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Anchor lead: New expansion of Medicare will allow more people to be seen by their physicians via telemedicine, Elizabeth Tracey reports

The federal government is expanding payments and reducing barriers for people to be seen by their physicians via telemedicine in the wake of the COVID-19 pandemic. Justin MacArthur, director of neurology at Johns Hopkins, says this is all to the good.

MacArthur: We’ve been using telemedicine for years, but we’ve clearly ramped up very substantially in the last couple of weeks, for obvious reasons. Patients love it. And we’re learning very rapidly that almost everything can be done via a telemedicine approach.  It’s amazing how much of the neurological exam you can do creatively through mimicking, through gesturing, through asking patients to do certain things. A lot of the examination is really observation and telemedicine really lends itself beautifully to that.  :29

MacArthur says that many medical visits can be accomplished very well utilizing telemedicine along with various apps and other technology, and advises people to reach out to their doctors to find out if such visits are possible. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Who is at risk for severe disease with COVID-19? Elizabeth Tracey reports

Obesity, smoking history, and the presence of other health conditions have been identified as putting someone at increased risk of severe COVID-19 disease. Patricia Davidson, dean of the Johns Hopkins School of Nursing, isn’t surprised.

Davidson: Those factors are not dissimilar to risk factors for any infectious diseases. It underscores the importance of looking at the importance of looking at physical vulnerability and frailty, the elderly, those whose immune systems are already compromised are at higher risk. These are important messages that we have to take forward even after this pandemic fades away – we know it will – to making people recognize what their risk factors are for a range of different conditions.   :31

Davidson says for now, if you’re in a risk group pay close attention to the recommendations of public health authorities and follow them. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What is the status of testing for COVID-19? Elizabeth Tracey reports

Testing for the coronavirus continues to be of paramount importance in helping contain the pandemic, with new testing coming online nationally every day. Lisa Maragakis, director of infection control at Johns Hopkins Hospital, applauds this development.

Maragakis: We are very fortunate at Johns Hopkins Medicine to have a laboratory that has provided us with in house capacity of testing for the corona virus. However this capacity remains limited, and we must prioritize it to those who are at the highest risk. Those of us with potential exposures outside of the workplace will be contacted by public health authorities and given further instructions about the need for potential self-isolation or quarantine.  :28

Maragakis notes that all testing options at the moment rely on a technique called polymerase chain reaction or PCR, which makes many copies of the virus’s genetic material so it can be detected. Additional testing methods may be available soon. At Johns Hopkins, I’m Elizabeth Tracey. 

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Anchor lead: We can engage our nervous system to slow down moral injury, Elizabeth Tracey reports

When we feel stressed in the workplace, as many healthcare providers do, one arm of our nervous system known as the sympathetic system may be on overdrive. Cynda Rushton, a bioethics expert at Johns Hopkins, says bringing this reaction into awareness and engaging the calming arm of the nervous system called the parasympathetic, may help.

Rushton: When we’re in the midst of these situations our nervous system has just gone wonky. We are reactive, we’re more rigid. Being able to recognize I’m really upregulated right now and having some tools. As simple as taking a few deep breaths, to get our parasympathetic nervous system online, can help us in the moment. Then we might also have the energy to look more creatively at what are the patterns in our system that are causing this problem and then how do I use my energy and insight to make bigger change?  :33

Rushton says using such skills may help clinicians avoid moral injury over the long term. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How do we recognize for ourselves that we may be headed toward moral injury? Elizabeth Tracey reports

Many people in the healthcare environment are using the term ‘moral injury,’ to describe how they feel about the workplace. Cynda Rushton, a bioethics expert at Johns Hopkins, says there is an upside to finding the right words to describe one’s mental state, and its part of a process of identifying suffering.

Rushton: The first phase is mute suffering. We’re not even able to find the words to describe our experience. The second phase is expressive suffering, where we begin to name the suffering. By doing so it gives us an opportunity to say, okay, so now what? The third phase is transformation. So how do we actually confront the fact that yes, we are experiencing moral distress, or moral injury. Is it possible to in any way transform that into a less destructive experience?  :33

Rushton says naming the elephant can help you enlist the help of others in learning how to transform suffering. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can ‘moral injury’ be treated? Elizabeth Tracey reports

Moral injury is a more severe form of moral distress, experienced by those who feel they are acting contrary to their values, and it’s being embraced by health care professionals. Cynda Rushton, a bioethics expert at Johns Hopkins, says the term has been around for some time.

Rushton: The term actually started in the military. It was applied to soldiers who had to carry out missions that at the fundamental level really violated their personal values and yet because of their role in the military they had to carry out an action that they wouldn’t have otherwise chosen. It’s a term that really started there and was often associated with PTSD and some of the psychological scars of war. Now there have been people who’ve picked up the term in healthcare.  :32

Rushton says recognition of the problem and its severity will help point the way toward ways to address it. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new term is being used to describe anguish on the job for medical professionals, Elizabeth Tracey reports

Moral injury. That’s the term some medical professionals are using to describe their mental state after prolonged exposures to situations where they feel compelled to make choices they wouldn’t if they were acting alone, and it is a major contributor to burnout. Cynda Rushton, a bioethics expert at Johns Hopkins, offers a definition.

Rushton: Moral injury to me is part of a continuum of moral suffering. What it points to is the anguish people feel when they feel like they’ve violated their core values, their sense of who they are and what they stand for. The continuum is that I think moral suffering can range from the sort of vague sense that something is wrong all the way to feeling like I have acted so contrary to my values that it really leaves me with a wound.   :32

Rushton says the term does help convey the depth of what people are feeling. At Johns Hopkins, I’m Elizabeth Tracey.