Dr. Watson, Come Here, I want you – 

April 11, 2020 – The rules were revised in order to promote physical distancing, and thus decrease the spread of COVID-19. But the change has also profoundly improved the ability for providers like me to address the ongoing national epidemic of addiction and overdose that preceded COVID-19, and that will almost certainly outlast it. Many of my patients are unemployed, tenuously housed, or without any housing at all. With this rule change, I can now prescribe to patients who don’t have bus money to make it to clinic, but who have a phone, or can borrow one. I can prescribe to patients I would never see in clinic, even if I gave them bus tickets, because it is too hard to navigate our halls and elevators while also carrying their sleeping bags and tents. And I can see patients who live in rural parts of our state and don’t have the resources to travel. Certainly, there are still significant barriers to care — access to phones, wireless, and data plans chief among them. Nevertheless, this is a critical advance.

Providing care virtually also has another important benefit. In the rush of a busy clinic day, it can be difficult to remember to ask about the details of a patient’s life, the context in which their health, disease, and habits develop and thrive. It is even harder to pay sufficient, focused, attention to the answers. But when I see John on screen, I don’t have to remember to ask if he smokes. He’s puffing away in front of me. More than that, I see the relief it brings him, on that orange couch, in this scary time, and that helps me understand when he says he’s not yet ready to quit. When I see my next patient, I don’t need to remember to inquire about housing: he’s calling from a Walmart parking lot, near where he plans to camp for the night. Later that evening, I see only the shadow of my last patient, inside her car, tight and dark. I don’t need to wonder why her answers are clipped, and she can’t seem to focus.


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