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Physiatry: Alice Chen
28 Plays5 years ago
Season 1, Episode 10: Dr. Alice Chen is a physiatrist at Hospital for Special Surgery in Stamford, CT. Listen to Alice talk about acupuncture and the holistic nature of pain.
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Transcript
Introduction and Guest Welcome
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, Jon Neri. Today, my guest is Dr. Alice Chen. Dr. Chen is a fellowship-trained physiatrist and interregional specialist in the non-operative management of spine and sports disorders. She practices at the Hospital for Special Surgery in Stanford, Connecticut.
00:00:36
Speaker
Dr. Chen received her MD from the University of Michigan Medical School and completed her residency at UMDNJ Kessler Institute for Rehabilitation. Dr. Chen, welcome to the show. Thank you so much. Happy to be here.
Tribute to Healthcare Workers
00:00:51
Speaker
So before we get started, I just wanted to briefly address COVID-19. We are recording this on April 1st, 2020, in the heart of the pandemic. I just wanted to tip my cap to the brave selfless healthcare workers on the front lines. I'd especially like to dedicate this episode to a classmate of mine at University of Michigan, who works as a nurse and recently tested positive for COVID-19. So thanks for your bravery and get well soon. Yes, I hope he gets well soon.
Understanding Physiatry
00:01:22
Speaker
So I just wanted to really start with the basics in your own words. What is physiatry? Physiatry is the specialty of physical medicine and rehabilitation. It's a smaller specialty, and many people don't actually know about it. There's two divisions of it. There's the physical medicine piece of it, which is the piece that
00:01:47
Speaker
is often thought of as musculoskeletal medicine. So it's the medicine of how your muscle joints and bones move together and how they help you function out in the real world.
00:02:02
Speaker
The other piece of it is rehabilitation and that's the medicine of getting a patient from a position where they're unable to do things to a position where they are. So that's the rehabilitation after injuries such as stroke or long-term disability like after being on a ventilator or traumatic brain injuries or spinal cord injuries. It's the medicine of
00:02:29
Speaker
getting back to the person's baseline. So the balance of the two, the physical medicine and the rehabilitation, is the art of getting the patient, the person back to doing what they want to be doing.
Collaborative Role in Patient Care
00:02:53
Speaker
So the part of that you said was the musculoskeletal. So when you look at a musculoskeletal patient's care team, you kind of have an orthopedic surgeon, a physical therapist, and perhaps an interventional radiologist. You throw in a physiatrist like yourself. Can you kind of talk about how you work in tandem with all those professionals and what role you sort of play and what kind of things you leave for other parts of that care team?
00:03:21
Speaker
Sure. I like to tell people, because it seems to be a very broad explanation. And certainly our field encompasses many, many disorders. And so many of us end up sort of fine tuning our expertise into niches. But I like to tell people that this is very much like external medicine as opposed to internal medicine. So we're oftentimes the frontline people that see patients that come in with
00:03:51
Speaker
Basically anything that is hampering a function, most of the time it's pain or weakness. And we start with the diagnosis, you know, figuring out where the injury is. Well, first of all, if there is an injury, where the injury is and what's hampering the ability of that person to be able to do what they want to be doing.
00:04:17
Speaker
We oftentimes get athletes. I think that's sort of the more well-known thing of what we do within sports medicine, muscular skeleton medicine. A soccer player comes in and they've twisted their ankle and their foot first. Maybe they don't even know they've twisted their ankle. All they know is they come in and their foot hurts and they can't play ball.
00:04:39
Speaker
And so our mission is to really try to get that soccer player back to playing soccer. So we have to figure out why the foot hurts and how to then treat it accordingly.
00:04:56
Speaker
We work in tandem with orthopedic surgeons if that person needs surgery. We work with physical therapists as oftentimes that patient will need some physical therapy to get better. Sometimes we prescribe medication. Sometimes we prescribe bracing. So it really encompasses sort of the front lines of that first
Referral Process Explained
00:05:21
Speaker
that first visit after some patient's coming in and not understanding why they can't do what they want to do. Interesting. Do you find that people, like you were saying with the soccer player, too often jump to say like an orthopedic surgeon or another healthcare professional before getting that external look with a physiatrist?
00:05:44
Speaker
I think that's probably what's happening in many, many cases. I don't think there are as many physiatrists as there are say orthopedic surgeons or even family practice medicine, which has some specialty in sports medicine as well. So that does seem to happen quite a bit. Sometimes we'll get sort of the reverse referral where the orthopedic surgeon recognizing that
00:06:08
Speaker
The issue that they're seeing the patient for is not a surgical problem. Recognizing our expertise in managing the non-operative management will get referrals from the orthopedic surgeon. We do try to educate our primary care doctors. For many people, the first doctor that they see is going to be their family practice physician or their internal medicine physician.
00:06:34
Speaker
So if we, you know, we do try to educate our primary care physicians on what we do so they know to refer to us. But it's not unusual to get referrals back and forth between even our sports medicine, family practice physicians, and physical therapists sometimes will refer to us, orthopedic surgeons will refer to us. Do you have patients that are, have seen an orthopedic surgeon, have gotten surgery, and you're part of their follow-up care after surgery?
Treatment Techniques for Back Pain
00:07:04
Speaker
That also happens as well. Sometimes we'll see a patient recognize that that patient needs surgery. Let's say the patient needs an arthroscopic knee surgery to repair a meniscal injury. You'll see the surgeon will follow up with them until the surgery has healed and the patient is
00:07:26
Speaker
Hopefully near back to where they were but if there seem to be glitches and sometimes unfortunately what can happen is secondary issues can happen. Let's say they've been out of commission for a while and then they develop some weakness because they haven't been adaptive and now their hip hurts them or now their back hurts them. And more often times follow up after the surgery to address the sequelae of the original injury. Okay.
00:07:53
Speaker
Some techniques that I know that are in your toolkit include radio frequency ablation, medical acupuncture, and various forms of injections. Can you discuss in what scenarios you use these different tools?
00:08:09
Speaker
Sure, all those things are the interventions that I use. I like to think of those as my tools. Unlike some other specialties, I think I'm lucky to have a field where really my primary
00:08:25
Speaker
skill is in the skill of diagnosis and then everything else that I'm doing is really tools that I use to help treat the diagnoses that I make. So if a patient frequently will come in with back pain and that seems to be the large bulk of the patient population I see is back pain, neck and back pain.
00:08:46
Speaker
patient comes in with back pain and very typically that back pain is coming localized from the joints of the spine and that's most people complain of through the achy stiffness that they get in the morning or you know sharp pain when they move in a certain way that stays right in the back and that oftentimes is related to pain coming from the joint and so one option if they are responding to
00:09:16
Speaker
conservative care, which would be the physical therapy and strength training piece of it. We can, if necessary, do a block to determine if the pain is coming from the joint. So we block the joint with anesthetic and
00:09:33
Speaker
put a little steroid to decrease inflammation. And if that seems to be the localizing source of the pain, and the patient still has persistent pain, we do the radiofrequency ablation, which is a procedure where we burn the nerve that feeds the joint.
00:09:50
Speaker
So there's thankfully a very small, accessible nerve that feeds the joint that doesn't cause muscular weakness, but it doesn't cause your leg to become paralyzed or, you know, it's a nerve that
00:10:08
Speaker
predominantly functions to give sensation to the joint. We can burn that nerve, that's what the radiofrequency ablation means, is using radiofrequency ablating or burning the nerve so that the joint is rendered numb. And that's one pain-relieving procedure that I do.
00:10:34
Speaker
another avenue that I use is in patients who have pain and want to take a different route and they want to try some alternative or complementary type treatments to address their pain and for whatever reason they either can't or don't want to take medication or they want something adjunctically to add to their physical therapy, we do acupuncture to help alleviate back pain.
00:11:03
Speaker
Also do epidural injections if the patient is having pain that's not being alleviated with physical therapy for nerve-related pain, oftentimes coming from a herniated disc. So basically, if there's an area that hurts, I probably have some sort of intervention that I try to employ to use it.
00:11:28
Speaker
Those are really just tools to get the patient back to being able to function and get stronger. I always tell my patients,
Causes of Back Pain
00:11:40
Speaker
you know, these fancy injections and, well, they sound very promising because the patient comes in and they just want their pain taken care of. I like to explain to them that, you know, the goal really is to get their function back. So we really got to get the strength to
00:11:58
Speaker
to support the structure so that it's not so painful. So it's oftentimes not so simple as just sticking a needle in it. Taking a step back, you said that neck and back pain is one of the most common things you see. What is the reason that you see people having that? Is it A, because of something as serious as trauma, or is it more lifestyle things being overweight, sitting a lot, et cetera? What are the causes for that typically?
00:12:28
Speaker
I think depending on the study that you look at, the number one or number two cause for all chief complaints to the doctor is low back pain. So it's a national epidemic. It's a big problem in our country, is low back pain. So I think part of the reason that the large majority of my practice is back pain is because it is so prevalent.
00:12:56
Speaker
I think there's statistics of something like 85% of all people at some point will take time off for back pain or will have a doctor's visit for back pain. Wow. Yeah, it's quite high.
00:13:13
Speaker
But what are some of the underlying reasons for that being the case? Is it like people are overexerting themselves in a physical way? They have some sort of trauma? Or is it like being overweight or sitting too much? What are the main things you could pinpoint as to why people have such an issue with back pain?
00:13:35
Speaker
I think it's multi-factorial. Maybe once upon a time. It's interesting because back pain seems to be more of a primary chief complaint amongst developed countries. And I think that is because we've sort of gotten away from hunter-gatherer lifestyle. We wake up in the morning
00:14:00
Speaker
Maybe we crawl out of bed, brush our teeth, go down the stairs, maybe that's our physical activity. Grab our coffee, get in the car at 25 minutes, sit in the office eight hours, get back in the car. Maybe if you're really good, you might exercise for 20 or 30 minutes. But we spend most of our day very sedentary. And I don't think that's really what our bodies were
00:14:27
Speaker
were really built for is this prolonged sitting type of activity. And so I think that that starts to then wear on our system. And because our spine is central to our system, the spine gets a large brunt of that. I think also we've gotten a much larger population of neck pain because now we use our smart devices though.
00:14:55
Speaker
And again, I don't think we were meant to look down for hours on end at a small little five inch device. So I think that that probably plays a role into it. Obesity certainly is a big problem in our country.
00:15:11
Speaker
And the reason that's relevant is because many people do carry a lot of their weight sort of at the midsection and that mechanically places a lot of pressure on the low back as well as obesity also leads to some inflammatory factors and inflammation in the joint is oftentimes a factor in pain as well.
00:15:40
Speaker
You know, there are other features, the way we fit. We fit it in a computer.
00:15:48
Speaker
So I think there's a lot of mechanical factors that contribute to the widespread prevalence of low back pain. I think that's why if you just do a quick Google search, you'll see just, you know, back pain treatments and devices and seating and death type things. It's a billion dollar industry, you know, it's, people are,
00:16:15
Speaker
people are willing to pay almost anything to treat their back. I see all kinds of crazy devices, you know, you hang upside down or, you know, put on a copper bracelet or, you know, hang a magnet over your head. I don't know, like there's so many different things that people are willing to do to treat back pain. And I think it's partly the way we live. And I think it's partly the diseases that are as a result of how we live.
00:16:44
Speaker
The most intriguing tool that we discussed before to me is acupuncture.
Integrating Acupuncture with Western Medicine
00:16:51
Speaker
Can you elaborate on the mechanism of acupuncture? You know how it works. And in your eyes, does the efficacy of the practice kind of depend on how much the patient is sort of buying into it?
00:17:08
Speaker
So that's an interesting question. I think a lot of people, and I used to tell patients, I said, you know, I've been doing this for long enough that I can now say, you don't have to believe in it for it to work. I've had several patients come in and say, well, I don't really believe in this, but I'm going to try it because my wife or my daughter or whoever told me that, you know, I should try it. Or I, you know, I don't know what else to try, but I don't want back surgery. So let's try this.
00:17:34
Speaker
There's been enough research to show that acupuncture for certain treatment, for certain diagnoses certainly exceeds placebo effect. And placebo effect is somewhere in the range of 28 to 30%, which is actually in and of itself pretty compelling if you get something that's 30% effective with little to no
00:18:01
Speaker
repercussions is still a significant, it's not 0%. So, but that being said, acupuncture has been shown to be effective. In fact, there's a whole division of complementary and alternative medicine that was born out of acupuncture interest
00:18:23
Speaker
And that's in the Department of the NIH. They have a whole division that studies nothing but complementary treatments to try to get more science on how it works. My training in acupuncture is actually specific to an acupuncture school for physicians only. And so it is an interest in the academy of
00:18:53
Speaker
of learning. I have my traditional medicine of the hip bones connected to the back and all the different anatomical and blood vessels and nerve endings and skin and welcome and how they interact. And then when I went to learn acupuncture, the physician who was teaching it
00:19:20
Speaker
Joe Helms had said, you know, I need you for a moment to put all of your medical knowledge aside and learn a new way of thinking. Because in the acupuncture realm, they describe the body as a series of meridians, which is channeled.
00:19:46
Speaker
And dysfunction of the body is related to a dysfunction of one of these meridians. And so there's 15 meridians, which is different than thinking of the blood system, the circulatory system, or muscular system, or our nerve system. And acupuncture has been mapped out across these 15 meridians, and treatments are based
00:20:16
Speaker
and treating these blockages of the meridians, which is based on your diagnosis, again, of where the blockages are. I find that with the acupuncture treatments that I'm using, where I'm trying to diagnose an acupuncture diagnosis, sort of parallel to diagnosing my allopathic or my standard medical, Western medical diagnosis, that they oftentimes can help each other.
00:20:47
Speaker
So, for instance, if I get a patient, and there's five phases within acupuncture phase of learned, you know, there's metal and word and fire. And it's interesting because it sounds a lot more voodoo-y, I suppose, when I describe it in English, that in its traditional language as Chinese,
00:21:13
Speaker
It doesn't have the same connotations as just being elements of earth or wind or fire. It actually has a way of describing, being more descriptive as opposed to elements that are very concrete.
00:21:37
Speaker
So when I see a patient who seems very inflamed with a lot of back pain and they're right in the face and writhing and almost explosive, I would say that patient's very fire or very hot. Or I would say the patient has a lot of back spasm, the muscles are in tension and there's a lot of spasm.
00:22:02
Speaker
You can bridge those to the acupuncture world and the allopathic world. At least that's what I do. So if in the future I end up treating that patient with acupuncture, I think to myself this person would do well with the acupuncture world as a dispersion treatment. So I think along those lines of that variety. And in terms of what we've proven within the study of acupuncture,
00:22:28
Speaker
I don't think they have a defined idea exactly how it works from a cellular level. So what they have shown is that it does matter where you stick a needle, just sticking a needle into any old place in the body is different than placing them at a precise acupuncture point along a channel. For instance, they did a study where they injected at
00:22:56
Speaker
acupuncture points with some technetian which is like a radio sensitive isotope.
00:23:04
Speaker
The injectate actually traveled along these meridians, whereas if you injected the technetium in a random sham point, non-acupuncture point, it just sort of stayed locally and dispersed locally. So I thought that was very interesting when I was getting my training. Another study that was kind of interesting was that
00:23:28
Speaker
You know, the acupuncture needles that we use are metallic, and they have to be metallic. And the reason for that is that when you turn the acupuncture needle, as I place the needles, I give it a little bit of a turn, it actually changes the polarity. It goes from plus to minus.
00:23:50
Speaker
And so many acupuncture is actually employed using electrical current to move along that current.
00:23:59
Speaker
And it was described back in the olden days that you'd use bamboo, acupressions, which are pretty self-torturous. And the reason that would work was because they would use live bamboo, which had water in it and conductive, therefore. So we do know that there's something that's happening. We do know that it seems to be traveling along these predescribed channels.
00:24:24
Speaker
And there's enough studies that show that it has efficacy. But the problem is that it's hard to do this study because there's so many different fields of acupuncture. There's different schools of acupuncture and different ideas of proper treatment. And so the research on it isn't very standardized.
00:24:50
Speaker
Yeah, what you're saying definitely leads me into a further holistic discussion, I guess I wanted to have. A lot of your practice sounds like it revolves around relieving pain, which I guess is in general like what a physician does, but particularly in physiatry, it sounds like.
Complex Nature of Pain
00:25:08
Speaker
So can you define pain in the physiological sense and then also in the holistic sense and maybe describe how you synthesize these in your practice?
00:25:20
Speaker
pain is sort of a unique experience. And for all of the advances we've made in medicine, we still don't really have a test to measure pain. And so it's only as good as a person describes their pain. And so the International Society of Pain actually describes pain as one of emotional, sensory, and cultural
00:25:52
Speaker
So, a physical entity, a physical stimulus can occur to cause pain. So, if you cut yourself, you know, you get the chemical markers of cytokines and inflammation and these are
00:26:14
Speaker
These are protected because you send a signal up to your brain to tell the brain that something bad has happened and you should avoid that. Or I should say, if you put your hand on a hot stove, you'll move your hand away because it's painful. Actually, reflexively, your body, before it even knows it's in pain, knows to pull it away because of the stimuli. So that's the physical somatic.
00:26:38
Speaker
Then there's the emotion component to it, which is, I can't believe I burned my skin and oh my gosh, I'm going to have to, you know, the emotion of the pain. And that has a lot to do with, you know, how the individual responds to that pain.
00:26:58
Speaker
We certainly see people with very similar injuries with a wide variety of responses to it. And then the cultural aspect of what is culturally acceptable in terms of how they express their pain. So pain is pretty complex because there's no one measure for pain. And so what we often do is we ask people to standardize their own pain
00:27:27
Speaker
So I'll ask patients, you know, on a range of zero being no pain and 10 being the worst pain, where's your pain level at? And that gives me a gauge of where they're starting out from in terms of their level of suffering and both emotionally and physically. And that gives me a way to sort of gauge the progression and success of our treatment options.
00:27:55
Speaker
But as I tell people, sometimes people come in and they want an MRI because they want to know why they're in pain. And I like to explain to them, you know, there's no test for pain. We have lots and lots of tests to tell us the way things are working or not working, but we don't have a test for pain. Right, yeah. I think the emotional and
00:28:20
Speaker
physical distinction between pain is interesting. I know that Buddhist thought makes a distinction between pain and suffering. Pain is sort of this inevitable aspect of life while suffering is brought on by grasping and not accepting the pain. Does that inform?
00:28:41
Speaker
how you interact with patients where you kind of say you have two individuals who both have a certain injury, but one is reacting very differently. How do you kind of cater your care depending on how much suffering they're, quote unquote, causing themselves?
00:29:00
Speaker
Well, I always believe my patient. A patient comes in and they tell me they're in 8 out of 10 pain. They're in 8 out of 10 pain. Now whether or not I can tie that 8 out of 10 pain to a specific abnormality on an MRI or an x-ray or on my physical exam isn't always
00:29:22
Speaker
you know, isn't always one-to-one correlation to their level of pain. But I try very hard to not say to the patient, you know, you don't have pain. And in fact, I never say to the patient that they don't have pain because if the patient's coming to you because they're complaining of pain, you have to believe them.
00:29:44
Speaker
I do oftentimes broach the subject of what else is going on in their lives. And actually many times patients will volunteer that I think I'm under a lot of stress. I think that might be causing my neck pain. What do you think? And I will say, you know, definitely. And it's not just because the person
00:30:05
Speaker
is it tough enough or, you know, zen enough or whatever, there's a physiologic response that occurs when we are under stress that makes us more vulnerable to pain.
00:30:17
Speaker
And there's a physiological, and so I ask about a lot of things, you know, not just what your stress level is, but you know, how well are you sleeping? We also know like if you don't get good quality sleep, you're going to be in more pain. You don't get good nutrition. If you don't, if your psychological health is not optimized, you're more vulnerable to pain. We know patients who are depressed,
00:30:42
Speaker
are more likely to have chronic pain as well. But there's a lot of physical factors that play into how a person expresses an injury. Do you believe just even coming into your office talking about their pain and maybe some of the factors like stress or other things that are going on in your life, that in and of itself just decreases the pain?
Patient Empowerment in Treatment
00:31:12
Speaker
You know, sometimes patients will actually say, you know, I feel so much better after talking to you. And I think there is value in.
00:31:21
Speaker
Well, and I think for one, when a patient comes in and sees the physician, they're making an active, they're doing something actively or something that they may feel helpless about. So when they have, oftentimes people have pain and they'll say, you know, it's a very helpless feeling because I don't know what to do to alleviate it. But sometimes just making that first step and seeing the doctor,
00:31:45
Speaker
give the patient some control back. And I think that that's very empowering. And at least if this doesn't bring down the pain down from eight to six, at least they feel like they're doing something and that there's a plan. And I do try to make sure that, one, I understand why the patient is there, what the patient expects from the visit, and then what our plan is.
00:32:14
Speaker
to reach that goal. And I think sometimes just having a concrete plan of here's what we're going to do. Here's what I think your diagnosis is. Here's what I think we're going to do. Here's what we can do about it. And then it gives the patient a roadmap to follow. And I think that can be very empowering. And that end of itself sometimes can alleviate pain.
00:32:39
Speaker
I want to shift gears a little bit and talk about just a medicine in a broader sense and ask you, what are the gifts and challenges of being a woman in medicine?
Women in Medicine
00:32:52
Speaker
I don't know. I've never not been a woman in medicine. So I think that medicine is
00:33:04
Speaker
is incredibly gratifying, and I think that nothing that's gratifying isn't hard. So, you know, I expect that the things that I do to, that I get the most joy out of and the most gratification out of it are by its very nature going to be challenging. So, in terms of specifically to being a female in medicine,
00:33:34
Speaker
I think there are challenges when one isn't being understood. So I don't know if that's always because I'm a woman or not a woman. But of course, you know, when you meet challenges and you have difficulty communicating what challenges are or when you feel that you're not being understood, that can be very challenging. I think that I graduated at a time when
00:34:04
Speaker
There were, I think, my graduating class was 28% women. It was not a lot of women. These days at University of Michigan, go blue, which is where I went to medical school. The medical school class is actually 51% women. So there's actually, for the first time ever, more women than men in that class. And I suspect that probably changes the dynamic some.
00:34:35
Speaker
I think that being a woman in medicine, you know, there are the sort of funny things that we all share amongst my other fellow women colleagues of being mistaken for, you know, for not being the doctor. There's a joke that somebody had posted, which was, when
00:35:05
Speaker
when your woman doctor comes in and introduces herself as a doctor, and then treats you, tells you your diagnosis, tells you your treatment, and then says she's a doctor, and then shakes your hand and then leaves your room.
00:35:30
Speaker
it means that she wasn't your nurse, she's your doctor. I didn't say that very elegantly. I think most of my colleagues have had that experience where I happened to have a male medical assistant come in and he took the blood pressure from my patient and said a few niceties, walked out and then I came in and introduced myself, saw the patient, gave a diagnosis plan and
00:35:58
Speaker
And I said, you know, is there anything else I can help you out with? And the patient said, yeah, when is the doctor coming back in? And so we had those types of challenges. And so much less so now than there used to be. So I think that the fabric of medicine is changing a little bit now that there are more women in there.
00:36:26
Speaker
But like I said, I only know my own experiences. And whatever challenges I've faced, I also absorb into what I've achieved. And I don't know if that helped answer your question at all.
00:36:46
Speaker
No, yeah, I mean, it's just an ongoing discussion. Like you said, the fabric of medicine is changing. So I think it's important to just continue a constant dialogue regarding life.
00:36:57
Speaker
what doctors what what healthcare looks like you know uh... i don't think you know actually that one of the most empowering things i've done at the female position is i just returned from a conference which was called
Women Physician Wellness Conference
00:37:12
Speaker
uh... the women uh... position wellness conference and it was a conference of all women physicians from all different fields they're coming together and talking about uh... you know their their experiences
00:37:27
Speaker
And a lot of it was venting and talking about scenarios like I just talked about where you're not always recognized or your accomplishments or being talked over or your ideas being passed off as somebody else's and those types of challenges.
00:37:50
Speaker
really unique and empowering to go to the conference. And it is something that I have to say. I don't think, well, I know it wasn't available, you know, 15, 20 years ago. And now I think with the increasing numbers,
00:38:09
Speaker
we as women physicians don't always feel like we are by ourselves and increasingly we can empower each other to just go out there and do it and not second guess ourselves.
Telehealth During COVID-19
00:38:25
Speaker
I just want to bring it back to the present again with what's going on with COVID. I know you're doing some increased visits with telehealth. Can you just talk about how that's been going and do you feel that it compromises the doctor-patient relationship at all?
00:38:45
Speaker
Telehealth has been interesting, it certainly has been interesting and it's been a fast learning curve. I think they've been trying to roll it in. Telehealth has been trying, they've been trying, people within medicine and certainly the government have been trying to roll in things like telehealth to try to get to broaden access.
00:39:08
Speaker
If there are challenges certainly with it, it's very hard to do a physical exam within my field without being able to physically be present with the patient. That being said, there are, it certainly is better than nothing and I've been doing some televisions with my patients and if I can visually see them and I can instruct them as long as the patient's able to follow directions,
00:39:35
Speaker
and understands my direction, so it definitely forces me to improve my communication verbally on how I want them to proceed because I have to be a little bit more creative on doing the physical exam.
00:39:54
Speaker
I see some benefits in doing televisits for the patient that might have limited access to be able to get to us as physicians. So, for instance, I saw a patient the other day who had
00:40:09
Speaker
severe acute back pain. And I don't think that patient would have physically been able to get to my office. He was in so much pain, so he was sort of laying on his couch. And so at very least I could talk to him. I could see him. I could sort of instruct him. And so there was a lot of value to the televisit there.
00:40:31
Speaker
On the other hand, the other day I had somebody who had sprained their knee and that was very hard to assess because short of just being able to see that it's swollen and that the patient was limping, it's very hard to gauge how much swelling and how much laxity or give there is without really touching the knee. So I don't think that
00:40:56
Speaker
at least within my field of musculoskeletal medicine, that we're going to be replaced by computers or televisits 100%. But I definitely think it'll be a useful tool and this pandemic has sort of forced our hand. And I think that it will change a component of medicine ongoing even after we get past this
00:41:26
Speaker
Um crisis And just uh, I think for the better Just a general uh physician question related to covet I know that um, like obviously like emergency physicians, uh internal medicine people are are definitely being strained a lot on the front lines, but are For like the whole physician population are are
Healthcare Professionals' Role During COVID-19
00:41:53
Speaker
Are doctors from all specialties kind of trying to be recruited to sort of help in the shortage of providers on the front lines?
00:42:04
Speaker
I definitely have gotten notices from New York State government, and from Connecticut government, sort of a call to action. And that's just generally, I think, because I have an MD, I think they've sort of put it out there to all health professionals that if they don't have an active license, or if they've been recently retired, they've encouraged people to come out of retirement and volunteer their efforts.
00:42:32
Speaker
I have heard from other physiatrists who practice more of the inpatient rehabilitation that they've been asked to redirect and be treating more general medicine patients as opposed to just their physiatry patients. But myself, I have not been. We are staying within our specialty and we are taking call and
00:43:02
Speaker
the urgent care portion of the orthopedic.
00:43:07
Speaker
here at our hospital. So, you know, just because this pandemic is occurring doesn't mean that people aren't continuing to have orthopedic issues and problems. And so our hospital has sort of shifted gears to treating those urgent orthopedic issues that maybe would have gone to the emergency room, but really since they're, you know, people aren't wanting to go there and expose themselves potentially
00:43:35
Speaker
to the virus. And also, they're wanting more specialized orthopedic care. And so we're taking call for that. All right.
Dr. Chen's Personal Interests
00:43:54
Speaker
Well, I just wanted to finish up real quick with a series of fast-paced questions that tell us more about you. So you practice out of Stanford, Connecticut.
00:44:04
Speaker
And speaking on behalf of All Millennials, we know Stanford from The Office. Are you an Office fan? I love The Office. So who's your favorite Office character?
00:44:15
Speaker
Or favorite office moment? Oh, my favorite office moment. You know, actually, it wasn't necessarily an office moment, but I just saw a cute podcast, it was in a podcast, a cute thing with John Kravitzky and Steve Carell, where they go down memory lane. And this was just out, like, a couple days ago.
00:44:37
Speaker
And that was, that was great. And I hope you look it up. I think John Kaczyski is doing something called, like something like Just Good News or something like that. He was trying to do something positive and upbeat. And he brought our funeral neighbor, like, laughing about their favorite moments. So you should take a look at that.
00:44:57
Speaker
Oh gosh, so many funny moments. I loved the, was it the 3K or the marathon at Steve Carell, where Michael is like doing this marathon and it's really hot out and he's like carb loading while he's running and it's an awesome, funny, funny episode.
00:45:22
Speaker
And then at the end he finishes and I think he's only gone like around the block or something. I think Jim and Pam skipped out on that one if I recall correctly. They dogged it, they walked it. I think they went home. I'll take you back down memory lane when you were roaming State Street in South U. What's your favorite activity to do in Ann Arbor?
00:45:53
Speaker
Oh, wow. And let's go into Rick's. Oh, yeah. Great fans, great fun times. My friends and I always liked Dollar Domestics. That's a good night. That's right. Well, back in my day with Dollar Pictures, so that's how old I am.
00:46:14
Speaker
But that was a good deal even back then. Let's see, I loved something in med school that we did, which was called the Galen Smoker, and we did a spoof musical every year, and that was super fun too. Very cool. Couple more for you here. Do you have a hobby that you enjoy? Gosh, hobbies. I play a little bit of golf, not very well. Not lately.
00:46:43
Speaker
my hobbies right now. I love reading. You don't get to do that a whole lot. Um, just finished up Mitch Algum's most recent book. Um, and you know, I think it was his most recent book. Um, and
00:47:00
Speaker
What else do I love doing? I like exercising. I really love working out. So I like to, I'm not a great runner with a physiological dose for running, but I do 5Ks now and then. And I like to work out and be outside. Excellent. Lastly, you have a shout out to perhaps a mentor in your medical career or your life?
Acknowledging Mentors and Giving Back
00:47:25
Speaker
Oh, well, quite a few.
00:47:29
Speaker
Within my field of psychiatry, there's a man named Joel DeLisa who really was very instrumental in building the field of physical medicine and rehabilitation into a much more respectable field.
00:47:52
Speaker
And I think he said something to all of us while we were training, which was, you know, you've been blessed with being in one of the best training programs in the country. And so in exchange, I really urge you guys to give back to the field. And then that's always sort of stuck with me. The importance of sort of putting the word out there on what we do and making sure that we're practicing really good quality
00:48:24
Speaker
Dr. Alice Chen, thanks for joining the show. Thank you so much, John. Take care. Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neery. Be well.