Why Don't We Just Ask A Doctor

June 24, 2020

Just like you, I spent mid-March through mid-May arguing over the phone with my friends and family about this virus based on various articles and videos we’d all seen. Then I remembered that I know a doctor. And more importantly I know a lot of people who know him.  That means he’d have to tell me the truth to keep his reputation.  

Dr. Michael Tehrani, MD is an award-wining doctor and CEO of MedWell Medical and his practice is located right here in Long Beach near the traffic circle.  I had a very straighforward conversation with him and asked him all the questions I had on my mind about the virus.  Here’s the Q&A:

 

Michael S. Tehrani, M.D.

Internal Medicine & Geriatrics

 

Q&A

 

Q: What sort of doctor are you and what do you specialize in?

A: I am a geriatrician, which means I work in the niche of mainly seeing older adult patients, and specifically understanding their wants and needs.  We are especially well-versed in knowing all the health and medical resources available to this age group.

Our practice runs differently than other doctor groups. All our patients get a one-hour time block so they don’t feel rushed.  That way we can go over everything including medications and what other specialists have told them.  Seniors typically have multiple medical problems and you can’t just address that in a few minutes.  You have to be able to answer all of their questions.

With seniors, something small can become something big very quickly.  So we don’t say come back in 2 weeks.  If there’s a problem we say your appointment is today or tomorrow.  

Q: Do you remember the moment you heard about COVID and what you thought?

A: When we first heard about it… we didn’t know what it is that we’re dealing with.  We didn’t know what to think about it.  Is this another flu?  We just took extreme caution.  It was tough because when we watched the media we heard put on masks, don’t put on masks, etc.  So just like everyone else we had a lot of confusion.  But as a geriatrics office, knowing it could affect our vulnerable population, we took extreme measures until we could learn more about it.

Q: For you what did those extreme measures look like?

A: We started doing video visits instead of in-person visits. We educated to avoid hospitals and the general public as much as possible until we could learn more about it.  We even distributed masks to our patients. Our priority was educating our population on what this is and helping patients get masks and any required Personal Protective Equipment (PPE).

Q: You were also working in a hospital in addition to your private practice, right?

A: I usually work in a hospital but I stepped away from that very early on this year. Before there was even one case in America.  With a specialty in geriatrics I knew I wouldn’t want to expose myself to anything we didn’t know about while dealing with my older patient population.

Q: So if you are a private doctor, where do you learn your information? What is your trusted source of expertise?

A: I have friends at the hospital who are doctors and nurses in the Emergency Room, ICU, and Medical Floors.  I read the most up-to-date articles like anyone else and am communicating with physicians at our local hospitals who are seeing it front line.

Q: How have your viewpoints changed since you first heard about the coronavirus?

A: As of now, what we know about the virus is that it’s very contagious. About three times more contagious than a regular influenza virus.  We see it has a higher death rate than the regular influenza virus.  We see that it particularly affects people with weak immune systems and a lot of those are seniors.  We see that it is highly transmissible. Where one person with the flu usually gives it to one other person, one person carrying this virus seems to give it to about three or four.

One reason for its transmission is that it spreads on much, much smaller particles than the flu... They are aerosolized and come out of people’s mouths and noses like a spray, not like droplets that just fall to the ground.  Even while you’re just talking it can spread.  We see that it lives in the community longer than the flu.

Q: So are you a proponent of mask wearing?

A: Yes, I highly recommend wearing one.

Q: What is the action you’ll take if your patients do get it?

A: We would ask them to go on Vitamin C, Zinc, Vitamin D, antibiotics, and possibly other treatments depending on the situation.  The next thing we would do is tell them to isolate themselves so they don’t pass it to anyone else until they’re better.

Q: Are you telling people to go on those medicines preemptively?

A: I’m not.  We can always err on the side of caution, but at this time, the truth is we don’t really know what works for certain.  We’re recommending face masks, but if you’re doing well and are healthy we’re not going to add any medications for well patients with no symptoms.

One thing about my personal belief is the less medicine the better. We should be striving to take you off, not add more. I do believe in medicine, but my belief is you come into this world not on meds and you should leave not on meds.  A life span is a big circle. Less is more on older adults.  I tend to remove things unless the benefits of the medicine are greater than the risk of the medicine.  

Think of driving. There are risks involved with everything.  How much safety do you want to take.  Wear your seatbelt?  Good.  Go only 35 mph?  Ok.  But we’re not going to stop driving all together.  The more precautions you take, the higher percentage of safety you have.  But we also have to take the quality of life of our patients into consideration. This virus is not going away without a vaccine or treatment. Take precautions including wear masks, stay six feet apart, avoid crowded situations, and wash hands, and I limit it to that for now... That’s what I’m telling my own parents and my patients, and that’s where I would want to be at if I was a senior.  The virus really just gets in your body through your nose, mouth, and eyes, so wash your hands!

Q: With more sectors of the economy reopening, including restaurants, how do you feel about people going out to eat?

A: Because this virus is so targeted toward older adults I would advise my patients to continue to take the same precautions they are now including keeping six feet distance, wearing the mask, and avoiding crowded places, and maintain good hygiene.  I am going to recommend caution until there’s a treatment or a vaccine.

You can think of the virus as a living thing. This virus wants to live like all of us do.  It happens to need humans to live. If the human has immunity, medications, or a vaccine the virus dies.  Right now, we don’t have a vaccine and we don’t have a medication.  So right now the only way to kill it is to build immunity by catching it and beating it.

But if you haven’t had it, the virus is kind of like a lion roaming the streets. If you go out, it’s looking for you.  The reason we’re being less restrictive as a society is not because the virus is gone, but because the hospitals have more capacity to take on new patients.  We’ve built procedures in the hospitals so they have become efficient at housing more patients. We are better trained, have more resources, equipment, etc.

Look, I think eventually everyone is going to get the virus.  I am hoping my patients can avoid contracting it until we have a treatment or a vaccine at which point they can better fight it off. Until then there’s not much we can do. If you contract it, it’s a battle between the virus and your body.

Q: Are you going out to restaurants at all?

A: I’m not because I work so closely with seniors, me and my staff have to be extremely cautious so that we don’t contract it and then pass it to our patients.

Q: So do you have any guesses as to when we might have a vaccine or a treatment?

A: It usually takes about a year for a vaccine. We’re hoping early next year we should have something.  But people need to remember over the next few months that even if it’s not on the media, the virus is still here.Unfortunately, the media controls what we think about.  The vulnerable population should still take precautions until there is a vaccine or treatment.  

I would like to see the media educate seniors that just because the economy is open does not mean anything is safer.  It just means hospitals have capacity.  Older adults should continue to take precautions until there is a vaccine or treatment.

Q: Do you see a problem with isolation and depression for those staying home an extended period of time?

A: Just from personal experience, the majority of people I see who are depressed are mainly in community livings because they have been restricted from interacting with the outside world. Although they understand this precaution, it has been very hard on them to not see their family and friends.  At the same time we have overcome this challenge by providing our patient community with electronic tablets to help them interact in ways they hadn’t before, such as video chats with their families and friends or learning new activities or games on their iPad.

As for what people should be allowing themselves to do, it’s not a black and white answer.  The more precautions you take, the more likely you reduce your exposure.  You don‘t have to stay home.  You can still go out but just maintain your precautions.  You just need to know you remain vulnerable until there’s a treatment or a vaccine.  

Q: Can you think of any positives to take out of the last three months?

A: Well, particular to our office, it’s definitely a big success that we haven’t had any cases so far, thankfully. I think prevention is key, although it’s been hard…

I think the positive of all this for a lot of people is they’ve gotten closer to themselves, they’ve gotten closer to neighbors, they’ve learned more about technology, and on our end they’ve learned the power and usefulness of telemedicine.

Also a lot less people have been getting sick. And maybe that’s partly because they’re taking more preventative and proactive care of themselves and ironically not coming to doctor’s office and other places where there are a lot of sick, contagious people. People are home. People have been learning to take better care of themselves and they’re better at managing their own bodies because they don’t want to end up in the hospital.

Thank you Dr. T, this has been very helpful!!    908


 

 

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