| Health & Wellbeing
Telemedicine's challenge: Getting patients to click the app
Powers sits in the living room of her Brooklyn apartment in New York,
and has a telemedicine video conference with physician, Dr. Deborah
Mulligan. (AP Photo/Mark Lennihan)
Walmart workers can now see a doctor for only $4.
The catch? It has to be a virtual visit.
The retail giant recently rolled back the $40 price on telemedicine,
becoming the latest big company to nudge employees toward a high-tech
way to get diagnosed and treated remotely.
But patients have been slow to embrace virtual care. Eighty percent of
mid-size and large U.S. companies offered telemedicine services to their
workers last year, up from 18 percent in 2014, according to the
consultant Mercer. Only 8 percent of eligible employees used
telemedicine at least once in 2017, most recent figures show.
"There's an awful lot of effort right now focused on educating the consumer
that there's a better way," said Jason Gorevic, CEO of telemedicine
provider Teladoc Health.
Widespread smartphone use, looser regulations and employer enthusiasm are
helping to expand access to telemedicine, where patients interact with
doctors and nurses from afar, often through a secure video connection.
Supporters say virtual visits make it easier for patients to see a
therapist or quickly find help for ailments that aren't emergencies. But
many still fall back to going to the doctor's office when they're sick.
Health care experts have long said that changing behavior can be hard. In
telemedicine's case, patients might learn about it from their employer
and then forget about it by the time they need care a few months later.
Plus emotions can complicate health care decisions, said Mercer's Beth
"My little kid is sick, I want them to have the best of care right away,
and for some people that might not register as a telemedicine call," she
Some patients, especially older ones, also just prefer an in-person visit.
"Going to the doctor's office is a big event in their life and something
they look forward to," said Geoffrey Boyce, CEO of InSight
Telepsychiatry, which provides virtual mental health services.
Tom Hill is among that crowd. The 66-year-old from Mooresville, Indiana,
said he's never used telemedicine and has no plans to.
"I believe in a handshake and looking a guy in the eye," said Hill during a
recent shopping break at a downtown Indianapolis mall. "I don't buy
anything online either."
But the practice does gain fans once patients try it.
Julie Guerrero-Goetsch has opened her MDLive telemedicine app several times
since first using it about a year ago to get help for a sinus infection.
The Fallon, Nevada, resident was skeptical, but she didn't have time to go
in person. MDLive connected her to a doctor soon after she opened the
app. She said he started asking questions about symptoms "just as if I
was sitting in a doctor's office" and prescribed an antibiotic.
Caitlin Powers tried telemedicine recently after hearing about it through a
friend. The Columbia University graduate student was feeling stuffed up
and worried she might be coming down with the flu. She said her
appointment started on time, lasted 10 minutes, and she spoke by video
with a doctor in Florida while never leaving her Brooklyn apartment.
"As a student, I don't really have time to spend three hours waiting to see
a doctor, and this was so easy," she said.
Doctors have used telemedicine for years to monitor patients or reach those
in remote locations. Now more employers are encouraging people covered
under their health plans to seek care virtually for several reasons.
Telemedicine can reduce time spent away from the job, and it also can cost
half the price of a doctor's visit, which might top $100 for someone
with a high-deductible plan. However, those savings can be negated if
telemedicine's convenience causes people to overuse it.
Walmart said it cut the cost for virtual visits to give another care option
to the more than one million people covered by its health benefits.
Employers aren't the only ones pushing the technology.
The drugstore chains CVS Health and Walgreens are promoting apps that let
customers connect to doctors. Some insurers like Oscar Health are
offering it for free to customers as a first line of treatment.
Ease of use is one of the reasons researchers and telemedicine providers
think the practice will become more widespread in several areas of care.
Those include dermatology and follow-up doctor visits after a surgery or
Mental health visits are another area ripe for virtual care because
patients can feel more comfortable talking to a therapist in their own
home, said Boyce of InSight Telepsychiatry, which delivers mental health
care in about 30 states.
Boyce said people also like the anonymity of a virtual visit.
Mental health visits were the most common use of telemedicine by patients
until primary care overtook that specialty a few years ago, Harvard's
Dr. Ateev Mehrotra and other researchers found in a recent study of
claims data from a large insurer.
Research firm IHS Markit estimates that telemedicine visits in the U.S.
will soar from 23 million in 2017 to 105 million by 2022. But even then,
they will probably amount to only about one out of every 10 doctor
visits, said senior analyst Roeen Roashan.
MDLive CEO Rich Berner said telemedicine is like the digital video recorder
TiVo, which took a while to catch on with viewers.
"People were so used to doing things the other way that it just took a
little while to kind of really go mainstream," he said. "But when it
did, it went mainstream big-time." (AP)
Hospital: Doc gave near-death patients excessive pain meds
The main entrance to Mount Carmel West Hospital is shown
Tuesday, Jan. 15, 2019. An intensive care doctor ordered
“significantly excessive and potentially fatal” doses of pain
medicine for over two dozen near-death patients in the past few
years. (AP Photo/Andrew Welsh Huggins)
Columbus, Ohio (AP) -
An intensive care doctor ordered “significantly excessive and
potentially fatal” doses of pain medicine for at least 27
near-death patients in the past few years after families asked
that lifesaving measures be stopped, an Ohio hospital system
announced after being sued by a family alleging an improper dose
of fentanyl actively hastened the death of one of those
The Columbus-area Mount Carmel Health System
acknowledged the doses were larger than needed to provide
comfort for dying patients. That raises questions about whether
there was an intentional or possibly illegal use of the drugs to
The system said it has fired the doctor,
reported findings of an internal investigation to authorities
and removed 20 employees from patient care pending further
investigation, including nurses who administered the medication
as well as pharmacists.
Mount Carmel said the situation came to light
because an employee reported a safety concern. The health system
shared no information about what might have prompted employees
to approve and administer the excessive dosages.
“Regardless of the reason the actions were
taken, we take responsibility for the fact that the processes in
place were not sufficient to prevent these actions from
happening,” Mount Carmel President and CEO Ed Lamb said in a
video statement. “We’re doing everything to understand how this
happened and what we need to do to ensure that it never happens
The attorney who brought the lawsuit said, in
that case, either layers of safeguards repeatedly failed to flag
a “grossly excessive” dosage of fentanyl, or the medical
professionals intended to accelerate the death of the patient,
79-year-old Janet Kavanaugh.
“On balance, it’s hard to believe the former
occurred rather than the latter. ... This is not just a simple
situation of an error,” lawyer Gerry Leeseberg said.
The lawsuit was filed in Franklin County
against the health system, a pharmacist, a nurse and the doctor,
whom it identifies as William Husel.
Case records listed no attorney yet to
comment on Husel’s behalf. There is no public personal phone
listing for him, and other numbers linked to him weren’t
accepting calls Tuesday.
Husel’s case emerges amid a national debate
over physician-assisted death. In such cases, physicians
prescribe medications in life-ending amounts to terminally ill
Five states - California, Oregon, Vermont,
Washington and Colorado - allow the practice, and 20 have
considered but not passed legislation to do so, according to the
nonpartisan National Conference of State Legislatures. A Montana
court also legalized it there, though there’s no regulatory
framework in place. In Ohio, the practice remains illegal. A
bill that would have allowed terminally ill, mentally competent
patients to self-administer a prescription to end their lives
failed to gain traction in the last legislative session.
But Joe Carrese, a faculty member at the
Johns Hopkins Berman Institute of Bioethics, said that such laws
are carefully crafted. He said that if Husel administered lethal
quantities of drugs to unwitting patients in order to end their
lives, his acts didn’t meet the definition of physician-assisted
“In this case, if that was the intent, this
was essentially euthanasia, which is not legal anywhere in the
United States and not at all the same as physician-assisted
death,” he said.
Franklin County Prosecutor Ron O’Brien
confirmed that his office has met with doctors, hospital
executives and attorneys and that an investigation is underway,
but he wouldn’t discuss details. He said they’ve received
cooperation from Mount Carmel, which operates four hospitals
around Columbus, and from parent organization Trinity Health,
one of the country’s largest Roman Catholic health care systems.
Records show the State Medical Board in Ohio
has never taken disciplinary action against Husel. It’s unclear
whether that board ever received a complaint or conducted an
investigation about him, as such records are confidential under
Ohio law, and outcomes are made public only if the board takes
Husel was a supervised resident at the
Cleveland Clinic from 2008 to 2013, according to a statement
from the medical center. It’s now conducting an internal
investigation of his work, but it said a preliminary review
found that his prescribing practices were “consistent with
appropriate care provided to patients in the intensive care
Carrese, from the bioethics institute,
commended Mount Carmel for encouraging a culture in which
medical staff and other employees can come forward without fear,
but he said the extent of the allegations is concerning.
“The fact that there may be other patients,
up to 26 other patients, really calls into question whether the
culture of safety and reporting that they’re shooting for,
whether there’s more work that needs to be done,” he said.
The allegations carry echoes of prior Ohio
cases in which patients were killed.
Nurse’s aide Donald Harvey, dubbed “the Angel
of Death,” claimed responsibility for killing more than 50
people in Cincinnati and Kentucky hospitals during the 1970s and
’80s, mostly by poisoning. Many were chronically ill patients,
and Harvey claimed he was trying to end their suffering.
Admitted serial killer Michael Swango, the
former physician dubbed “Dr. Death,” pleaded guilty to killing
four people, including one while interning at an Ohio State
University hospital, and was believed to have poisoned dozens as
he moved between hospitals in various places.
Leeseberg, the attorney in the Mount Carmel
lawsuit, said an important difference in this case is that
multiple people were involved in the patients receiving the
“The pharmacist has an obligation to question
an order, and the nurse has an obligation to question the order
as well,” Leeseberg said. “All of those safeguards were
overridden or ignored. It’s like nothing I’ve ever seen.”
Companies navigate dementia conversations with older workers
Mary Radnofsky, diagnosed with a rare form of
leukoencephalopathy and in the early stages of dementia, tries to recall
a recent phone conversation in her home on Friday, Jan. 18, 2019, in
Alexandria, Va. Faced with an aging American workforce, U.S. companies
are increasingly navigating delicate conversations with employees
suffering from cognitive declines or dementia diagnoses, experts say.
(AP Photo/Kevin Wolf)
Chicago (AP) – Faced with an
aging American workforce, companies are increasingly navigating delicate
conversations with employees grappling with cognitive declines, experts
Workers experiencing early stages
of dementia may struggle with tasks they had completed without
difficulty. Historically punctual employees may forget about scheduled
meetings. And those who have traveled to the same office day after day,
sometimes for years on end, may begin to lose their way during their
“I’ve talked to a number of
families where a person didn’t realize they had the disease and they
didn’t know what was going on. And they got fired for performance issues
before anyone knew what the diagnosis was,” says Ruth Drew, the director
of information and support services at the nonprofit Alzheimer’s
Association. Drew also oversees the organization’s 24-hour help hotline.
The Bureau of Labor Statistics
estimates the number of U.S. workers between the ages of 65 and 74 will
balloon 55 percent between 2014 and 2024, with 86 percent growth for the
working population over 75.
It’s that 65-and-up age group
that’s most likely to face dementia diagnoses, though early-onset
symptoms can afflict younger people. And even though studies show the
rate of dementia diagnoses has actually fallen in recent years, the
sheer number of older U.S. workers expected to remain in the workforce
has increasingly left employees and employers wrestling with the
prospect of dementia in the office.
“And it’s not just managing missed
deadlines. It’s about managing their frustration with everything that’s
changing,” says Sarah Wood, director of global work-life services at
Workplace Options, a North Carolina-based consultation and training
organization. “If this person has been a dependable employee for 40
years and is now missing meetings, they’ll be beating themselves up over
The Americans with Disabilities
Act, which guarantees certain rights and workplace accommodation, covers
individuals with Alzheimer’s diagnoses and certain other forms of
dementia depending on the employee’s position and level of impairment.
“The trick is figuring out what
tasks they can still perform and what they can still do safely to
continue to contribute,” Wood says.
Possible accommodations might
include issuing written instructions rather than verbal commands, or
reassigning a heavy machine operator or employee to a desk job, says
David Fram, director of Americans with Disabilities Act and equal
opportunity services at the nonprofit National Employment Law Institute.
He notes that employers cannot simply fire an employee solely because of
a disability or dementia diagnosis if that person can still perform
certain job requirements.
“The next question is whether
they’re qualified for their job. And that’s the tougher point, depending
on how advanced (the dementia) is,” he says. “People have to do the
essential functions of the job.”
This creates a delicate balance
between employer and employee. For some, disclosing dementia to an
employer could open the door to workplace adjustments. For others,
there’s fear of stigmatization or even termination.
Mike Belleville, 57, a former
telecommunications technician at Verizon now living in Bellingham,
Mass., was diagnosed with Lewy body dementia in 2012.
He said receiving his diagnosis
“was almost like, ‘Hey, here’s what’s wrong with me. And here’s the
reason why I’ve been messing up.’”
Belleville says his “aha” moment
came when his performance began to slip and younger colleagues he
initially trained began coaching him through his job.
He says he wouldn’t have had access
to certain benefits like short-term disability insurance had he not
fully disclosed his condition to his employer. His supervisors
eventually scaled back his hours and reduced his workload, allowing him
to work several months with a regular salary before going on disability
“If you’re driving a semi
cross-country and you keep getting lost, OK, you shouldn’t be doing
that. But could you work in the loading dock? Could you have a desk job?
What are the ways we can accommodate people so that they can continue
contributing meaningfully to society?” asks Al Power, an internist and
geriatrician who has extensively researched and written about dementia.
After initially being misdiagnosed,
Mary Radnofsky, 60 and a former professor now living in the Washington,
D.C., metropolitan area, learned she had a rare form of
leukoencephalopathy, which caused minor strokes, seizures and cognitive
Her worsening condition led her to
step away from her teaching career at the University of Hawaii in 2011,
even before her official diagnosis.
“Apparently I ‘looked’ healthy both
on paper and in person, had a very good education, and was ‘too young’
to have dementia,” she says.
Early dementia symptoms often
mirror other ailments that may impair cognitive function, or even other
types of dementia. Belleville, for example, was initially diagnosed with
early-onset Alzheimer’s before doctors recognized his condition as Lewy
Muddling matters further are
instances in which patients plead with their doctors to run more tests
or cushion the severity of their symptoms in medical reports, says Rod
Blough, a former human resources executive at Luxottica who at 58 years
old was diagnosed with early-onset Alzheimer’s disease and Lewy body
“If a patient is adamantly opposed
to having a certain diagnosis, they might be able to influence a certain
doctor not to put that language into their medical record. And that can
help you on the employment side,” he says. “If your employer wants to
see medical documentation, you can show them papers that suggest you’re
still well enough to work.”
Blough notes that this may not be
the best option for employees long-term, considering their access to
Social Security Disability and other resources will be influenced by
possibly inaccurate medical documentation. But he says dementia
sufferers’ decisions about whether to remain in the workforce are often
Power, the geriatrician, suggests
that the U.S. is “still in denial in terms of public policy” related to
the aging workforce and supporting employees with dementia. And that, he
says, has placed a “greater burden on society.”
“I don’t think people have gotten
their heads around how to respond to this rapidly aging population,” he
says. “We should have been planning for this 30 years ago.”
AP-NORC Poll: Edit baby genes for health, not smarts
In this Oct.
9, 2018 photo, an embryologist adjusts a microplate containing embryos that
were injected with gene-editing components in a laboratory in Shenzhen in
southern China’s Guangdong province. (AP Photo/Mark Schiefelbein)
Washington (AP) -
Most Americans say it would be OK to use gene-editing technology to create
babies protected against a variety of diseases - but a new poll finds they’d
draw the line at changing DNA so children are born smarter, faster or
A month after startling
claims of the births of the world’s first gene-edited babies in China, the
poll by The Associated Press-NORC Center for Public Affairs Research finds
people are torn between the medical promise of a technology powerful enough
to alter human heredity and concerns over whether it will be used ethically.
Jaron Keener, a
31-year-old exhibit designer at Pittsburgh’s Carnegie Museum of Natural
History, said he’s opposed to “rich people being able to create designer
But like the majority
of Americans, Keener would support gene editing in embryos to prevent
incurable diseases. His mother has lupus, an inflammatory disease that may
have both environmental and genetic triggers.
Lupus has been “a
looming presence my entire life. I’ve been around somebody with a chronic
illness and I’ve seen the toll that has taken, not just on her life, but the
life of my family,” he said.
Gene editing is like a
biological cut-and-paste program, letting scientists snip out a section of
DNA to delete, replace or repair a gene. Altering adult cells would affect
only the patient being treated.
But editing genes in
eggs, sperm or embryos would alter the resulting child in ways that can be
passed to future generations - a step with such profound implications that
international science guidelines say it shouldn’t be tested in human
pregnancies until more lab-based research determines it’s safe to try.
The AP-NORC poll shows
about 7 in 10 Americans favor one day using gene-editing technology to
prevent an incurable or fatal disease a child otherwise would inherit, such
as cystic fibrosis or Huntington’s disease.
Roughly two-thirds of
Americans also favor using gene editing to prevent a child from inheriting a
non-fatal condition such as blindness, and even to reduce the risk of
diseases that might develop later in life, such as cancers.
Side effects are
possible, such as a gene-editing attempt that accidentally alters the wrong
DNA spot, and the poll finds 85 percent think that risk is at least somewhat
But about 7 in 10
Americans oppose using gene editing to alter capabilities such as
intelligence or athletic talent, and to alter physical features such as eye
color or height.
The poll highlights
that if gene editing of embryos ever moves into fertility clinics, there
will be some hard choices about what non-fatal disorders should qualify,
said Columbia University bioethicist Dr. Robert Klitzman. What if scientists
could pinpoint genes involved with depression or autism or obesity - would
they be OK to edit?
“It’s one thing to look
at the extremes of fatal diseases versus cosmetic things, but in the middle
are going to be these very different issues,” Klitzman said.
That reported gene
editing in China was an attempt to create babies resistant to HIV infection,
a target that many scientists in the U.S. and elsewhere decried because
there are effective ways to prevent the AIDS virus.
The poll shows most
people think it is at least somewhat likely that gene editing could wipe out
certain inherited diseases and lead to other medical advances.
Yet despite the medical
enthusiasm, more Americans oppose than favor government funding for testing
on human embryos to develop gene-editing technology - 48 percent to 26
percent. About another quarter of the population takes no stand.
Without that research,
how could gene editing ever become a choice for families hoping to avoid a
“That’s a good
question,” said Keener, the Pittsburgh museum worker, who opposes such
funding for fear that research would lead to designer babies rather than
“If there would be a
way to narrow the scope of research, I would be OK with government funding,”
he said. “I just don’t have a lot of confidence people wouldn’t use it for
their own gain.”
Indeed, the poll
uncovers a lack of trust in science: About a third think this kind of gene
editing will be used before it’s adequately tested, as many scientists say
happened in China. Nearly 9 in 10 people think the technology will be used
for unethical reasons, including 52 percent who say this is very likely to
three-quarters of Americans say gene editing probably wouldn’t be affordable
for the average person - raising the specter of certain genetic diseases
becoming a problem only for the poor.
“People appear to
realize there’s a major question of how we should oversee and monitor use of
this technology if and when it becomes available,” said Columbia’s Klitzman.
“What is safe enough? And who will determine that? The government? Or
clinicians who say, ‘Look, we did it in Country X a few times and it seems
to be effective.’”
Poll: Most favor gene editing for disease prevention