June 1, 2021
Originally published in Authority Magazine – June 1, 2021
BY DAVE PHILISTIN
One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?
In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. Margarita Loeza.
Dr. Margarita Loeza is a Los Angeles-based family physician and Chief Medical Information Officer who works at the same local nonprofit community health center, Venice Family Clinic, where she and her family were patients years ago.
As a child, Dr. Loeza received a referral for treatment of a congenital hip condition at Venice Family Clinic. Inspired by the care she received, she decided that she wanted to be a doctor when she grew up. Today, as a doctor at Venice Family Clinic, she leads the development and implementation of the Clinic’s telehealth program that has effectively treated and continues to treat thousands of low-income patients during the COVID-19 pandemic.
Dr. Loeza is a graduate of the University of California, San Diego School of Medicine and trained at the San Bernardino County Hospital in the department of Family Medicine. Dr. Loeza also served on the Board of Doctors for Global Health, Latino Physicians of California, and Refugee Health Alliance. Since 2013, she has served as faculty advisor for Flying Samaritans at UCLA, which operates a monthly clinic in Tijuana where Dr. Loeza and other volunteers deliver free health care to a small community. During the pandemic, Flying Samaritans continued to provide visits via telemedicine from the US to Tijuana. In addition, she serves a mentor for first-generation medical and pre-medical students as part of MiMentor and as a First-Generation Co-Faculty Advisor at the David Geffen School of Medicine at UCLA.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
When I was a child, and when Venice Family Clinic was still in its early years, my parents Roberto and Graciela sought medical help for my condition. I was born feet first and my hip was dislocated on the way out. I endured years of doctor visits, hospitalizations and surgeries as a result. My parents, both immigrants from Mexico, had no health insurance, so the nonprofit community clinic where I now work was a vital resource for my family. The orthopedic doctor who helped fix my hip became my hero.
After my residency, I returned to Venice Family Clinic as a volunteer to provide medical care and help my community. I thought all Clinic doctors were volunteers until 2001, when I realized that I could apply for a job at the Clinic that I grew up with and still serves my community to this day. This past April, I officially celebrated my 20-year anniversary working at Venice Family Clinic.
My health care experience — like the experiences of many of our patients — is a real-life testimony to Venice Family Clinic’s commitment to transforming the lives and health of our patients regardless of their income or immigration status.
Can you share the most interesting story that happened to you since you began your career?
Early in my career, I felt that my voice was not heard because I’m a woman and a person of color. Latinx physicians make up less than 6% of doctors in the United States, and Latinx women physicians like myself only account for around 2%. As a college and medical student, I searched for first-generation, female Latinx mentors to help guide my career, but I did not find them accessible to me.
This type of representation really matters: It is so important to have a diverse group at the table to ensure voices like mine are heard in health care, and to empower and inspire people from different backgrounds to work in a field where they are currently underrepresented. Being able to work with and learn from folks from different cultures and with different experiences can only make us better doctors.
Diversity is also a key component of delivering quality patient care. As an example of the challenges that arise without representation, at one Boston-based hospital, clinicians struggled to clearly communicate with patients who did not speak English during the pandemic. Those patients had a 35% greater chance of death from COVID-19.
At Venice Family Clinic we pride ourselves on meeting our community’s needs, and that starts with understanding our patients. Along with my Clinic colleagues, I see diverse patients of every ethnicity daily. Over a third of our patients speak Spanish as their primary language. My ability to speak with these patients not only in their native language, but also with a shared sense of culture and experience, is a key part of effectively treating the whole patient. Humans and relationships are complicated, and building trust often begins with a shared experience or background.
That is why I now serve as the Vice President of the Alliance in Mentorship Board that supports MiMentor and am also on the Latinx Physicians of California Board of Directors, where I serve as the Latinx Legacy Roundtable Leader. At Venice Family Clinic, I have become a mentor to medical students from underrepresented communities, and this has added joy to my work.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” — Dr. Martin Luther King
Lack of access to quality health care is one of the biggest risks to health and happiness in America today. Choices are limited for people without a lot of money, and the absence of high-quality health care can lead to sickness and death for people unable to afford it.
Health care is not like transportation, where you can buy a used car or take the bus to save money. Instead, it can force all-or-nothing decisions like having to pay top dollar for surgery or face a lifetime of physical difficulty. For someone who can’t afford that surgery, there is no cheaper option.
People without access to care or financial resources also face greater risk. At the start of the COVID-19 pandemic, everyone who had a computer and the ability to work remotely could stay home and keep themselves and their family safe. Meanwhile, essential blue-collar workers, farmworkers, and people who couldn’t work remotely had to leave their homes and work in public, leaving them and their families more susceptible to COVID-19.
At Venice Family Clinic, we pride ourselves on providing high quality comprehensive health care to those families and individuals who might otherwise go without the care they need. With 64% of our patients living below the federal poverty line and a robust street medicine program that helps treat people experiencing homelessness, Clinic staff works around the clock to ensure our community has access to comprehensive quality care.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
I am forever grateful to my parents. They found a way to support me and adapt to a new, radically different environment to ensure I had the best future possible. As the oldest of five, there was no way I would be able to live at home and continue my education while looking after my younger siblings — it was just too much work. For my parents, on the other hand, it was not easy to let an 18-year-old woman go live in a dorm on campus at Occidental College. They fully supported and trusted me, but they took a lot of heat for it from their friends, who believed I should just get married or start working full time instead of going to college. My parents’ hard work and love made my dream of being a doctor possible. I would not be where I am today without them.
Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?
Telehealth and telemedicine are wonderful resources and a great supplement to face-to-face visits, especially during the ongoing COVID-19 pandemic. Obviously in-person visits and treatment are ideal for many types of visits, but that simply wasn’t the world we were living in as recently as a couple months ago.
As we return to normalcy, being in the same room as a patient is a key part of health care for good reason: You can look directly at the patient, hear their heartbeat, take their other vitals and examine their bodies for signs of swelling, infection and other issues. You can touch areas where there’s pain to ascertain the degree of pain. You can also administer injections and other in-office treatments that aren’t possible over a phone or computer. Just as importantly, you can pick up on the little things like body language and subtle cues that you might miss over the phone.
On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?
Telehealth has been such an important resource throughout this pandemic, and it would be hard to overstate its value to both clinicians and patients. With widespread need and the emergency approval of reimbursement for remote care, telehealth visits allow doctors like me to work with patients, make diagnoses and give patients necessary referrals, all while being reimbursed at our full rate to ensure we can continue providing sustainable care to our community. At Venice Family Clinic, we conducted as many as 76% of our billable appointments over phone during the pandemic. This number will decline as COVID-19 risk declines and patients return to doctor’s offices, but it is crucial that we keep this increased access open for people in need.
While it is imperative that we preserve telehealth as a fully reimbursable option, it will be great to see people back in the office as well. I have a lot of patients who I see every month, some of whom I’ve been treating for up to 20 years, and I miss seeing them in person.
Not being able to see some patients face-to-face can be an obstacle. If patients can’t describe what they are feeling, or don’t know the names of their medications, it can be more challenging to take care of them. Direct observation can tell a doctor a lot of valuable information.
As an example of the power of being in the same room, I treated one patient who had pain in their hand but was unable to articulate exactly where it hurt. Without being able to directly observe her in person, I would not have been able to correctly diagnose her issue.
Recently I saw a patient with abdominal pain. Because she was in an exam room with me, I could run tests right away, and I discovered that she needed to go to the Emergency Room that very evening to have an emergency appendectomy. From our conversation alone, I would never have been able to diagnose her accurately because her description of her symptoms wasn’t enough to form a diagnosis. Fortunately, we were able to get her treatment in time.
Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)
Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?
Telehealth is essential to expanding people’s access to health care as well as increasing our national health system’s capacity. It has been an invaluable resource for Venice Family Clinic and its patients throughout COVID-19, and we intend to continue to offer the same expanded access and capacity post-pandemic.
Throughout the pandemic, Venice Family Clinic never closed. Instead, with the help of telehealth and our resourceful staff, we adapted. We totally reimagined the Clinic’s infrastructure to meet the needs of our community during the pandemic: using telemedicine to diagnose and treat patients, COVID testing, administering vaccines, hosting food drives, and tackling the social determinants of health beyond COVID-19 by directly aiding patients without enough to eat or a place to sleep and quarantine. This is an extension of what Venice Family Clinic has always done: Treating our patients as a whole person by taking care of needs that go beyond basic medical care.
Telehealth and telemedicine have allowed the Clinic to increase its capacity and offer more patients access to comprehensive care including primary care, behavioral health counseling, health education, insurance enrollment and other services.
As we begin to return to interacting more normally with each other, we cannot let go of the advantages of telehealth. The health of our society relies on each of us, and COVID-19 has helped illustrate how important it is that health care is accessible to everyone, especially communities of color, who experienced significantly higher death and diagnosis rates.
Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?
In my experience, telehealth starts with a simple tool that I view as the bare minimum: a phone. Any remote connection between patient and doctor begins with a phone to connect us. Once that connection is made and a level of trust is established, we can start to discuss the issues the patient is facing, and I can start to diagnose, help them make treatment decisions and develop a care plan. Sometimes just that phone call is enough: Often, people with anxiety and depression just need to talk to someone. Other patients have questions about COVID-19 and vaccine options. But that all-important patient connection starts with a simple phone call. For people experiencing homelessness, like roughly 5,000 of the patients we see at Venice Family Clinic, or people without reliable internet service, access to care by phone is essential.
As the digital divide continues to widen, and our patients continue to struggle with poverty and lack of access to emerging technologies, the phone will continue to be the most important telehealth tool for Venice Family Clinic.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
The perfect telehealth system would ensure equal access to care for everyone, regardless of income or socioeconomic status. Before we spend billions on exciting new tools and gadgets, we need to focus on the most important part of health care: ensuring that we provide high quality comprehensive health care to families and individuals, especially people who might otherwise go without the care they need. We should leverage technology only insofar as it helps us to improve that care and quality of life for our patients.
We still have a long way to go to get to this point, but making sure phone visits continue to be an option to connect patients with their doctors is key. At Venice Family Clinic, we see about 27,000 patients each year — 64% of whom live below the federal poverty line and almost 5,000 of whom are experiencing homelessness. Many of them have limited transportation options and may have to take several buses to get to one of our clinic sites. Many work in jobs with limited or no sick leave, so they may have to give up all or part of a day’s pay to see a doctor. Being able to offer phone visits means these patients don’t have to make sacrifices just to see their clinician.
Even among our patients experiencing homelessness, almost all have a phone or access to one. We can use videoconferencing technology for those patients who have sufficient technology, bandwidth and knowledge; but for many, a phone visit is the best option.
Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?
Yes. I want patients to know that we will continue to do our absolute best to serve them, and we really appreciate everyone who trusts us with their health care.
The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?
While this technology is exciting in the abstract, I am not convinced that it is the answer for all our patients at this time, and I am concerned it will continue to widen the digital divide. I believe that the cost of developing and adopting this technology is better served going directly to patient care.
We need to take care of our patients and their needs today. I would prefer that money go directly to benefitting our patients in tried-and-true ways, whether that be subsidizing care for people who cannot afford it or leveraging existing technologies to provide care to people who were previously unable to access it.
Is there a part of this future vision that concerns you? Can you explain?
As telemedicine technologies continues to expand, the growing digital divide may eventually leave our poorer patients behind. To prevent this, we must focus on accessibility and technological literacy for our patients. I am also concerned that people view telemedicine as connected to this pandemic now and may be reticent to explore its possibilities after the pandemic has subsided. Telemedicine itself is a great tool, so I really hope that it will not always be connected to the pandemic.
Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
If I would like to see universal healthcare for all people living and working in this country.
How can our readers further follow your work online?
Please visit our website, https://venicefamilyclinic.org/
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.