Defying the distance: 70-year-old psychiatrist embraces telemedicine
I had very specific instructions to Dr. Little’s house, which he had given me with careful detail over the phone. He lives just down the street from the school; take a left, a right, and park in the alley. There would be a doorbell above the water hose. I appreciated this attention to detail, and the fact that Dr. Little was so eager to give me directions told me a lot about him as a physician: He was considerate, precise, and cared enough about me to make sure I didn’t end up accidentally driving to Los Angeles (good thing—I’m what you might call “directionally challenged.”)
Not that Dr. Little regularly gives people directions to his house. In fact, I’m probably one of the few people to see his office in person. And my 95 mile drive to Dr. Little’s house—an hour shy of his “commute” to his psychiatry practice at Feather River Hospital in Paradise, California. This commute would take him, in theory, about three hours one way.
Dr. Little works three days a week and sees about 14 patients per day, visiting with patients from the comfort of his own home office. At 70 years old, he’s been practicing medicine for decades, his devotion to psychiatry and his patients led him to find new, innovative ways to care for them—all while trying to maintain a life-work balance. The switch to telehealth was a no-brainer for Dr. Little, who has a history of going the extra mile (or a thousand) to find new opportunities to help members of his community.
Dr. Little grew up in West Virginia. “My mother’s side of the family had a history of ADHD and bipolar disorder, so I came to psychiatry the natural way—I had family members with these types of illnesses. I didn’t realize I was going to be a psychiatrist until I did my clinical rotations and everything just felt right,” he told me. After being a dental technician for a couple of years, he attended medical school in West Virginia on a Navy scholarship. He was drafted during the Vietnam war, and he saw many psychotic “first break” patients in his tenure there. One night he recalls admitting a whopping 14 people from the medivac at the David Grant Medical Center, where he and other physicians didn’t get everyone to bed until 3am.
During his 33 years in the Navy, Dr. Little not only provided care to his patients, but also assisted in initiating the electronic health record system for military medicine. Before he joined Adventist Health nearly a decade ago, he had a private practice in Oak Harbor, Washington. Then he and his wife were motivated to move to California for a very specific reason. Two very specific reasons, actually.
Their son and daughter-in-law were going to have twins.
Not that they weren’t up for it, by any means. “I’ve had a lot of very different, fun experience in my career,” says Dr. Little, “I’ve always been up for a new adventure.”
Dr. Little and his wife moved to Paradise, California, where he was hired at Feather River Hospital. While this move was an improvement in distance to his new grandkids, it wasn’t until the twins were older that Dr. Little and his wife decided it was time to live closer to them—near Tracy, California—to have more opportunities to see them grow up. While, at 70, Dr. Little could retire if he wanted to, he decided to jump at the chance to try telehealth.
Instead of commuting three hours to see his patients every day, Dr. Little takes just a few steps on the white-carpeted stairs of his home, up to his office. There, he has a computer desk with double monitors, where a small camera perches on top of one like a small bird. Next to his desk is a chair that I can only describe as “a blue velvet dream,” and surrounding it all are built-in shelves filled with books about medicine and psychiatry, and I even spotted a few shelves devoted to historical non-fiction. And instead of traditional bookends, Dr. Little has peppered his shelves with an assortment of polar bears.
Why the polar bears? I ask.
“It’s kind of a funny story—it started as a ‘thank you’ gift,” says Dr. Little. He explains that while he was working at the naval hospital in Oakland, he was assisting a lady performing remote diagnostic viewing. One of the exercises involved flipping through a magazine. “So I opened it and it was a picture of a polar bear, and thinking that was ‘too gruesome,’ I grabbed another magazine. I opened it to a picture of a grizzly bear. And the third magazine opened to another polar bear! So I thought, ‘Well…I guess I’m going to have to deal with this.’ They’ve since become a totem animal, of sorts.” He points to his polar bears along the shelves—about a dozen of them, made of wood and glass and various metals. He explains that they are from all over the world and then he laughs and admits that “They’re kind of like me, I’ve been compared to a bear at times!”
As technology makes leaps and bounds towards improving the way we go about our daily lives, telemedicine is a convenient, cost-saving method for seeing your doctor in non-emergent situations. It has created many opportunities for helping patients in rural communities—or those who couldn’t otherwise visit their doctor until their illness forced them to be admitted to the hospital. Facilities such as Tillamook Regional Medical Center have hit the ground running with virtual visits, even receiving national recognition for their use of telemedicine to reach the members of their community. And while Dr. Little was eager to use this method, a few of his patients were hesitant.
“Telemedicine can be a little off-putting,” he says, “At least for folks my age, or older—I would say the younger groups are so accustomed to things like Skype and Facebook that it’s not a problem for them.” Dr. Little says that while most of his patients are happy to have virtual visits, a couple have continued to want the traditional method. For these patients, Dr. Little sees them during his bi-monthly visits to Feather River.
What are these “virtual visits” really like? For Dr. Little’s patients, the only difference is that he is not physically sitting across from them for their hour-long sessions. Dr. Little shows me the login screen where he “sees” patients: A camera is focused on a small sofa inside a room at Feather River Hospital. After filling out a questionnaire about their moods since their last visit, the patient takes a seat and begins their visit as usual. If anything unusual happens, Dr. Little has direct contact with his nurses via Skype, who are ready to intervene if needed.
Dr. Little says he’s blessed to have a good team at Feather River. “You have to plan ahead, know your routines and have processes in place. You have to have good communication with your nurses and medical assistants,” he says, “They’re your hands. You have no hands when you’re doing telemedicine.”
How much longer does Dr. Little plan to keep his practice? “Oh, maybe about five years,” he says. I ask him what he thinks telemedicine will look like then, and he says he thinks it’ll be “faster, slicker than what we have now,” although he admits that the current system is on-point. He also says that he hasn’t lost any of the personal connections he feels with his patients. “It’s not rocket science, by any means,” he says, “If you grew up as a Star Wars kid, it’s not as big of a deal.”
I ask Dr. Little what has been the best part of using telehealth. “I still get to work for Adventist Health, see my patients, and my 9-year-old twin grandsons—along with their brother, who is two years younger,” Dr. Little says. He smiles and says it’s a joy to be able to spend more time with them spontaneously, whereas before this he was only able to see them about once every other month. “And I get to have lunch with my wife every day, which is very nice.”
Sometimes, being a homebody is the greatest way to help your community.