Telehealth Best Practices: Dr Jacob “Gus” Crothers of Groups Recover Togethe rOn How To Best Care For Your Patients When They Are Not Physically In Front Of You

It’s crucial to ensure good internet connectivity. Invest in broadband for your practice and ask patients to use Wi-Fi if possible. If Wi-Fi access is an issue, as is often the case with our patients at Groups Recover Together, encourage patients to drive to local libraries or areas in the community that have free Wi-Fi, and take the appointment from the car.

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 Jacob Crothers.

Jacob Crothers, MD. is an addiction medicine specialist and chief medical officer of Groups Recover Together, the national leader in value-based care for Opioid Use Disorder.

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?

Thank you for including me! I am the National Medical Director at Groups Recover Together, and a board-certified addiction medicine specialist. I am a fifth-generation physician. Both of my parents are physicians, and I never considered being anything else. I was originally trained in primary care, but during my training, I met my mentor, who was practicing addiction medicine. I saw the potential to make a tremendous impact in the addiction space, so I decided to pursue this path.

Can you share the most interesting story that happened to you since you began your career?

A few years ago, I was at a fancy dinner at a medical conference with dozens of doctors, and an elderly woman started choking. I performed the Heimlich maneuver, but she lost consciousness, and it started to seem like she would not survive. Thankfully, a fireman happened to be walking by, and he had the tools to intubate and save her life. It was a shocking reminder of how important the right tools are — without them, even though she was surrounded by doctors, she would have died.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

My father used to say, “Whatever in life is worth doing, is worth doing well.” I really strive to live by that. It reminds me to bring quality to everything and helps me remember my priorities.

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?

There was a nurse I used to work named Fran Puoppolo with who took me under her wing. She was an addiction nurse who helped me complete my first project in Addiction Medicine and really helped me to get excited about the field and begin picturing a career in this corner of medicine that didn’t get much attention. Without her enthusiasm, patience, and dedication, I’m sure I wouldn’t be where I am today in my career.

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?

Telehealth is an amazing tool, but there are definitely benefits to having a patient in front of you. First, the ability to physically touch a patient in an exam is invaluable. For example, you need to be able to touch a patient to perform an abdominal exam or look inside an ear. Similarly, you can’t perform any procedures, such as a minor surgery or the administration of a vaccine, via telehealth. Finally, it’s far easier to establish an emotional connection and a rapport with a patient in person. It’s not impossible to do remotely, but certain things about an in-person visit make it easier and faster, such as laying a hand on their shoulder or looking them right in the eye. These things are challenging, and often impossible, to replicate in a virtual appointment.

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?

One of the most frustrating pitfalls of telemedicine is poor internet connectivity. If either party doesn’t have a reliable connection, and audio/video are compromised, you’ve lost your only way to communicate. Additionally, it can be difficult to treat a patient who isn’t holding still via telehealth. In a casual video call, you may not notice someone moving around, but a telehealth appointment is still a professional encounter, and the constant motion can present some challenges.

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.)

Adequate preparation can go a long way when it comes to addressing, and even preventing, the challenges of telemedicine:

• First, it’s crucial to ensure good internet connectivity. Invest in broadband for your practice and ask patients to use Wi-Fi if possible. If Wi-Fi access is an issue, as is often the case with our patients at Groups Recover Together, encourage patients to drive to local libraries or areas in the community that have free Wi-Fi, and take the appointment from the car.
• Second, be aware of the setup of the patient’s room and work with them to improve it as needed. Lighting is critical, as is a steady camera. Consider investing in equipment that you can offer them, such as a ring light or phone stand, or encourage them to improvise.
• Third, remember that patients can reliably take many of their own vital signs, or can utilize apps that will do it for them. Pulse, height, weight, respiratory weight, and often, even blood pressure can be measured without your physical presence.
• Fourth, remember to be specific and give detailed instructions. Neither you nor your patients are used to the level of detail that will be necessary — for example, describing exactly how to move an arm or a leg, how to change the draping of their clothing, or how far away to hold their camera.
• Finally, spend extra time on the “soft skills” of establishing rapport, connecting emotionally, and getting in the mindset of your patient. These are such critical elements of the medical encounter and they require a bit more effort in a telemedicine encounter. Being deliberate about your intentions and practices in this regard will help to recreate the connection that could otherwise be lost.

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?

Telehealth can absolutely create benefits that traditional in-office visits cannot provide, especially in addiction medicine. One of the most valuable advantages is its ability to overcome access barriers. At Groups Recover Together, since the pandemic, we’ve served hundreds of patients who geographically do not have access to us, or to any high-quality treatment providers. With telemedicine, they can access industry-leading, high-quality care for their needs. Additionally, telehealth is bringing back the benefits of the house call. Physicians can learn so much about a patient from their surroundings — for example, we can see firsthand how chaotic or safe a patient’s living situation is, and if it is conducive to recovery. In addiction medicine, we can perform a “fridge check” and see what foods they have or if food insecurity might be an issue. Patients tend to appreciate when their providers ask for a tour of their home, as they feel we’re going the extra mile in offering quality care. Finally, telehealth makes it much easier for family members and health advocates to join appointments. They can hear conversations with physicians firsthand and ask questions in real time. In my field, family is a huge part of recovery, and we encourage taking advantage of this type of arrangement.

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 amount of technology that mimics physical exam maneuvers has been increasing and offering excellent benefits. Smartphones can take a pulse oximeter reading with increasing accuracy and applications are coming that will be able to take blood pressure with a smartphone. Tools like these will be effective in helping to replicate the benefits of an in-person visit, and we will likely see an explosion of options in the next 5–10 years, but now, software solutions are leading the way. It’s critical from a patient’s perspective to have all information in one telemedicine suite — from checking in to collecting insurance information. If these solutions aren’t seamless, they won’t succeed; patients are relying on this type of tool to take them through the process step by step when they aren’t physically in the presence of medical professionals.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

The perfect system definitely doesn’t exist yet. I would design what I think is missing from the U.S. healthcare system: a truly robust, portable medical record that travels with the patient.. Many countries outside of the U.S. have successfully digitized patient medical records and created unique patient identifiers, making their medical history easily accessible for any healthcare provider. For example, if a patient in the U.S. travels out of state and has a medical emergency, the hospital they go to will have no information on their pre-existing medical conditions, allergies, medications they take, or any other data because it’s not easily sharable.

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?

I think patients should know that 85% of care comes from an individual’s medical history and family medical history. All of this is completely shareable via telemedicine. The fancy machinery in a doctor’s office only adds about 15% of the value to making a diagnosis, on average. A skilled physician can get the vast majority of the value out of telemedicine.

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?

There is a great deal of active research in these spaces, but it’s not immediately on the horizon. The technology that excites me comes from additional peripherals, and the possibility of getting more information out of your smartphone.

Is there a part of this future vision that concerns you? Can you explain?

My biggest concern is equitable access to healthcare. We develop countless tools and new technologies, but unfortunately, only wealthy patient populations have access to them much of the time. Instead of making healthcare more equitable, technology tools often widen the disparity between socio-economic groups in access to care.

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. :-)

I would either try to inspire our leaders to really focus on health equality and leveling the playing field, or to shift the focus away from fancy tech and more toward disease prevention and the lifestyles, social factors, and structural determinants of health, such as income inequality, access to clean water, and education.

How can our readers further follow your work online?

You can learn more about Groups Recover Together at www.groupsrecovertogether.com and follow us on Facebook, Instagram, and LinkedIn at @groupsrecovertogether.

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.