Under COVID, Medicine Changed Forever

It’s hard to imagine an industry that has been as singularly transformed by the events of the past two and a half years than medicine. From debates over efficacies and safety of fast-tracked vaccines, to the physical and mental toll the pandemic took on doctors and nurses, to the manner in which health care is administered over long distances, there’s almost nothing across the industry that’s emerged unscathed.

And yet, for all of the challenges and misery the coronavirus wrought – and still does today with the rise of variants that have spiked numbers – history may regard 2020 and the years that followed as one of the most important periods in the history of medicine. If that sounds unusual or even vulgar, consider that from the darkest circumstances throughout history – war, famine and yes, even plague – some of humanity’s greatest innovations have emerged.

Dr. Cam Patterson

Dr. Cam Patterson, chancellor of University of Arkansas for Medical Sciences, said that curious axiom is already at work in how physicians treat patients, thanks to onrushing technology, seemingly on every front.

Left to right, Cam Patterson, M.D., MBA, Brian Jones, D.H.Sc., CEO/president of SHARE Foundation; Steve Cousins, board of directors chairman for SHARE Foundation during a $1.5 million grant presentation.

“There’s so much going on that I don’t think that there’s any one next big thing; it’s an ‘all of the above’ scenario,” he said. “[Technology] will allow us to hone our ability to make diagnoses earlier in the course of disease. We saw it with our global testing that we did during COVID, but also mobile mammography. I think you’ll see more mobile diagnostic platforms here in Arkansas going forward.

“And, COVID-19 allowed us to push the digital edge of health care forward more quickly. In large part, not just because of excellent technologies, but in breaking down barriers – barriers to payment and barriers to patient acceptance.”

Kevin Phelan, Ph.D., demonstrates ultrasound scanning for high school students learning about health care careers during the virtual Health Professions Recruitment and Exposure Program.

Patterson said technology is having another ancillary effect on the medical industry – a change in the art-science balance that has ruled medicine throughout time. It’s a phenomenon, he notes, that has changed dramatically just during the course of his own career.

Veronica Ussery (on screen) is joined with (front right) Karen J. Dickinson, M.D.; (second row, left to right) Patti Griffey, a simulated patient, and Sherry Johnson; and (third row, left to right) Jerry Halpain, Andrew Warr, simulated patient, Margaret Glasgow, Matthew Spond, M.D., and another simulated patient. All photos courtesy of UAMS.

“I trained in the last pandemic, which was HIV,” he said. “An interesting comparison between when I trained and what’s going on now is, both my cohort and the current cohort of students that are being educated have felt that the system was being overwhelmed.

“The big difference is more of a focus on quality and the personal touch. We have better data to address those issues now than we did when I was training. Also, the physical space; our students are much more comfortable managing patients within the digital realm now than we had the opportunity to when I was training.”

Given the manner in which medical schools, hospitals and other health care entities have had to pivot in recent years – including digital classrooms and hospital wards bustling with medical devices so advanced as to boggle the imagination – it’s little wonder that each succeeding generation of physicians and nurses is one step farther away from the bedside.

Dr. Kyle Parker

“One question is, what is this going to do to telemedicine? Is it going to speed it up? And the answer is well, yeah,” said Dr. Kyle Parker, CEO of Fort Smith-based Arkansas Colleges of Health Education. “Once we get enough of the dark fiber that’s all over the state of Arkansas running down these highways turned on, I think it’s going to grow a lot.

“A more important question is, the tools that are out there, the equipment that’s out there, is it conducive to telemedicine? In certain situations, yes, absolutely. It can take blood pressure, it can take temperature, but it’s not going to supplant people to treat acute appendicitis. We can do some simple procedures for people who typically go into clinics, and we’ll be able to do that remotely, but who’s going to be looking at them?”

Parker said ACHE has already devised ways to draw students back into the personal elements of medicine during their medical training.

Members of ACHE’s senior staff, Board of Trustees and others shovel dirt at an official groundbreaking for a new ACHE facility. Photo courtesy of Les Smith, ACHE.

“Part of our plan here with our rotations is, we send our students into the rural areas, and we do that very intentionally,” he said. “One reason is so they will get accustomed to providing expert care without all the equipment you would find in the larger cities. They learn more by having less. And secondly, we move them into these remote areas because we hope they’re going to fall in love with it and therefore wish to stay.”

Parker said the issues surrounding personnel and medical access are much thornier than keeping up with medical technology, and also more essential. It’s no secret that states that suffer from a comparative lack of medical access and options have far lower health scores, or that those states are usually poorer, smaller and more rural. In a word, Arkansas.

“When you look at the numbers, whether it’s physician assistants, medical doctors, practicing nurses or nurse practitioners, there’s just simply not enough bodies out there yet, and that’s why we formed ACHE in the first place,” Parker said. “We’re trying to get more bodies out there who can begin to relieve all of these underserved communities. And underserved doesn’t mean indigent; I’m talking about access to health care.

“This year, I think we were 49th in the country on the list of states with the most underserved areas, and Oklahoma is 48th. When you have 48th and 49th together, and start to draw circles, we’re in one of the most underserved areas, if not the most underserved area, of the country.”

Patterson said headcount isn’t the only variable in the complicated equation for providing quality medical care for all, regardless of zip code. He said institutions in Arkansas, including medical schools, are often hamstrung by systemic deficiencies in students’ readiness for the rigors of post-secondary education.

“We definitely can do better,” Patterson said of primary and secondary education. “There are plenty of Arkansans who graduate from high school or college and are ready to take on the challenges that are presented at UAMS. But there are also a lot of really smart kids who have the inner talents and resources to go into health care, but don’t have the educational background.

“That’s a challenge, especially in students who have received their education in rural parts of the state, where secondary education is less uniform, and the impact that has on students.”

Patterson said the situation presents itself so often that UAMS has created programs to help these students overcome the educational deficiencies they may have experienced thus far. He said this investment is particularly important, as these students are often from the most severely underserved areas, places most in need of a hometown boy or girl to come back with a medical degree to serve the population.

“Our diversity, equity and inclusion division has a pathways program for K-12 students to get them interested and engaged in STEM curriculum,” he said. “Then, we have a post-baccalaureate program for students who want to go to medical school, but don’t have the test scores they need to get in.

“We bring them to campus and give them a curriculum, including test-taking skills so that they can get into medical school. Then, hopefully, they’ll go back to the communities where they came from and serve in those underserved communities across the state.”