Life on the Frontlines–Primary Care

By Lyla Cachola Prather, M.D.

As a primary care physician, my job is to keep my patients healthy and out of the emergency rooms and hospitals, especially during this pandemic. We are a patient’s first resource, and a crucial step to helping maintain balance in the medical system. The emergency room should be a patient’s last resort except in a true emergency, and especially during this COVID-19 pandemic.

Many primary care practices have now implemented state-of-the-art technology to help keep their patients safe. Telemedicine (or online consultation) allows me, as a physician, to come into the patient’s home so they don’t have to risk unnecessary exposure. This is especially important for people who are at high risk of developing serious complications if contracting COVID-19. These include patients who have underlying pulmonary conditions like asthma, COPD/emphysema, or who are smokers, those that are immunocompromised due to steroid use, medications for cancer treatment or organ transplants, or patients on medications to control autoimmune conditions like rheumatoid arthritis or lupus, and those that have chronic kidney disease, diabetes, or heart disease.

The list encompasses over 75% of the patients in my practice, so it has been very important to me to utilize telemedicine to be able to serve my patients, but in a way that doesn’t increase their risk of contracting COVID-19.

In a time when it is so very important to shelter in place, especially for high-risk patients, this new platform allows me to do my job, and be able to ensure my patients’ medical needs are met. My staff and I come in to work every day to be here for you, so you can stay safely at home and receive the care and follow up that you need without risking potential exposure during this health crisis.

Photo by Dr. Lyla Cachola Prather, M.D.

For many of my older patients, telehealth has been a surprisingly smooth transition, especially since many have described themselves as “tech-challenged.” To bridge this gap, we have enlisted their children and grandchildren to help them.

It is heartwarming to see a patient’s anak or apo sitting next to their Lolo or Lola during the visit. They often laugh together and give each other high-fives afterwards. This new type of family bonding and interaction has been an inadvertent and welcome benefit of this platform, as a result of the pandemic.

I want to assure everyone that if your primary care physician has requested to see you via a telemedicine visit rather than in-person, this does not mean that we care about your health less. It means that we are taking extraordinary, new measures to make sure you stay as healthy as possible, and that you have access to us despite the need to shelter in place or quarantine.

While our offices may still be open for urgent needs, our goal is to keep the healthy and high risk from being exposed, and to keep a close watch of those that are sick so we know if you can continue to safely be at home, or if you need to be evaluated further.

We have been trained to examine with all of our senses, not just by touch. There is a lot we can tell online by just hearing your voice, seeing how you look, breathe, move and respond. These actions can tell us if you are doing fine or if you need to come in to be seen or go for testing.

Rest assured, we will ask you to come and see us, or go and get additional testing or evaluation outside your home if needed. Right now, it is important to weigh the risks associated with possible COVID-19 exposure against the medical necessity of in-person care.

These are very complex times, and we as a society are charting unknown waters. We miss seeing our patients in person, getting those hugs and hearing your laughter in our offices. We can’t wait to welcome you all back to clinic on a regular basis.

But for now, unless absolutely necessary, let’s work together to work around this virus, to keep us all safe. Stay home, shelter in place, minimize your exposure risk, and reach out when you need us. We are here for you.

DR. LYLA CACHOLA PRATHER is an internal medicine doctor at Cachola Medical Clinic in Kalihi. She is the President-Elect of Philippine Medical Association of Hawaii.

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