When Doctors Make House Calls, Modern-Style!
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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.❞
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. ❞
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!
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Debate over tongue tie procedures in babies continues. Here’s why it can be beneficial for some infants
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There is increasing media interest about surgical procedures on new babies for tongue tie. Some hail it as a miracle cure, others view it as barbaric treatment, though adverse outcomes are rare.
Tongue tie occurs when the tissue under the tongue is attached to the lower gum or floor of the mouth in a way that can restrict the movement or range of the tongue. This can impact early breastfeeding in babies. It affects an estimated 8% of children under one year of age.
While there has been an increase in tongue tie releases (also called division or frenotomy), it’s important to keep this in perspective relative to the increase in breastfeeding rates.
The World Health Organization recommends exclusive breastfeeding for the first six months of life, with breastfeeding recommended into the second year of life and beyond for the health of mother and baby as well as optimal growth. Global rates of breastfeeding infants for the first six months have increased from 38% to 48% over the past decade. So, it is not surprising there is also an increase in the number of babies being referred globally with breastfeeding challenges and potential tongue tie.
An Australian study published in 2023 showed that despite a 25% increase in referrals for tongue tie division between 2014 and 2018, there was no increase in the number of tongue tie divisions performed. Tongue tie surgery rates increased in Australia in the decade from 2006 to 2016 (from 1.22 per 1,000 population to 6.35) for 0 to 4 year olds. There is no data on surgery rates in Australia over the last eight years.
Tongue tie division isn’t always appropriate but it can make a big difference to the babies who need it. More referrals doesn’t necessarily mean more procedures are performed.
chomplearn/Shutterstock How tongue tie can affect babies
When tongue tie (ankyloglossia) restricts the movement of the tongue, it can make it more difficult for a baby to latch onto the mother’s breast and painlessly breastfeed.
Earlier this month, the International Consortium of oral Ankylofrenula Professionals released a tongue tie position statement and practice guideline. Written by a range of health professionals, the guidelines define tongue tie as a functional diagnosis that can impact breastfeeding, eating, drinking and speech. The guidelines provide health professionals and families with information on the assessment and management of tongue tie.
Tongue tie release has been shown to improve latch during breastfeeding, reduce nipple pain and improve breast and bottle feeding. Early assessment and treatment are important to help mothers breastfeed for longer and address any potential functional problems.
The frenulum is a band of tissue under the tongue that is attached to the gumline base of the mouth. Akkalak Aiempradit/Shutterstock Where to get advice
If feeding isn’t going well, it may cause pain for the mother or there may be signs the baby isn’t attaching properly to the breast or not getting enough milk. Parents can seek skilled help and assessment from a certified lactation consultant or International Board-Certified Lactation Consultant who can be found via online registry.
Alternatively, a health professional with training and skills in tongue tie assessment and division can assist families. This may include a doctor, midwife, speech pathologist or dentist with extended skills, training and experience in treating babies with tongue tie.
When access to advice or treatment is delayed, it can lead to unnecessary supplementation with bottle feeds, early weaning from breastfeeding and increased parental anxiety.
Getting a tongue tie assessment
During assessment, a qualified health professional will collect a thorough case history, including pregnancy and birth details, do a structural and functional assessment, and conduct a comprehensive breastfeeding or feeding assessment.
They will view and thoroughly examine the mouth, including the tongue’s movement and lift. The appearance of where the tissue attaches to the underside of the tongue, the ability of the tongue to move and how the baby can suck also needs to be properly assessed.
Treatment decisions should focus on the concerns of the mother and baby and the impact of current feeding issues. Tongue tie division as a baby is not recommended for the sole purpose of avoiding speech problems in later life if there are no feeding concerns for the baby.
A properly qualified lactation consultant can help with positioning and attachment. HarryKiiM Stock/Shutterstock Treatment options
The Australian Dental Association’s 2020 guidelines provide a management pathway for babies diagnosed with tongue tie.
Once feeding issues are identified and if a tongue tie is diagnosed, non-surgical management to optimise positioning, latch and education for parents should be the first-line approach.
If feeding issues persist during follow-up assessment after non-surgical management, a tongue tie division may be considered. Tongue tie release may be one option to address functional challenges associated with breastfeeding problems in babies.
There are risks associated with any procedure, including tongue tie release, such as bleeding. These risks should be discussed with the treating practitioner before conducting any laser, scissor or scalpel tongue tie procedure.
Post-release support by a certified lactation consultant or feeding specialist is necessary after a tongue tie division. A post-release treatment plan should be developed by a team of health professionals including advice and support for breastfeeding to address both the mother and baby’s individual needs.
We would like to acknowledge the contribution of Raymond J. Tseng, DDS, PhD, (Paediatric Dentist) to the writing of this article.
Sharon Smart, Lecturer and Researcher (Speech Pathology) – School of Allied Health, Curtin University; David Todd, Associate Professor, Neonatology, ANU Medical School, Australian National University, and Monica J. Hogan, PhD student, ANU School of Medicine and Psychology, Australian National University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Hope Not Nope – by Dr. Dillon Caswell
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The author a Doctor of Physical Therapy, writes from both professional expertise and personal experience, when it comes to the treatment of long term injury / disability / chronic illness.
His position here is that while suffering is unavoidable, we don’t have to suffer as much or as long as many might tell us. We can do things to crawl and claw our way to a better position, and we do not have to settle for any outcome we don’t want. That doesn’t mean there’s always a miracle cure—we don’t get to decide that—but we do get to decide whether we keep trying.
Dr. Caswell’s advice is based mostly in psychology—a lot of it in sports psychology, which is no surprise given his long history as an athlete as well as his medical career.
The style is very easy-reading, and a combination of explanation, illustrative (often funny) anecdotes, and a backbone of actual research to keep everything within the realms of science rather than mere wishful thinking—he strikes a good balance.
Bottom line: if your current health outlook is more of an uphill marathon, then this book can give you the tools to carry yourself through the healthcare system that’s been made for numbers, not people.
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Protein-Stuffed Bell Peppers
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Hot, tasty, meaty, and vegan! You can have it all. And with this recipe, you’ll want to err on the side of overcatering, because everyone will want some. As for healthiness, we’ve got lycopene, lutein and a stack of other carotenoids, a plethora of other polyphenols, and a veritable garden party of miscellaneous phytochemicals otherwise categorized. It’s full of protein, fiber, vitamins, and minerals, relatively low-fat but the fats present are healthy. It’s antidiabetic, anti-CVD, anticancer, antineurodegeneration, and basically does everything short of making you sing well too.
You will need
- 4 large bell peppers, tops sliced open and innards removed (keep the tops; we will put them back on later)
- 1 cup quinoa, rinsed
- 1 can black beans, drained and rinsed
- 1 small zucchini (diced)
- 1 small eggplant (diced)
- 1 small red onion (finely chopped)
- ½ bulb garlic, minced*
- 1 tbsp tomato paste
- 1 tbsp chia seeds
- 2 tbsp extra virgin olive oil
- 2 tsp dried basil
- 2 tsp dried thyme
- 2 tsp black pepper, coarse ground
- 2 tsp ground cumin
- 1 tsp smoked paprika
- ½ tsp MSG or 1 tsp low-sodium salt
*we always try to give general guidelines with regard to garlic, but the reality is it depends on the size and strength of your local garlic, which we cannot account for, as well as your personal taste. Same situation with hot peppers of various kinds. This writer (it’s me, hi) would generally use about 2x the garlic and pepper advised in our recipes. All we can say is: follow your heart!
Method
(we suggest you read everything at least once before doing anything)
1) Combine the quinoa with the chia seeds, and cook as per normal cooking of quinoa (i.e. bring to a boil and then simmer for about 15 minutes until cooked and fluffy). Drain and rinse (carefully, without losing the chia seeds; use a sieve).
2) Heat your grill to a high heat. Combine the zucchini, eggplant, onion, garlic, and olive oil in a big bowl and mix well, ensuring an even distribution of the oil. Now also add the herbs and spices (including the MSG or salt) and mix well again. Put them all to grill for about 5 minutes, turning as necessary.
3) Heat your oven to a high heat. Take the grilled vegetables and combine them in a bowl with the quinoa-and-chia, and the black beans, as well as the tomato paste. Mix everything well. Spoon the mixture generously into the bell peppers, replacing the tops (it can be loosely), and bake for about 5–10 minutes, keeping an eye on them; you want them to be lightly charred, but not a burnt offering.
4) Serve! This dish works well as a light lunch or as part of a larger spread.
(before going in the oven with lids replaced to keep moisture in)
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- A Spectrum Of Specialties: Which Color Bell Peppers To Pick?
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- The Tiniest Seeds With The Most Value: If You’re Not Taking Chia, You’re Missing Out
- Chickpeas vs Black Beans – Which is Healthier?
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Monosodium Glutamate: Sinless Flavor-Enhancer Or Terrible Health Risk?
Take care!
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No-Frills, Evidence-Based Mindfulness
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What’s on your mind, really?
We hear a lot about “the evidence-based benefits of mindfulness”, but what actually are they? And what is the evidence? And, perhaps most importantly: how do we do it?
What are the benefits?
The benefits of mindfulness are many, and include:
- reducing stress
- reducing pain
- improving quality of life
- reducing fatigue
- providing relief from digestive disorders
- reducing symptoms of sleep disorders
- improving immune response
- providing support for caregivers
The evidence is also abundant, and includes:
- Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis
- Fusing character strengths and mindfulness interventions: Benefits for satisfaction and performance
- Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques
- Effects of mindfulness-based stress reduction on anxiety symptoms: A systematic review and meta-analysis
- The benefits of meditation and mindfulness practices during times of crisis such as COVID-19
Sounds great… What actually is it, though?
Mindfulness is the state of being attentive to one’s mind. This is at its heart a meditative practice, but that doesn’t necessarily mean you have to be sitting in the lotus position with candles—mindfulness can be built into any daily activity, or even no activity at all.
An exercise you can try right now:
Take a moment to notice everything you can hear. For this writer, that includes:
- The noise of my keystrokes as I type
- The ticking of the clock on the wall
- The gentle humming of my computer’s processor
- The higher-pitched noise of my computer’s monitor
- Birdsong outside
- Traffic further away
- My own breathing
- The sound of my eyelids as I blink
Whatever it is for you, notice how much you can notice that you had previously taken for granted.
You can repeat this exercise with other senses, by the way! For example:
- Notice five things you can see in your immediate environment that you’ve never noticed before. If you’re at home reading this, you probably think you’re very familiar with everything around you, but now see that mark on the wall you’d never noticed before, or a quirk of some electrical wiring, or the stitching on some furnishing, for example.
- Notice the textures of your clothes, or your face, or perhaps an object you’ve never paid attention to touching before. Your fingertips, unless you have some special reason this doesn’t apply to you, are far more sensitive than you probably give them credit for, and can notice the tiniest differentiation in textures, so take a moment to do that now.
- Mindful eating can be an especially healthful practice because it requires that we pay every attention to what we’re putting in our mouth, tasting, chewing, swallowing. No more thoughtlessly downing a box of cookies; every bite is now an experience. On the one hand, you’ll probably eat less at a sitting. On the other hand, what a sensory experience! It really reminds one that life is for living, not just for zipping through at a speed-run pace!
What about mindfulness as a meditative practice?
Well, those are meditative practices! But yes, mindfulness goes for more formal meditation too. For example:
Sit comfortably, with good posture, whatever that means to you. No need to get too caught up in the physical mechanics here—it’d take a whole article. For now, if you’re sitting and comfortable, that’s enough.
Notice your breathing. No need to try to control it—that’s not what this is about today. Just notice it. The in, the out, whether you breathe to your chest or abdomen, through your nose or mouth, don’t worry about doing it “right”, just notice what you are doing. Observe without judgement.
Notice your thoughts—no need to try to stop them. Notice noticing your thoughts, and again, observe without judgement. Notice your feelings; are you angry, hopeful, stressed, serene? There are no wrong answers here, and there’s nothing you should try to “correct”. Just observe. No judgement, only observe. Watch your thoughts, and watch your thoughts go.
Did you forget about your breathing while watching your thoughts? Don’t worry about that either if so, just notice that it happened. If you have any feelings about that, notice them too, and carry on observing.
We go through so much of our lives in “autopilot”, that it can be an amazing experience to sometimes just “be”—and be aware of being.
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Red Lentils vs Green Lentils – Which is Healthier?
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Our Verdict
When comparing red lentils to green lentils, we picked the green.
Why?
Yes, they’re both great. But there are some clear distinctions!
First, know: red lentils are, secretly, hulled brown lentils. Brown lentils are similar to green lentils, just a little less popular and with (very) slightly lower nutritional values, as a rule.
By hulling the lentils, the first thing that needs mentioning is that they lose some of their fiber, since this is what was removed. While we’re talking macros, this does mean that red lentils have proportionally more protein, because of the fiber weight lost. However, because green lentils are still a good source of protein, we think the fat that green lentils have much more fiber is a point in their favor.
In terms of micronutrients, they’re quite similar in vitamins (mostly B-vitamins, of which, mostly folate / vitamin B9), and when it comes to minerals, they’re similarly good sources of iron, but green lentils contain more magnesium and potassium.
Green lentils also contain more antixoidants.
All in all, they both continue to be very respectable parts of anyone’s diet—but in a head-to-head, green lentils do come out on top (unless you want to prioritize slightly higher protein above everything else, in which case, red).
Want to get some in? Here are the specific products we featured today:
Enjoy!
Want to learn more?
You might like to read:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Eat More (Of This) For Lower Blood Pressure ← incidentally, the potassium content of green lentils also helps minimize the harm done by sodium in one’s diet
Take care!
Don’t Forget…
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Own Your Past Change Your Future – by Dr. John Delony
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This one is exactly what it says on the cover. It’s reminiscent in its premise of the more clinically-presented Tell Yourself A Better Lie (an excellent book, which we reviewed previously) but this time presented in a much more casual fashion.
Dr. Delony favors focusing on telling stories, and indeed this book contains many anecdotes. But also he bids the reader to examine our own stories—those we tell ourselves about ourselves, our past, people around us, and so forth.
To call those things “stories” may create a knee-jerk response of feeling like it is an accusation of dishonesty, but rather, it is acknowledging that experiences are subjective, and our framing of narratives can vary.
As for reframing things and taking control, his five-step-plan for doing such is:
- Acknowledge reality
- Get connected
- Change your thoughts
- Change your actions
- Seek redemption
…which each get a chapter devoted to them in the book.
You may notice that these are very similar to some of the steps in 12-step programs, and also some religious groups and/or self-improvement groups. In other words, this may not be the most original approach, but it is a tried-and-tested one.
Bottom line: if you feel like your life needs an overhaul, but don’t want to wade through a bunch of psychology to do it, then this book could be it for you.
Click here to check out Own Your Past To Change Your Future, and do just that!
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