In Tuesday’s newsletter, we asked you foryour opinion of telehealth for primary care consultations*, and got the above-depicted, below-described, set of responses:

• About 46% said “It is no substitute for an in-person meeting with a doctor; let’s keep the human touch”
• About 29% said “It means less waiting and more accessibility, while avoiding transmission of diseases”
• And 25 % said “I find that the pros and cons of telehealth vs in-person balance out, so: no preference”

*We specified that by “primary care” we mean the initial consultation with a non-specialist doctor, before receiving treatment or being referred to a specialist. By “telehealth” we mean by videocall or phonecall.

So, what does the science say?

A quick note first

Because telehealth was barely a thing (statistically speaking) before the first stages of the COVID pandemic, compared to how it is now, most of the science for this is young, and a lot of the science simply hasn’t been done yet, and/or has not been published yet, because the process can take years.

Because of this, some studies we do have aren’t specifically about primary care, and are sometimes about specialists. We think this should not affect the results much, but it bears highlighting.

Nevertheless, we’ll do what we can with the science we have!

Telehealth is more accessible than in-person consultations: True or False?

True, for most people. For example…

❝Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare.

Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%.

Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information.❞

~ Dr. Wiam Alashek et al.

whereas…

❝Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people❞

~ Ibid.

Source: Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review

Now, perception of those things does necessarily equate to an actual increased barrier, but it is reasonable that someone who thinks something is inaccessible will be less inclined to try to access it.

The quality of care provided via telehealth is as good as in-person: True or False?

True, ostensibly, with caveats. The caveats are:

• We’re going offreported patient satisfaction, not objective patient health outcomes (we found little* science as yet for the relative incidence of misdiagnosis, for example—which kind of thing will take time to be revealed).
• We’re also therefore speaking (as statistics do) for the significant majority of people. However, if we happen to be (statistically speaking) an insignificant minority, well, that just sucks for us personally.

*we did find some, but it wasn’t very helpful yet. For example:

An electronic trigger to detect telemedicine-related diagnostic errors

this one does look at the incidence of diagnostic errors, but provides no control group (i.e. otherwise-comparable in-person consultations) for comparison.

While most oft-considered demographic groups reported comparable patient satisfaction (per race, gender, and socioeconomic status, for example), there was one outlier variable, which was age (as we quoted from that first study above).

However!

Looking under the hood of these stats, it seems that age is not the real culprit, so much as technological illiteracy, which is heavily correlated with age:

❝Lower eHealth literacy is associated with more negative attitudes towards I/C technology in healthcare. This trend is consistent across diverse demographics and regions. ❞

~ Dr. Raghad Elgamal

Source: Meta-analysis: eHealth literacy and attitudes towards internet/computer technology

There are things that can be done at an in-person consultation that can’t be done by telehealth: True or False?

True, of course. It is incredibly rare that we will cite “common sense”, (as sometimes “common sense” is actually “common mistakes” and is simply and verifiably wrong), but in this case, as one 10almonds subscriber put it:

❝The doctor uses his five senses to assess. This cannot be attained over the phone❞

~ 10almonds subscriber

A quick note first: if your doctor is using their sense of taste to diagnose you, please get a different doctor, because they should definitely not be doing that!

Not in this century, anyway… Once upon a time, diabetes was diagnosed by urine-tasting (and yes, that was a fairly reliable method).

However, nowadays indeed a doctor will use sight, sound, touch, and sometimes even smell.

In a videocall we’re down to two of those senses (sight and sound), and in a phonecall, down to one (sound) and even that is hampered. Your doctor cannot, for example, use a stethoscope over the phone.

With this in mind, it really comes down to what you need from your doctor in that consultation.

• If you’re 99% sure that what you need is to be prescribed an antidepressant, that probably doesn’t need a full physical.
• If you’re 99% sure that what you need is a referral, chances are that’ll be fine by telehealth too.
• If your doctor is 99% sure that what you need is a verbal check-up (e.g. “How’s it been going for you, with the medication that I prescribed for you a month ago?”, then again, a call is probably fine.

If you have a worrying lump, or an unhappy bodily discharge, or an unexplained mysterious pain? These things, more likely an in-person check-up is in order.

Take care!

Polyphasic Sleep… Super-Schedule Or An Idea Best Put To Rest?

What is it?

Let’s start by defining some terms:

• Monophasic sleep—sleeping in one “chunk” per day. For example, a good night’s “normal” sleep.
• Biphasic sleep—sleeping in two “chunks” per day. Typically, a shorter night’s sleep, with a nap usually around the middle of the day / early afternoon.
• Polyphasic sleep—sleeping in two or more “chunks per day”. Some people do this in order to have more hours awake per day, to do things. The idea is that sleeping this way is more efficient, and one can get enough rest in less time. The most popular schedules used are:
  • The Überman schedule—six evenly-spaced 20-minute naps, one every four hours, throughout the 24-hour day. The name is a semi-anglicized version of the German word Übermensch, “Superman”.
  • The Everyman schedule—a less extreme schedule, that has a three-hours “long sleep” during the night, and three evenly-spaced 20-minute naps during the day, for a total of 4 hours sleep.

There are other schedules, but we’ll focus on the most popular ones here.

Want to learn about the others? Visit: Polyphasic.Net (a website by and for polyphasic sleep enthusiasts)

Some people have pointed to evidence that suggests humans are naturally polyphasic sleepers, and that it is only modern lifestyles that have forced us to be (mostly) monophasic.

There is at least some evidence to suggest that when environmental light/dark conditions are changed (because of extreme seasonal variation at the poles, or, as in this case, because of artificial changes as part of a sleep science experiment), we adjust our sleeping patterns accordingly.

The counterpoint, of course, is that perhaps when at the mercy of long days/nights at the poles, or no air-conditioning to deal with the heat of the day in the tropics, that perhaps we were forced to be polyphasic, and now, with modern technology and greater control, we are free to be monophasic.

Either way, there are plenty of people who take up the practice of polyphasic sleep.

Ok, But… Why?

The main motivation for trying polyphasic sleep is simply to have more hours in the day! It’s exciting, the prospect of having 22 hours per day to be so productive and still have time over for leisure.

A secondary motivation for trying polyphasic sleep is that when the brain is sleep-deprived, it will prioritize REM sleep. Here’s where the Überman schedule becomes perhaps most interesting:

The six evenly-spaced naps of the Überman schedule are each 20 minutes long. This corresponds to the approximate length of a normal REM cycle.

Consequently, when your head hits the pillow, you’ll immediately begin dreaming, and at the end of your dream, the alarm will go off.

Waking up at the end of a dream, when one hasn’t yet entered a non-REM phase of sleep, will make you more likely to remember it. Similarly, going straight into REM sleep will make you more likely to be aware of it, thus, lucid dreaming.

Read: Sleep fragmentation and lucid dreaming (actually a very interesting and informative lucid dreaming study even if you don’t want to take up polyphasic sleep)

Six 20-minute lucid-dreaming sessions per day?! While awake for the other 22 hours?! That’s… 24 hours per day of wakefulness to use as you please! What sorcery is this?

Hence, it has quite an understandable appeal.

Next Question: Does it work?

Can we get by without the other (non-REM) kinds of sleep?

According to Überman cycle enthusiasts: Yes! The body and brain will adapt.

According to sleep scientists: No! The non-REM slow-wave phases of sleep are essential

Read: Adverse impact of polyphasic sleep patterns in humans—Report of the National Sleep Foundation sleep timing and variability consensus panel

(if you want to know just how bad it is… the top-listed “similar article” is entitled “Suicidal Ideation”)

But what about, for example, the Everman schedule? Three hours at night is enough for some non-REM sleep, right?

It is, and so it’s not as quickly deleterious to the health as the Überman schedule. But, unless you are blessed with rare genes that allow you to operate comfortably on 4 hours per day (you’ll know already if that describes you, without having to run any experiment), it’s still bad.

Adults typically need 7–9 hours of sleep per night, and if you don’t get it, you’ll accumulate a sleep debt. And, importantly:

When you accumulate sleep debt, you are borrowing time at a very high rate of interest!

And, at risk of laboring the metaphor, but this is important too:

Not only will you have to pay it back soon (with interest), you will be hounded by the debt collection agents—decreased cognitive ability and decreased physical ability—until you pay up.

In summary:

• Polyphasic sleep is really very tempting
• It will give you more hours per day (for a while)
• It will give the promised lucid dreaming benefits (which is great until you start micronapping between naps, this is effectively a mini psychotic break from reality lasting split seconds each—can be deadly if behind the wheel of a car, for instance!)
• It is unequivocally bad for the health and we do not recommend it

Bottom line:

Some of the claimed benefits are real, but are incredibly short-term, unsustainable, and come at a cost that’s far too high. We get why it’s tempting, but ultimately, it’s self-sabotage.

(Sadly! We really wanted it to work, too…)