The Pandemic in Rural America: A Q&A with Chris Morris, MD

Treating patients in rural communities comes with its own set of challenges, and practicing rheumatologists in these areas have been taxed further throughout the COVID-19 pandemic. Access to labs and other health services—which was already difficult in rural communities—has suffered as a result of COVID-19-related closures and hospital restrictions. But the expansion of telemedicine has been helpful, says Chris Morris, MD, of Arthritis Associates of Kingsport, Tenn. The busy, single-specialty practice employs three rheumatologists and five physicians assistants and offers X-ray, phlebotomy, infusion, dual-energy X-ray absorptiometry and musculoskeletal ultrasound services.

Dr. Morris spoke to The Rheumatologist (TR) about how his practice is faring during the ongoing pandemic.

Dr. Morris

TR: What have the most significant changes in your practice been as a result of the ongoing pandemic?
Dr. Morris: First of all, we’ve been very fortunate because we have not had to shut down completely. But we have seen a reduction in the number of patients coming into the office. We have done a number of telemedicine visits, and although this has trailed off, we still do several a week. Another issue in our area in southern Appalachia is that we don’t have multiple sites for phlebotomy and lab services. Also, a lot of hospitals closed their doors except for emergency situations. So our patients who need to have their medications monitored were finding they just didn’t have access to lab facilities.

In the office, we put Plexiglas over areas that were open window areas. And we actually obtained a kiosk that will test the patient’s temperature and detect whether the person is wearing a mask, instructing them to put on a mask if they’re not.

TR: How do your patients feel about telemedicine appointments?
Dr. Morris: We have patients who will literally travel two hours each way to come see us. So if they are stable and on medicines they’re tolerating, they really like having the opportunity for telemedicine.

The problem I’ve had with it is that there’s a lot of benefit to examining the patient, and telemedicine doesn’t really permit that. But it has its place. For stable patients, if we can ensure we’re able to get appropriate laboratory monitoring, it’s a reasonable thing to maybe [use telemedicine] every other, or every third, visit.

In our area, we have a lot of patients who can do telephone only because a number of our patients don’t have computers or access to high-speed Internet. And it wouldn’t matter if they did because they can’t read. The big cities have a lot more services, a lot more access to things. It’s sort of a negative that we see in the smaller towns—the areas that are what they call flyover country. We get the short shrift in a lot of different areas.

TR: How are you advising patients on COVID-19 vaccination?
Dr. Morris: We very strongly support patients getting flu shots and pneumonia shots—the shingles vaccination. I’ve not had anybody ask me really about the COVID vaccination. If it becomes available, I can guarantee I’ll be one of the first people up there—if I look at the data, and the vaccination looks good.

TR: Have guidelines for social distancing affected work in your office?
Dr. Morris: Some, but not a lot. We make sure we’re all wearing masks, and the patients are told to wear a mask or we won’t let them in the office. We’ve also told people to please space out. That’s why the kiosk is very nice, because we can literally know a patient’s temperature and whether they’re wearing a mask in two seconds. So that means there’s better flow [at the entrance], and we don’t have a line half way down the street outside our office.

We have separated seats in our waiting area for the lab—they’re easily six feet apart. Similarly in the X-ray area, we’ve spread out the seating.

TR: What lessons have you learned from the pandemic?
Dr. Morris: The first thing is that when we have new viruses, we have to be fluid in what we do. We are going to learn over time what works and what doesn’t work. And maybe from our experiences now we can look at things and do a better job of preparing for the future.

I’ll be curious to see what happens with the new anti-virals, and I’d like to see also how things go with the new vaccinations. Because of the push to find new treatments, we are actually seeing a lot more knowledge than we ever had about viruses in general and about this virus, the coronavirus family, and that’s going to help. The more we learn from this virus, the more we’ll be able to apply that at a future time.

Kimberly J. Retzlaff is a freelance medical journalist based in Denver.