 Aloha and welcome to the latest edition of Telehealth in Hawaii Happy New Year. I hope everybody had a restful, healthy, and fun holiday season. We have a great show for you today. The name of this show is Taking Care of Yourself in the New Year. What better way to have a conversation by taking care of yourself than one of our own local Hawaii board-certified physicians, Dr. Andrea Bernhard. Dr. Andrea Bernhard has been practicing in the state of Hawaii as a physician for over 10 years. She sees a lot of patients in person, in the hospital, as well as virtually at Cloudwell Health. And I will talk to her today about how we can take better care of ourselves in 2023. Andrea, how are you today? I'm good. How are you? I'm doing well. I'm doing well. Happy New Year. Happy New Year. It's good to see you. Good to see you. You as well. So you have a very exciting role. You see patients. You're a practicing physician here in Hawaii. You see patients in person. You also see patients virtually. But to get the conversation started today, tell us a little bit about yourself, where you're from, what brought you to Hawaii, and we'll go from there. All right. Well, I was born and raised in Texas. I did my medical school there. And then kind of on a whim came to Hawaii to do a rotation when I was a fourth year med student. I fell in love with the program I was at, the residency program I was at, and then met my future husband and ended up in Hawaii since then. I did residency in Hawaii, primarily at Wahua, and then joined a group of hospitalists after that. That's where I've been practicing for the past 10 years with the addition of joining Cloudwell. Excellent. Excellent. Excellent. Now, you have an interesting role. You see patients in the hospital, but you also see patients virtually at Cloudwell. How does that for you every day? I'm sure it keeps you pretty busy, in addition to having a family too. Yeah, it's a pretty busy, busy role that I have, but I enjoy it. Telemedicine is very different. I haven't done anything like that before. And it's quite different from my role in the hospital. But it's nice that I can actually do a bit of preventative health, which by the time I see my patients in the hospital, they're sick enough to need to be in the hospital. So it's kind of nice being able to see the other side of things, especially with the advent of the PCP services and things like that. So it's nice that I get to see both ends of the spectrum. Absolutely. Now, we're all have New Year's resolutions and things we want to focus on. And a lot of us focus on taking better care of ourselves in the New Year. From a physician's standpoint, from a medical standpoint, what are some steps that folks can take to start feeling better in the New Year when it comes to their physical well-being, their mental well-being? What are some steps? Well, I think you kind of have to look at three things, first of which is your physical exercise, second, your diet, and third, mental health. I guess maybe a fourth is your sleep health. I think sleep is really important for your body to be able to heal and rejuvenate itself. I think for me, in my experiences in setting New Year's resolutions, typically don't go over too well. It's hard to stick with. So I think making more realistic goals, starting small, it's kind of what I tell my diabetic patients. No one can expect to go from eating a pretty poor diet to having a complete life change. So maybe it starts with cutting out a serving of carbs with each meal just one time a day and then building from there. But I think that if you can set modest goals for yourself, whether that be starting out with exercise in just 15 minutes, maybe twice a week, once you kind of get into that habit, along with the exercise and the sleep, then I think that there will be room for progression with all of those things. But I think realistic goals is the key. Incremental steps, exactly. You mentioned the topic of sleep. So how does good sleep, what is exactly a good amount of sleep and how many hours of sleep should we typically try and get per night to really be at our best physical and mental health? Well, I actually just came out with a new study that said seven hours is the new eight hours. So that's good for people who maybe have a harder time sleeping. But yeah, I mean, trying to get seven hours of continuous sleep, that's really what's needed. We talk a lot too about sleep hygiene or sleep health, not falling asleep with the TV on, making sure you're in a very dark, quiet environment, trying to reduce any sort of stimulation before bed, don't exercise before bed, don't do things that are actually going to be waking you up. But I think that that's key to get you in that habit. So sometimes for some people, it's setting a bedtime and making sure that you're in that right place to achieve adequate sleep. But I think that if you can get a good seven hours uninterrupted is ideal. But of course, there are things that happen. So sometimes myself with my kids, I'm waking up multiple times a night and I can tell that since being a mom, it's taken a dramatic toll on my quality of life. I mean, not that I would exchange my kids for anything. But I mean, I find that even waking up, even if it's briefly one time a night, I mean, I find that I'm slower the next day if I'm like at work. I have a harder time focusing, I have a harder time completing my tasks, as opposed to actually getting a full night of uninterrupted sleep. I mean, it's like night and day. But then again, I've probably only had a few of those in the last three years. We all have that. I know the feeling. I assume things like, you know, we're all pretty hooked on our smartphones. I assume something like checking your emails or going on. Oh, absolutely. That's probably not something you want to do before you go to bed, huh? No, absolutely not. Yeah. And I mean, I'm a victim of that too, you know, trying to kind of catch up on things that you didn't have a chance to catch up on. But I think turning off devices, my husband's really great at that. He's not a device person. So he kind of turns off immediately at a certain time every day. And I think that that's absolutely key as well. Don't do Instagram or any sort of social media before you go to bed because you'll probably end up like up an extra hour or just not be able to turn off. So, yeah. Definitely. Now, you also see a lot of patients in telehealth. And how is telehealth improving the quality of care for the residents of the state of Hawaii? What are your thoughts on telehealth? Because you have a chance to do both. You've seen both. Yeah. I mean, the telehealth space, how is that improving quality of life? I mean, I think really significantly, you know, I find that a lot of my patients, you know, have their sometimes access issues. You know, maybe they work a job that doesn't allow for them to take off to go see a doctor, you know, during normal business hours, or maybe they don't have transportation or, you know, a whole host of other reasons, maybe childcare issues. You know, and I think sometimes, you know, certain physicians' offices too are a little wary seeing people in person if they, you know, do have a cough or, you know, any other type of cold symptoms, especially with COVID still, you know, being present in the community. So, you know, I think that it's a really convenient service that, you know, can offer good healthcare, you know, whether it be for an urgent care visit or whether I'm seeing, you know, a PCP patient, you know, a patient in my normal panel that we're just following up on labs or, you know, medication refills. But it's great because, you know, I see people at eight, 10 o'clock at night who wouldn't probably be able to be seen otherwise. So, I do think that the access issue is huge. So, I really think that that's one good thing that came out of COVID, to be honest, you know, is I think that healthcare is more accessible with, you know, telemedicine. Yeah. Now, you raise a good point, what sometimes can take months to be seen by a primary care physician can be reduced to just a matter of days, if not the same day. Oh, yeah. Or the same day, minutes sometimes, you know, I mean, I've had people that have been added onto my schedule 10 minutes before, you know. So, and it saves a trip to, like if I'm seeing someone at night, saves a trip to urgent care or the ER, you know, especially if it's something that can be easily triaged over the phone. And luckily we have 24-hour pharmacies too. But a lot of people that I see can start treatment if, you know, they require some sort of prescription treatment, you know, the same day, as opposed to having to wait the next day to, you know, call a physician's office to see if they're even able to be seen in person, which, you know, could take days. So I do think that it's a very convenient service that, you know, has helped a lot of, you know, different communities. Right. Now, you also touched a little bit of it on mental health as well. And you probably see a lot of patients who, in addition to trying to address any type of physical concerns or physical areas to improve, there's also the mental health as well. You know, what types of conversations do you have with your patients in this regard? And what can they do for help? I think, you know, by far the most, you know, pressing probably topic in regards to mental health that I've seen lately is stress, you know. I mean, I think stress plays a huge role in people's lives, you know, whether it's stress related to work, school, family life. And it does make a huge impact on someone's physical health. I really think that the mind and the body are very connected. So if you have good mental health, I think that that plays a role in maintaining good physical health as well and vice versa. So I, you know, I think for me, even if it's not an issue that we're talking about directly, you know, touching on, hey, is there something else going on in your life, you know. And usually people are very forthcoming about, you know, hey, yeah, you know, I'm dealing with stress, you know, this is what's been going on. And I think just having a conversation about it, you know, trying to identify what the stressor is is the first step. But I think that, you know, speaking to, you know, someone in behavioral health, like a therapist, a counselor, you know, even a psychiatrist, you know, to kind of help work through those stressful situations, you know, helping to further, you know, identify and target what the stressor is, you know, develop mechanisms of, you know, or coping skills to help to figure out what you can do in those stressful situations, you know, to try to minimize your stress and, you know, reduce the impact that it has on your mental and physical health. So I really do think that, you know, having that piece of talking to a therapist, even if it's just stress, you know, because stress is so important, I think that that's a great help. And then I think the second thing is, you know, depression. I see a lot of that not only in my, you know, role as, you know, a telehealth provider, but also in the hospital, you know, and it could just be situational depression, especially in the hospital, someone's gotten, you know, a bad diagnosis, right, you know, or they've recently lost a family member or something else, you know, there's something called situational depression where, you know, you are, you know, down or sad, which can, of course, impact sleep because of something that's recently happened in your life. And, you know, I think that, again, there, you know, being able to talk to someone about your feelings and what you're going through, I think is a good first step. And for some people, it does require some, you know, medication to help to get you through that spot. But, you know, I see that quite a bit in both of my roles in the hospital and in telemedicine. And I would think that this is also an area of mental health where telehealth can be very beneficial. Absolutely. To improve access from the comfort of your home, you can talk in private, you know. Yeah. Because a lot of people, I think that there's still a bit of a stigma about talking to a therapist where there shouldn't be at all. You know, it should be a part of our, you know, just like you go and you see your primary care doctor for a checkup. I kind of feel like that's what behavioral health should be. I think that everyone, no matter, no matter if you have a clinical diagnosis of depression, anxiety, you know, if you're stressed, whatever it might be, I think that everyone deserves like at least a yearly check-in to be like, hey, how are things going? What's going on in your life? You know, do what areas do we need to work on to help you improve your responses or your communication with others? You know, it could be something that simple that could really improve your life overall. But I think that, you know, with advent of, you know, behavioral health and telemedicine has been really beneficial because I think for some people it's like, okay, I don't have to go to an office. You know, I can do this from the comfort of my couch or, you know, my bed or wherever it might be, you know. And a lot of people are more comfortable in their home environment. So I do hope that that helps people to improve access and maybe break down some barriers. Yeah. Do you see patients who have addressed their, starting to address their mental health concerns, and then they feel more physically active? And if they feel more physically active, they're able to reduce things like blood pressure, cholesterol. I mean, like you said, they're interconnected. Have you seen situations like that with the patients you take care of? Absolutely. I think that once you can change your, sometimes the way that you think about things, it kind of opens up other possibilities to other realms of your life, you know. So I mean, I see that even with my mom, you know, I, you know, for a while, I think she was just kind of in this not so great place, you know, and then she started seeing a therapist and it was kind of like everything kind of just unpacked itself, you know, and it was like everything just kind of fit, you know. She started going to the gym more. She started, you know, hanging out with her friends more. She started having, you know, more of a social life, which, you know, that was kind of a big deal for us because, you know, she raised four kids and, you know, she dedicated pretty much her life to us. So I think that that really helped, you know, her in a, you know, personal example a lot, you know, not only with, you know, her mental health, but also with how she interacted with other people, her friends, work, and then that also translated to, you know, her physical health as well. So I think that overall, just by doing that, she's a happier, healthier individual. You know, she's not as stressed. She's able to communicate her feelings a lot better and tell us what she needs, you know, instead of just kind of keeping things bottled up and then that kind of created other issues within, you know, our family circle and, you know, beyond. So that's a very good story. That's a very, yeah. I mean, I've always had a great relationship with my mom, but, you know, she's, she's one of those that she doesn't really, she feels like she's burdening, you know, anyone who she talks to about what might be going on in her life. You know, so I really think that that helped her to kind of open up and understand that, you know, she wasn't alone, you know, anyway. Yeah. That's a really, that's a very close and personal story. I appreciate you sharing that with us. When you meet with your patients, you're touched on a good point about setting reasonable goals, practical goals. Is a practical goal something like, you know, if you, if I were to see you for an annual physical, is a practical goal, something like let's work Vic on losing 10 pounds over the course of one year. Like what's a, what's a measurable goal? Like when you say something that's realistic. I mean, I, I think it all depends on like where you're starting from, but I would say, you know, if you're, you know, based on what your BMI is, you know, body mass index, which I guess you kind of have to take that with a grain of salt because not every, I think they're transitioning to another form of measurement for that. But, you know, a body builder is going to have an elevated body mass index, but they're of course not overweight, right? But I think that for the average individual, you know, the goal should be getting healthy. I don't think it should be getting thin or weighing a certain number. You know, it should all be about health. Like what is the healthy weight for you based on your height, you know, and your age. So I think that that would be a great place to start, you know, say you're 10 pounds overweight. Okay, setting a goal of 10 pounds would be great, you know, maybe, you know, setting it at a pound a month, you know, but the goal would be sustained lifestyle changes, right? It shouldn't be about losing that 10 pounds. It should be about instilling lifestyle changes that you're going to maintain for the rest of your life or until you're physically able to do so, right? Because that's just going to lead to a healthier you. And I think once you establish that healthy lifestyle, then, you know, whatever, you know, weight that you need to lose or whether it's building body mass or whatever that is, that's going to happen naturally as you kind of change your lifestyle. So, right, that's a very good point. You know, you're probably often asked by your patients, you know, is telehealth the same as an in-person visit, you know, when it comes to getting a checkup? And what are your thoughts on that? You know, I think it's quite similar. I mean, I feel like the people that I talk to I mean, I feel like I have a connection with them just like I would if I met them in person. I think the only difference is that I can't physically lay hands on you, you know, but I think that my ability to connect with someone over the phone is just the same as what it would be in person. Like as long as I can see you, it's a little bit harder if I'm, if we're only talking on the phone and I can't see you and you can't see my mannerisms and I can't see yours. But, you know, I kind of feel like I connect with people this on the same level, really. I mean, the only, I think the only challenge is, is if, you know, someone comes in with a certain complaint, you know, like a maybe sometimes a musculoskeletal thing, you know, maybe they injured their knee or something like that. You're like, man, I would really kind of like to manipulate that in person. But still a lot of things can be done without having that piece of it, you know, but I think the physical touch is the only thing that's really different. And there's ways to work around it, I think. Yeah. So what's interesting about your background is your board certification is in family practice. So you see the whole gamut, don't you see kiddos? You see people, you know, maybe in their 70s and 80s, you see everybody, huh? I do. I mean, I don't see as many kids as I did say when I was in residency, just because, you know, working as a hospitalist, I see adults, you know, I mean, the youngest kid I've probably seen in the last few years in person has been probably 17 years old. But, you know, I still see kids, you know, for, for certain things on telemedicine and that's, it's great. But yeah, I, I find, I have found that, you know, in the last 10 plus years of practicing, I've kind of migrated more towards adults and, you know, the geriatric population, but that's just primarily because that's what I mostly see. But yeah. For the kids that you do see the parents, the mothers are probably so happy that they can easily get access to a physician to get their child so they can take a long time for, for, to get a general pediatric. Well, or in the middle of the night, I had a patient's mom once called because her son was having an asthma exacerbation. And I was a little concerned because, you know, that's not really something that you want to, you know, you, you don't take that lightly at all because it can be life-threatening. But, you know, she had issues because she didn't have, she had several other children. You know, it was like 11 o'clock at night. She had no one to watch the children so that she could take her son in to get evaluated in person. He had run out of his inhaler. You know, so we saw him, you know, but under strict conditions, which I talked to the mom about, I mean, luckily he was okay. And, you know, you can tell a lot just by looking at a kid and having them talk to you. Because of course, if it was not a safe situation, I would have made him go directly to the emergency room. But, you know, I, she was so thankful in that situation because all of her kids were at home asleep and she had children. She had, I think her youngest was maybe like six months. You know, so it's like, and I understand that as a mom, you know, you're like, I want what's best for my child. But also like, I am in a really tough spot right now where, you know, the other caregiver is not home. I have multiple other children. Like, what do I do? So anyway, I, you know, in that situation in particular, I think it really benefited her and, you know, we kind of discussed precautions. But, you know, I get that quite a bit. And the other thing is, you know, school notes. We see a lot of school notes from parents, you know, which definitely like saves a trip to the doctor's office and, you know, potentially, I mean, I guess depending on the doctor's office, but potential exposures there, if there are other sick children there, you know, because schools have become a lot more strict at, you know, allowing children back to school under certain conditions. So it's definitely easy to, you know, call and let us check out, you know, your child and have you tell us the story about what's been going on and we'll ask you all those questions and, you know, let you know if it's safe to go back or not. But that's definitely nice because it saves a trip. And I'd rather call from home, being a mom myself versus having to get both of my children out in the car, which oftentimes takes forever because they're fighting, getting in the car seat and, you know, all that kind of stuff. I know that feeling really well. Oh yeah, yeah. You have it, you touched on this and it's an interesting point. Many people, it's hard for them to take time away from their job to receive access to care. And then they have the situations at home where at times they're the only care provider in the home. Right. Able at the moment to provide for their children. So if you put both of those together, that quick access to telehealth for these types of situations that you describe is extremely valuable and can really help a lot to improve quality of care. Because like you said, any time cannot be wasted when it comes to some of those situations with your patients. Absolutely. I mean, because it's kind of like, I feel like for parents, especially of young children, it's like you have, well, even older children, but it's like you have two full-time jobs. You know, you're working and then you come home and you have the job of being a mom or dad, you know, and you know, it's hard. It's really hard. So I do think that it does, I think, lessen the burden, you know, like, okay, we're getting on this visit. We can be seeing the same day. We can do it right before you go to bed. Let's have that rash checked out. Let's have someone check out your symptoms. Do we need antibiotics for this? You know, I mean, we can do a lot over the phone, especially with, you know, good pictures and good video quality that could, you know, save you time and screaming and, you know, yeah, it's true, you know, with sending the images securely to you, you can take a look at things very, very quickly, you know. Yeah, absolutely. And if it's, you know, if it's something that is really not appropriate for telehealth, then, you know, we'll say so, you know, well, this, this is better seen in person, or let's go to an urgent care or an ER, whatever it might be, but at least you have someone who's physically laying eyes on, you know, the condition that you're worried about, and at least helping to navigate you and, and what's the, the most appropriate thing for your child, because of course, safety is what we value first and foremost. We want to deliver good care, but in a safe manner. So if it's anything that we do not think is safe to handle, you know, with a video visit, then we're going to let you know, because, you know, you and your child's safe, safety is first and foremost. Absolutely. Absolutely. Andrea, I know that, you know, you're a practicing physician, you're a mom, you have a lot going on in your life. And I want to take a moment to thank you for being on the show. You know, I know how many things you're juggling at the same time. And taking the time to speak to us about the importance of physical health, mental health, benefits of telemedicine, you know, your role, it's extremely valuable. And we appreciate you very much for being on. It's, and I just, everything you're doing for the community in Hawaii is just astounding. And we really appreciate you very much. Oh, well, thanks for having me. You're welcome. You're welcome. Mahalo. Happy New Year. And I will talk to you soon. All right. See you later.