Telehealth Best Practices: Dr DJ Polzin of Wild Bear Medicine On How To Best Care For Your Patients When They Are Not Physically In Front Of You
Original article published here. Interviewer: Dave Philstin
One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?
In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. D.J. Polzin.
Dr. DJ Polzin is a nomadic physician and the founder of Wild Bear Medicine, a virtual primary care clinic for nomads and “van-lifers”. Prior to his creation of Wild Bear Medicine, Dr. Polzin trained in a community health center where he treated underserved and under-represented patient populations through telephonic and virtual platforms. He also uses virtual platforms to coach pre-medical students through applying to medical school and provides holistic and integrative health coaching to folks around the globe. He is passionate about using a fusion of traditional healing practices, evidence-based medicine, and modern technology to help empower marginalized and underserved folks to manifest health.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
When I look back to my childhood, I can see the conception of my current passions and strengths. My mother would often pick me and my brother up from school and announce we were going on a spontaneous road trip! I see how this led to me being a free-spirit and living out of a camper van during medical school in the Pacific Northwest. From a young age, my grandfather taught me about the balance of the natural world as we explored the forests and lakes of the Midwest. This ultimately led to my passion for natural medicines and the understanding that connection to the natural world is vital to our health. My grandmother taught me kindness and that true fulfillment comes from using your privilege to help others. These values and experiences are what has led me on the path of becoming a nomadic physician and starting Wild Bear Medicine to address the needs of a community that previously did not have access to quality primary care.
Can you share the most interesting story that happened to you since you began your career?
There isn’t one specific story that stands out to me, but living out of a camper van during my clinical and hospital rotations was definitely a unique experience. Being able to leave at a moment’s notice and having a solar powered home with me everywhere I went allowed me to pursue so many opportunities. During my OBGYN rotation, I was able to have my tiny home at the hospital, and never missed the opportunity to deliver a baby. One winter, I was able to provide emergency medical care at a ski resort, something that would not have been possible without my home on wheels. I was even able to study for my board exam while boon-docking in beautiful remote coastline and forest areas.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“To find health should be the object of the doctor. Anyone can find disease.”
― Andrew Taylor Still
Throughout my medical education, this quote has reminded me to focus on helping patients find health through education, preventative care, healthy lifestyle, and treating somatic dysfunctions instead of working to treat disease only after it becomes overt illness.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
My partner — Wynne Weddell. Together we have overcome so many challenges and have had countless “once in a lifetime” experiences. Her intuition and natural wisdom has helped me grow as a person and a physician. Wynne has always been there to support me. We shared tears of intense sadness when my medical career required me to move across the country, and she came with me on that adventure. We shared laughter and euphoria while exploring the remote mountains of breathtaking Alaska. I can’t imagine being where I am today without her love and support.
Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?
Depending on the physician, it can be easier to build rapport with a patient who is physically in front of you. I believe this can be overcome by allowing the patient to learn more about the physician prior to the first visit via a website bio, intro video, or other means. It also helps to allow time during the appointment to get to know your patient.
One obvious benefit of having a patient physically in front of you, is the ability to examine patient with palpatory skills and with a stethoscope. Seeing a patient in a clinical or hospital setting also assures that the patient is in a predictable environment free from distraction or interruption. It also allows for vitals taken by staff with experience which ensures accuracy.
On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?
Without proper preparation, video and audio quality is sometimes not adequate for a smooth comprehensive visit. However, with preparation, tele-health can be extremely convenient for folks who are not able to come into the clinic for a visit. Distractions can also arise, especially when there are other people or pets in the same room as the patient, but this also can be prevented by setting expectations before the visit.
At times a patient may present virtually with a problem that needs treatment in office, requiring the patient to come in for a subsequent visit. Examples are skin lesions that require biopsy or cryotherapy. With that said, if an issue does not require hands-on treatment, the patient saves time by being seen via their phone or computer.
Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)
How to set the patient up for success ahead of time — Ask the patient to be in a quiet place, free from distractions, and with good internet connection. The patient should also have performed a test prior to the visit to ensure the audio and visual quality is good.
How to set yourself up for success ahead of time — Make sure you have a quiet, private location with good internet connection and a quality camera and microphone to ensure a quality experience. If you’re seeing patients from the road like me, consider using a cell phone signal booster for enhanced cellular and internet connection.
Know your limits.— It’s important to know and understand the limitations of telemedicine. Often, we will be unable to determine if a patient’s illness requires intervention or if labs or imaging are indicated without a palpatory or auscultatory exam. We must err on the side of caution and not hesitate to have the patient seen in person for further evaluation when indicated.
How to use the teach-back method — When a patient is not physically in front of you, it can be difficult to gauge a patient’s understanding. To ensure the patient understood and remembered the plan, I suggest having the patient explain the treatment plan back to you and demonstrate any stretches or positions of ease you have asked them to do.
How to follow up — One strength of telemedicine is that patients can attend appointments without the time commitment needed for in-person visits. Use this to your advantage and follow up with a timely brief telephonic or virtual visit to address any questions or concerns the patient has and ensure treatment plans are going well.
Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?
Absolutely! One of the greatest strengths of telemedicine is that it allows access to care for folks who live in medically underserved areas. Many of my patients have been elated to see me virtually because they were previously driving up to two hours for appointments. Having a patient drive all that way for a brief follow up appointment just doesn’t make sense! The ease of attending appointments also leads to better adherence to treatment plans which ultimately leads to improved outcomes for patients. For example, I have seen a great improvement in diabetic control in my rural patients who previously had difficulty following up.
Through the creation of Wild Bear Medicine, I learned that folks in the nomadic van-life community often delay seeking medical attention which can be detrimental. Ultimately most of them end up going to the emergency room or urgent care which can be costly and not ideal for many reasons. Through the use of tele-health, I am able to address this issue and provide quality comprehensive care to a community that I am so grateful to be part of.
My LGBTQQ IP2SAA patients have also voiced appreciation for the availability of telemedicine as it allows them to access a physician who provides socially conscious healthcare. Transgender patients in particular face discrimination and often find it challenging to access gender affirming care or even primary care, especially in rural settings. Having access to a doctor who understands their needs can be lifesaving.
Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?
The three most important tools I have used during telemedicine visits are video chat, home blood pressure/pulse monitors, and home oximeters.
Using a HIPPA compliant video chat has been invaluable for building rapport with patients and performing a thorough audio-visual exam of the patient. With quality internet connection, a video chat can be just as valuable as an in person visual exam. I have often been able to walk patients through a self-physical exam which has been helpful in gathering the information needed to make a diagnosis.
Having accurate blood pressure and pulse readings for a patient is also an important part of providing quality care. Home blood pressure cuffs allow patients to have follow up appointments without having to come into the office.
During the age of COVID-19, home oximeters have been tremendously helpful in determining the severity respiratory symptoms and deciding if a patient needs supplemental oxygen or treatment beyond supportive care. This simple tool, paired with patient history and video exam, allows COVID-19 positive patients to have tele-health follow-ups and avoid exposure that would occur during a clinic visit.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
Along with the previously mentioned tools, I would love to see increased access to digital stethoscopes, otoscopes, and ophthalmoscopes that integrate into virtual visit software. If these were available and well-functioning, it would improve the scope and quality of telehealth visits.
Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?
Along with making sure they have a strong internet connection and are in an environment free from distractions during their visit, I would also suggest patients have a pen and paper with them during the visit. I ask my patients to write down questions they have prior to the visit and take notes while we speak. This allows the patient to reference questions they may have and take notes on suggested treatment plans or other information that may come up. This is actually something that I suggest to my patients regardless of whether their appointment is in person or virtual.
The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?
I believe there is a lot of potential to benefit from integrating new technologies with tele-health. I’m constantly being surprised by the inventions being released. I actually had a previously healthy patient who was able to accurately detect the onset of a-fib using his watch, which prompted him to make an appointment. That blew my mind!
Is there a part of this future vision that concerns you? Can you explain?
While I am excited at the idea developing technologies that enhance our ability to detect and treat illness, I think we need to be putting just as much effort into increasing access to care. There are still many people in the world who do not have access to even the most basic healthcare, and I would be very excited to see innovation addressing that issue.
I think it is also important to mention that the human component is something that will never truly be able to be replaced by technology. There is no true substitute for the hands-on evaluation of a skilled physician or the healing power of human touch.
Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
Today, we are witnessing an epidemic of chronic disease. 6 in 10 adults in the United states have a chronic illness, and 4 in 10 have two or more chronic diseases. These numbers are even greater in our BIPOC and LGBTQQIP2SAA communities. Despite the amazing growth of medical technology, we are seeing a rise in chronic disease due to systemic factors and lack of access to care.
Many indigenous communities in the United States live without access to clean water, and many only have access to water with cancer causing contaminants such as arsenic or uranium. BIPOC folks have historically been forced onto reservations or inner-city neighborhoods directly or indirectly, and these areas have the highest prevalence of food deserts in the U.S. How can we expect to improve chronic health without first addressing these issues?
If I could inspire a movement, it would be a movement to address health disparities, especially in our most hard-hit communities. My dream is that we will address systemic issues as well as historical and current events that have resulted in the disempowerment of marginalized communities. I believe it should be the mission of our generation to integrate traditional wisdom and modern technological advancements to empower individuals to take charge of their health and provide the resources they need to succeed.
How can our readers further follow your work online?
Thanks for asking. If anyone would like to learn more about the Wild Bear Medicine project or would like to support our mission, I would love for them to visit WildBearMedicine.com!
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.
