergencies. If you’re having chest pain, trouble breathing, standing, eating, drinking, or speaking, you’ve been in a serious accident, or you have acute pain that is getting worse by the hour, go to the ER immediately. These are all symptoms that could indicate a life- or limb-threatening emergency.

  Ask yourself the unthinkable. Another way to think about whether you need emergency care is to ask yourself whether the symptoms you’re experiencing could potentially kill you. For example, a sprained ankle or sore throat isn’t likely to be fatal without an immediate emergency room visit. However, chest pain or trouble breathing could be the sign of a life-threatening condition and likely merits immediate attention.

  Make the decision with your pre-pandemic brain. I’ve said it multiple times on air: If you would have gone to the ER for the same symptoms in pre-pandemic times, go now. Plain and simple.

  Think for better or for worse. In general—with an extra emphasis on in general—really serious conditions don’t get better on their own. In fact, most get worse. If you’re deteriorating by the hour, call 911. But if your symptoms are getting better and aren’t life-threatening, consider calling your healthcare provider or going to an urgent-care clinic instead.

  Weigh your risk factors. Every patient is different, which is why it’s difficult to make blanket generalizations about non-specific symptoms to a general population. But no one knows your body like you do, along with your own unique risk factors and individual medical history (or at least, you should know these things—see here on how to conduct a pandemic self-assessment), which are all things to consider when weighing whether to go to the emergency room.

  For example, if you’re a man in your fifties with a history of high blood pressure and you start having chest pain, now is not the time to roll the dice on whether to go to the ER. However, if you’re a healthy twenty-year-old woman with mild chest pain and zero history of heart problems, it’s much less likely that you’re having a traumatic event. However, if a twenty-year-old woman with arrythmia starts feeling the same mild chest pain, the game changes.

  Focus on identifying the ducks. There’s a saying in medicine that I like to use often on air and in my medical practice: If it looks like a duck, swims like a duck, and quacks like a duck, it’s probably a duck. In other words, if you’re having similar symptoms to a condition that a doctor diagnosed you with before or have all the classic symptoms of a common ailment, it’s likely that’s what you have now.

  For example, if you’re prone to migraines and develop a headache, except maybe this one lasts a little longer, it’s probable that you’re having another migraine—it’s not likely, however, that you have an aneurysm or brain tumor. While it can be easy to spiral into imagining worst-case scenarios, especially with the help of Google Search, I always recommend checking yourself with the simple duck test.

  When the Worst Headache of Your Life May Actually Be

  When patients say they are having the worst headache of their life, we doctors take that complaint very seriously. “Worst headache of life,” or WHOL, is actually a medical term we use. If you find yourself using this phrase to describe your symptoms, call 911. While it’s rare, the pain could indicate a cerebral hemorrhage or ruptured aneurysm.

  Don’t let zebras in through the door. If identifying ducks isn’t your thing, here’s another saying I used on The View in the winter of 2020 about the likelihood of having the flu versus COVID-19 just because you have fever and cough: When you hear hooves outside your door, think horses, not zebras. In medical speak, “zebras” are rare conditions that affect a small percent of the population—think brain tumors and super rare diseases. The likelihood that you’re suffering from a zebra is really low. If your symptoms aren’t severe and the only reason you’re considering a trip to the ER is to rule out the possibility of a zebra, I’d call your healthcare provider. Remember, common things occur commonly, and an increased risk of a rare event is still a rare event.

  Just because you can do something in medicine doesn’t mean you should do something. Just because you can go to the emergency room doesn’t mean you should go to the ER. Sometimes, reframing your outlook is all you need to help guide you to the best decision for your health.

  Remember that life is one big risk. Every time you leave your house or someone you live with leaves the house, you’re risking possible exposure to COVID-19, along with dozens of other pathogens. That doesn’t mean that you can or should live your life in a sterilized plastic bubble. If there’s ever a reason to risk potential pathogen exposure, it’s to go to the ER and potentially save yourself from something possibly far worse than the coronavirus.

  Don’t be afraid to call your doc. Every doctor’s office or clinic has an answering service or a way to reach the physician or provider after hours or over the weekend. If you’re unsure about the risk-benefit ratio of going to the ER for a non-life-threatening condition, call your doctor. Don’t worry: You’re not disturbing him or her. As a doctor, I’d much rather hear from a patient about a potential problem, no matter how minor, than receive a call from the hospital that my patient suffered a major traumatic health event because they were too intimidated to contact me.

  Your health is in your hands. No matter where you go, whether the ER, an urgent-care clinic, or a primary-care office, wash your hands thoroughly and keep your distance from other patients—two things we should do even when we’re not facing a pandemic. I also suggest that you wear a mask if recommended or if you simply feel more comfortable with personal protective equipment. Finally, always ask for your medical records and copies of any test results when you leave so that you have them on hand and readily accessible if you need follow-up care from a different provider.

  The Truth About Urgent Care

  How to know when to go to an urgent-care clinic instead of the ER? Urgent-care clinics fill an important need in the United States, serving as an intermediary step between your nine-to-five doctor’s office or clinic and the local hospital’s emergency department. Urgent-care clinics are perfect for diagnosing non-life-threatening conditions like the flu, strep throat, and other illnesses for which you may not want to wait until Monday morning—or simply the next morning—for a diagnosis.

  The reasons to go to an urgent-care clinic over the ER for these types of ailments are multifactorial. First, the risk of exposure to communicable diseases like COVID-19 is often lower in urgent-care facilities, where there are fewer sick patients overall and those who are there tend to spend less time at the clinic than they do in hospitals. Second, urgent-care clinics usually save patients time and money over a trip to the ER, which can cost you hours in wait time and thousands of dollars in deductibles or co-pays, even if you have health insurance. Finally, when you choose to go to an urgent-care clinic for ailments that aren’t medical emergencies, you reduce the strain on local hospitals, allowing them to use their resources for critical care to those in your community who need it the most.

  The Pros and Cons of Telemedicine

  In March, after New Jersey issued stay-at-home orders and canceled all elective surgeries, I shut down my medical practice in Englewood and started relying on telemedicine to see patients virtually. While I had used telemedicine before, this was the first time I’d used it extensively and almost exclusively, like most doctors had to do at the beginning of the COVID-19 outbreak.

  Telemedicine, which uses technology like live video streaming to diagnose and treat patients, was not particularly widespread before COVID-19 shut down nearly every family physician’s office nati
onwide. In fact, according to a recent survey by McKinsey & Company, only 11 percent of Americans had used telehealth in 2019—fast-forward to April 2020, and 46 percent had tried telehealth in just the first two months of the pandemic.12 Additionally, 76 percent of all patients say they are interested in trying telehealth now that the pandemic has made the service essential for continuous medical care.13

  Despite many patients’ willingness to talk to a doc online, misperceptions about telemedicine persist, mainly that the practice isn’t as effective as in-person visits and that it devalues the patient-doctor relationship. While doctors obviously can’t do everything by video or phone, we can diagnose, prescribe, and treat patients with a range of conditions and issues. In fact, research shows that telemedicine even helps save lives, providing immediate, around-the-clock care to patients while limiting their exposure to potentially deadly infectious diseases like COVID-19. The service can be especially beneficial to older patients, those with physical disabilities or travel limitations, and people who live in rural areas, all of whom can receive care more conveniently and rapidly through telemedicine.

  Telemedicine also typically costs less than in-person visits14 and can save some patients thousands of dollars by preventing future medical emergencies, according to studies.15 You can also save a ton of time by scheduling a telemedicine appointment, obviating the trip to a doctor’s office and any time you may spend there in a waiting room. When I was practicing almost exclusively through telemedicine, I was finally able to see patients on time because I wasn’t also dealing with stacks of paperwork (it’s much easier to combine digital chartwork and video calls) and a waiting room full of potentially sick people.

  Punctuality wasn’t the only advantage of telemedicine for me during the early pandemic. The service also allowed me to be able to physically see patients, which doctors obviously can’t do over the phone (though some of my patients were actually fine with a good old-fashioned phone call). That’s key, because it lets us do the subjective part of a patient visit when we look for things like whether someone appears disheveled or anxious or has any other visible clues to their overall physical and mental state.

  With some patients, I also asked them to take their own vitals like temperature and heart rate, which is easier to do during a video call when I can make sure the information is being collected properly. I also used our video sessions to order remote testing if needed, review prior test results, prescribe medication, and give specific health recommendations. Live video also let me connect more intimately with my patients than I could by phone or email (although calls, texts, and emails are considered part of telehealth—a broad umbrella term that includes traditional telecommunication tools in addition to video streaming and more advanced technology).

  At the same time, I’m an OB-GYN—a specialty where in-person tests and tactile physical exams are critical. These can’t be administered remotely, so while there was plenty that I could still do, I was limited in my practice. During the initial outbreak, I had to ask a few patients to meet me at my office—or I sent them a culture swab through the mail—in order to run tests when I thought the matter was more urgent and telemedicine alone wasn’t going to cut it.

  There are other disadvantages to telemedicine, too. You can’t give oxygen, run an IV, or administer other lifesaving care via telemedicine. Doctors also can’t draw blood, take urine, or perform other tests that may be necessary. While some specialties like psychiatry, dermatology, and chronic disease management are better suited to telemedicine, others like obstetrics and surgery aren’t. I believe there is also something irreplaceable about being in the same room as patients and being able to interact more intimately with them than a screen would ever allow.

  But these drawbacks are small when you consider what telemedicine has allowed doctors to do during the pandemic: provide healthcare to millions of Americans who may have otherwise not been able to receive medical attention. This is huge—and one reason why telemedicine will only continue to expand now that the pandemic has exposed how easy, convenient, and critical the service is to our new normal.16

  I would encourage anyone who’s hesitant to use telemedicine to try it. After all, the practice, like the pandemic, isn’t going away anytime soon, and as you can see, there’s a host of potential advantages for the patient, including that the service reduces the risk of COVID-19 exposure while saving you time, money, and possible health complications down the road.

  If you’re still unenthusiastic, remember that people are often suspicious about new technology the first time they use it, then usually grateful that they gave it a shot. The first time I deposited a check online, for example, I was skeptical. Really? I’m just going to take a picture of this check and it’s going to magically end up in my bank account? But it worked—and it’s worked every time since. Today, this is how I prefer to bank, because it’s easier and more convenient than going to the bank in person.

  Seven Must-Haves for Home Health

  When most of the country went into lockdown at the beginning of the COVID-19 outbreak, many Americans had no idea that they actually needed to stay at home for weeks at a time. They wiped grocery-store shelves clean of everything from refrigerated egg substitute to toilet paper to trash-can deodorizers. But amid all this panic buying, many forgot some of the most important essentials: things they needed in order to take care of their health at home, on the off chance of a major medical emergency and the very likely possibility of a minor health ailment. These essentials include not only prescription drugs but also other common medical supplies people should consider having on hand, whether we’re facing a pandemic or not. Here are seven items to consider stocking up with now so that you’re better prepared for whatever and whenever a health ailment might come your way:

  1. Extra Rx. When lockdown orders went into effect early in the outbreak, millions of Americans were left scrambling to get advance refills of prescription meds in order to stay at home for weeks. Some weren’t able to get the refills due to insurance problems, while others faced shortages because of increased demand and medical supply-chain issues.

  If you take a prescription drug, I recommend that you have at least two weeks’ worth of extra meds at home, regardless of whether there are ever stay-at-home orders again: As we learned from the pandemic, our medical-supply chain is vulnerable, and a dozen other similar events could interfere with drug availability. Talk with your doctor about advance refills; if your insurance company refuses to pay, call and explain the reason—many insurers have and will make exceptions. Just be sure to keep extra prescription drugs in a cool, dry, secure place, away from children and teenagers.

  2. A mini pharmacy. Prescription drugs aren’t the only medical supplies that face shortages—dozens of over-the-counter (OTC) drugs like cough syrup and certain antacid formulas were also in short supply during the first few months of the outbreak. What’s more, you never know when you’ll need a bottle of Pepto Bismol at two in the morning. For these reasons, I suggest stocking up on a variety of OTC drugs, even those you’ve never used before and think you may never need—because the time you inevitably need an OTC drug is always the time when you can’t get it. Be sure to include a medication to treat pain, nausea, constipation, gas, allergic reaction (e.g., Benadryl), allergies (e.g., Claritin), itching (e.g., hydrocortisone cream), skin infection (e.g., bacitracin), acid reflux, nasal congestion, and diarrhea.

  3. Two thermometers. Drugstores sold out of thermometers just days after the first coronavirus case was identified in the United States. This left many without the ability to measure one of the symptoms of the virus, which is also a classic sign of many other ailments, including the flu, an adverse reaction to a medication, and heatstroke, among others.

  While you’re stocking up, be sure to buy not one, but two thermometers. It’s underreported, but thermometers can be wildly inaccurate. For example, when my daughter, Chloe, went to get a COVID-19 screening before an ice-hockey camp, she had her temperature che
cked at a drive-through facility with a forehead gun. The nurse told her she had a fever of 101.9, even though she felt perfectly fine and had no symptoms of COVID-19, let alone any other illness. A second reading on a different device proved that her temperature was totally normal.

  4. A smartwatch, digital fitness tracker, wristwatch, or pulse oximeter. One reason I like wearing my smartwatch is that it makes checking my heart rate super simple and convenient—all you have to do is look down at the device. But you don’t need a smartwatch or digital fitness tracker to keep tabs on your pulse—something you may want to do during a pandemic, as variations in heart rate can indicate a range of health problems, even when you have other obvious symptoms. For example, a resting heart rate above 100 beats per minute or below 50 beats per minute can be a sign of a heart problem, infection, medication overdose, thyroid issue, or other ailment that may warrant medical attention.

  You can also check your heart rate using a pulse oximeter, a small electronic device that slips on your finger and uses light to measure your body’s blood-oxygen levels. Apple’s watch also checks the oxygen saturation in your blood. Pulse oximeters have become popular since the pandemic as a way for people to measure their respiratory health at home—just be aware that most oximeters don’t provide a very accurate oxygen reading.

  You can also check your heart rate using an old-fashioned wristwatch: Simply find your carotid artery on the side of your neck, place your index and middle finger over the spot, and count the number of heartbeats for a full minute.