The modern world hinges on the ability to create better user experience through carefully crafted design.

Author: Sahil Page 1 of 13

Are Graduate Degrees Still a Smart Idea?

It seems like a simple question on the surface, with an equally obvious answer. Yes, you might say, as do millions of Americans who pursue further education. And for the better part of the 20th century, nearly any graduate degree was a surefire way to advance your career and get a strong return on your investment.

However, as the Wall Street Journal recently demonstrated using an interactive tool, it appears that this age-old wisdom may not hold up in modern times. Certain schools and programs, especially in the arts, have significantly higher debt burdens compared to earnings. Even with the cachet of a prestigious Ivy League school, earnings may be slim.

Chalking this up to the universities bilking students of their money might be an exaggeration of a particular cause, but it appears that do see “master’s degree programs as largely unregulated cash cows that help shore up their bottom line,” according to Kevin Carrey. However, I think that there is another element that this argument overlooks: inflation. Since the 20th century, we have seen a divergence of income to cost of living and a divergence of productivity and income.

In combination, these factors contribute to a far more unequal society whereby the tools to achieve social capital are no longer attainable without a large amount of familial or dynastic wealth.

Image courtesy of the Wall Street Journal, 2021

I encourage you to check out the tool and input degrees from school that you are interested in attending, currently attend, or have attended in the past. While it is not comprehensive (some fields such as medicine only show a limited subset of schools and programs) there are definitely nuggets of information present in this data.

On a side note, I think it’s fascinating to see how well this information is represented visually. It makes the data far more compelling than a table and I especially like the case study animation as you scroll down the page culminating in the full data set.

Dossier

“Is a Graduate Degree Worth the Debt? Check It Here,” by James Benedict, Andrea Fuller and Lindsay Huth, July 15, 2021. https://www.wsj.com/articles/is-a-graduate-degree-worth-the-debt-check-it-here-11626355788

“‘Financially Hobbled for Life’: The Elite Master’s Degrees That Don’t Pay Off,” by Melissa Korn and Andrea Fuller, July 8, 2021. https://www.wsj.com/articles/financially-hobbled-for-life-the-elite-masters-degrees-that-dont-pay-off-11625752773

“Master’s Degrees Are the Second Biggest Scam in Higher Education,” by Jordan Weissmann, July 16, 2021. https://slate.com/business/2021/07/masters-degrees-debt-loans-worth-it.html

Can Flying Help Patients Beat Cancer

Image courtesy of the Wall Street Journal, 2021

In a recent article in the Wall Street Journal, Dr. Ateev Malhotra and Barak Richman wrote about the “brutal” trip Maki Inada makes for her cancer treatment. For patients who live outside of a large metropolitan area, it can be extremely challenging to balance receiving cutting-edge treatment with maintaining their jobs and home life.

Maki Inada is juggling a lot these days. She’s a biology professor at upstate New York’s Ithaca College, where she balances teaching and research on messenger RNA (suddenly a topic of global interest). She is a mother of a vivacious 10-year-old who just finished fourth grade, and that means lots of driving back and forth to gymnastics and swimming practice. And she has lung cancer. In April, after years of clean scans, the cancer was back. She just had major surgery and is starting chemotherapy again. She has a lot of appointments with her local oncologist and her oncology team at the Dana-Farber Cancer Institute in Boston.

One silver lining of the pandemic for Ms. Inada was that she didn’t have to drive to Boston for her appointments. She began having video calls with her doctors and planned to conduct many of her postoperative and oncology appointments via telemedicine. But regulatory changes in the past month have thrown a wrench in those plans. Dana-Farber told Ms. Inada she’ll have to be physically located in Massachusetts for a visit. She doesn’t have to go all the way to the doctor’s office, a 5½-hour drive each way. She can drive 3½ hours, cross the border into Massachusetts, pull over, and have a telemedicine visit in the car.

So for her next appointment, the grandparents drove 11 hours to Ithaca to watch their granddaughter, and Ms. Inada and her husband drove to Boston. After she had some scans at the cancer hospital, she quickly had a telemedicine visit from the lobby. But she had to skip one of her postoperative appointments because you can only drive back and forth so many times.

This sudden, severe and senseless inconvenience results from one of the historical vestiges of U.S. healthcare. The practice of medicine is regulated by state medical boards, which can license doctors only to practice medicine in their state. Traditionally, medicine is “practiced” where the patient is located. If Ms. Inada is in New York during an appointment, then her physician must be licensed in New York even if he is somewhere else.

Ateev Mehrotra and Barak Richman

While Malhotra and Richman argue for state medical licensure reciprocity, there are still certain situations that require the patient to be seen in-person. This is where organizations such as Angel Flight and similar can become lifelines for patients.

Josh Flowers, of the YouTube channel Aviation101, joined one flight and shared his experience in the video below.

Inada makes good use of telehealth services to be seen by providers, despite the tedious drive she must make to the Massachusetts border for legal reasons. In fact, I’ve written about the value of telehealth in the WFCC Newsletter. I suggested that we reframe the discussion of telehealth from reducing costs to increasing access to care.

This year, we have seen radical shifts in the way that healthcare is delivered. Early on, the COVID pandemic forced many non-urgent medical visits to be cancelled, including at the free clinics, helping healthcare institutions reduce the strain on limited resources. Almost immediately, the WFCC embraced the idea of virtual visits by setting up a free telehealth program. This idea was born out of the need to continue treating patients who would otherwise be almost completely disenfranchised from the healthcare system. Their ailments and conditions did not simply disappear overnight. Instead, telehealth became a lifeline for the uninsured and underinsured population in central Massachusetts.

[. . .]

Prior to the COVID pandemic, telehealth was seen primarily as a method to reduce costs. However, for free medical programs, telehealth should instead be seen as a method to increase access to care. It erases geographic boundaries and allows patients to not worry about transportation or scheduling time off from work or from childcare responsibilities. Looking at telehealth technology through this lens leads to a mindset that encourages the build-out of necessary infrastructure to reach patients and break down barriers to healthcare for disenfranchised populations. It becomes easy to justify the need to invest resources in public facilities, such as keeping public libraries open for longer hours or providing dedicated equipment and tutorials in multiple languages.

[. . .]

Ultimately, telehealth is not a substitute for in-person visits. While the circumstances may force virtual visits to continue throughout the foreseeable future, it is not sustainable for all types of conditions. Some simply cannot be treated through telehealth. Healthcare institutions should determine where telehealth can be an effective way to help increase care, for example, in treating conditions such as depression, hypertension, or diabetes.

[. . .]

“Telemedicine was a solution to an immediate problem,” says Dr. Ateev Mahrotra, but perhaps it can become part of the long term solution too. When in-person visits return, telehealth can be used to augment the care that free medical programs provide and get more patients access to the care that they need. To do so requires defining a comprehensive telehealth policy that addresses the needs of both patients and providers with the explicit goal of increasing access to healthcare. Patients who still require in-person care or do not have access to telehealth services can still come in. Others, particularly for follow ups where it can be challenging to get patients to come back, may instead opt for a virtual visit. Setting up the facilities to provide this level of effective telehealth services at the free clinics requires funding and up-front investment from the community, local governments, and other institutions.

Sahil Nawab

Dossier

“A Cancer Patient’s Brutal Commute,” by Ateev Mehrotra and Barak Richman, July 12, 2021. https://www.wsj.com/articles/a-cancer-patients-brutal-commute-11626129627

“Telehealth for Free Medical Programs, Now and in the Future,” by Sahil Nawab, April 26, 2021. http://www.sahilnawab.com/blog/telehealth-for-free-medical-programs-now-and-in-the-future/

“We Landed at the WRONG AIRPORT! – Flight VLOG #2 – IFR BOS to PHL,” by Matt Guthmiller, February 10, 2017. https://www.youtube.com/watch?v=lmgnqKsWXGI

“Getting there is HALF THE CURE – Angel Flight – Cessna TR182,” by Aviation101, November 17, 2020. https://www.youtube.com/watch?v=bEErswxxGSg

Double Slatted Wing

The Business Case for Electric Aviation

I’ve written quite a bit about electrification of aviation and in general, but this was in early 2020. Since then, the landscape has continued to change at an staggering pace.

However, the arguments I made in both of these articles—that internal combustion engines will be better suited for the aviation use case and that ground-based electric vehicles will drive electric innovation—stand true.

It would be amazing to see electric passenger aircraft, and given the business case that Wendover Productions describes in his video, it might be a more realistic goal than I ever thought possible. Even a few years ago, electric aviation was vastly different from its state now. Each year, new innovations bring us much closer to an electric future.

Dossier

“The Dilemma of Electric Aviation,” by Sahil Nawab, January 10, 2020. http://www.sahilnawab.com/blog/the-dilemma-of-electric-aviation/

“Electrification of Last Mile Delivery,” by Sahil Nawab, April 24, 2020. http://www.sahilnawab.com/blog/electrification-of-last-mile-delivery/

Scrap the proposed $1,000 landing fee. Keep general aviation alive.

An open letter to Massachusetts State Senator Julian Cyr.

Note: This letter is in response to the Massachusetts State Senate Bill S.2305, proposed by State Senator Julian Cyr. This bill proposes to implement a $1,000 landing fee for most types of general aviation aircraft operations within the Commonwealth of Massachusetts.

State Senator Cyr,

Just as I do, I am confident that the entire Massachusetts aviation community appreciates your openness to dialogue and discussion regarding Bill S.2305. A conversation to address the climate impact of aviation is indeed worth having. As aviators, we are the first to recognize that we contribute significantly more carbon emissions per capita than the average American. However, it is clear that this bill, in its current and any revised state, does not accomplish the goals that it sets out to without causing significant, irrevocable ramifications to the Commonwealth.

In this letter, I will outline the potential benefits and damages that this bill will cause should it be implemented as law. However well-intentioned, I hope to show that this bill is ultimately misguided and cannot accomplish its goal, namely that of “mitigat[ing] the climate impact of private and corporate air travel.” Instead, it strangles the general aviation community while allowing wealthy “private jet owners” to easily sidestep regulations and continue contributing the same carbon footprint without bringing in any additional revenue that can be reinvested in research and development.

Firstly, we must discuss the definitions of private and corporate air travel. There is quite a bit of ambiguity in the term. The general public might assume that private and corporate air travel refers only to “private jets;” the likes of LearJets or Citations. Often, these aircraft are chartered by wealthy clients and corporations to transport executives, their staff, or their families to and from work and vacations. These aircraft are commonly registered in tax havens and have opaque ownership structures. In this category, the cost of operation for such aircraft ranges from a thousand dollars per hour up to several tens of thousands of dollars per hour. For most such travel, a landing fee would amount to little more than a nuisance, essentially part of the cost of business and operation. It would certainly not discourage this type of travel nor reduce carbon emissions.

While these types of operations certainly do exist, particularly in Martha’s Vineyard and Nantucket, the general public may not be aware that there is an entirely separate category of aviation, which is made up of a community of pilots and their friends and families who fly explicitly for the joy of aviation and the transcendent nature of flying a small plane high above the Earth. These aircraft are often registered in Massachusetts to individual owners or their families. Many others cannot afford to own the aircraft and instead rent a plane for a hundred dollars per hour, scraping together money to afford a short flight on the weekends. The general public might recall small Cessna’s flying overhead or even visit one of the many airport diners in Massachusetts for lunch while watching planes take off and land. It is also these aircraft that are used for flight training so new pilots have a simple platform to learn from.

The colloquialism of private air travel clouds the above two disparate categories of aviation. Therefore, from here onwards, we will refer to first category of operations as “private jet aviation” and the second category of operations as “general aviation.” It is the general aviation category that will suffer the most through the unintended consequences of the bill.

Both private jet aviation and general aviation contribute to the economy of the Commonwealth, however, the proposed 1,000 dollar landing fee will essentially wipe out general aviation in its entirety. It would make it nearly unattainable for an average family in Massachusetts. All the while, it would likely do little to raise revenue for reinvestment into sustainable aviation. Simultaneously, this bill does not effectively advocate for appropriate action to combat climate change.

It is important to recognize that aviation also presents a number of other impacts beyond carbon emissions that are potentially more addressable. For example, airport fire suppression foams are particularly toxic as they often contain fluorinated compounds. Fluorinated compounds help produce a film, which is particularly useful to smother fuel-based fires. These eventually leach into groundwater after being used to put out an aircraft fire. As a result, investing in the research and development of an alternative film-forming fire suppression foam is an imperative so that fluorinated foams can be phased out completely. Likewise, aircraft fuels to this day contain tetraethyl lead to prevent engine knocking. While this additive was phased out in automotive gasoline, aircraft engines often use higher compression ratios for efficiency, which requires preventing engine knock and detonation within the cylinder.

Instead, I suggest that you regulate other high carbon industries, invest in alternative fuels and electric propulsion—which creates jobs instead of removing them—and put forward strong incentives for public transportation across the state and the region. Addressing these problems will allow aviation to be much cleaner without the negative impact to the economy and most importantly, without suffocating general aviation and making flying a small plane, and its immense freedom, completely unattainable to an average family in Massachusetts.

It is that core tenet of freedom that defines our society today. As aviators, we have the freedom to, on a whim, head to the airport and pack up our families into a small plane to visit and experience places that would otherwise be completely impractical. In fact, it is this very principle of unfettered freedom that so strongly resonates with pilots and the American public at large. It is why, as children, many of us dream about soaring through sky and clouds, examining the world from a birds-eye perspective.

An image I captured of Lake Quinsigamond in Worcester, MA. The bridge pictured is the Kenneth F. Burns Memorial Bridge between Shrewsbury and Worcester.

As I have written before, the “rich legacy of aviation in the United States, from the first flight of the Wright brothers’ plane through to modern commercial jet airliners, has allowed the United States to develop the most widely dispersed general aviation infrastructure in the world. With that, comes the freedom of flight.” The United States has the largest number and highest density of airports of any nation in the world. We have free and widely available air traffic control services, supported by the federal government. Airports scattered throughout the state provide jobs and are core to small and isolated communities, such as those in Western Massachusetts as well as your own district, Cape Cod and the Islands.

In contrast, Europe already has a suffocating general aviation environment. Nearly every airport has landing fees and handling fees. Even communicating with air traffic control and the safety services that they provide can require a fee, which is why we support federally managed air traffic control services and strongly oppose privatization. European pilots always note how refreshing general aviation is in the United States. These fees ensure that fewer people are able to pursue their dreams of being a pilot.

I am incredibly blessed to have the privilege to work towards my private pilot certificate. It has been one of the most invaluable and impactful activities that I have ever pursued and my training as a student pilot has significantly shaped my perspective. It has allowed me to grow as a person, gain autonomy, and recognize the immense beauty and serenity of flight. It has taught me that flying the plane is the easy part. Being a pilot is much more—it’s about training, decision making, dealing with emergencies, and how to think and react when things go wrong.

From my home airport in Mansfield, MA, I can look to my right and see the skyline of Boston and I can look to my left and see Mount Wachusett. From the air, we can see how close together and interconnected the entire state is. I distinctly remember flying to Nantucket myself early on in my flight training, excited by the fact that it was only a short 30 minute flight rather than a multi-hour drive and ferry ride. The economic impact of aviation is significant in Massachusetts, especially in Martha’s Vineyard and Nantucket.

Now, Ernest Hemingway said that he always regretted he had never written about aviation. Here was a fellow dead good at descriptions of some highly technical endeavors; I note boating, fishing and hunting. Why did he (correctly) feel himself balked of the outlet of aviation writing?

Because, to do so — he understood — requires two specific skills: One needs to be able to write, and one needs to know how to fly.

Almost all aviation writing is purple prose. Antoine de Saint-Exupéry, Anne Morrow Lindbergh and Beryl Markham all wrote about the supposed drama of the landscape and the clouds and so on. They could fly, and, in flying, they sought to express their love in prose. The problem, however, is that the drama of flight does not take place between the pilot and the environment, but between the airplane and the pilot, and between the pilot and himself.

The best aviation writing takes place not in novels, or films, but in the flying magazines. Here, pilots are communicating, in technical language, the drama that took place, finally, within themselves: difficulties, happenstance or error compounded by laziness, fatigue, ignorance or pride; ignorance beaten out through near-averted tragedy; theory triumphing over fear, or excised through practice.

[. . .]

The drama in aviation writing does not rest in writing about flight, but in writing about a flight.

For each flight, for the pilot, is structured like a drama. It has an objective (called a destination), a plan, containing a beginning, a middle, and an end, after which the pilot is free to compare his objective to his performance, re-evaluate his plan and draw conclusions based upon his lack of perfection.

David Mamet

I consider myself to be a writer and storyteller. I have written extensively about flying and how it connects to my other experiences. In order to do so, I rely on a broad and multi-disciplinary perspective. It will be an immense loss to society if fewer aviators are able to tell their stories to their children and grandchildren. The opportunity will no longer exist for children in the future to experience and be inspired by the wonders of aviation. Unfortunately, that is a direct consequence of Bill S.2035.

There is so much potential for good that can be done through general aviation. For example, pilots volunteer with organizations such as Angel Flight to fly patients free of charge to specialized, life-saving medical care. This is especially valuable to bring patients from throughout the state and the region to our cities to receive world-class healthcare and participate in clinical research. Sea turtles too, can benefit from general aviation. Critically endangered Kemp’s Ridley turtles often become trapped in Cape Cod Bay in the winter. These turtles are rescued and flown by volunteer pilots to Florida for rehabilitation. Flying minimizes the turtles’ stress during transportation and increases their chances of their survival.

While at university, I was the vice-president of the WPI Aviation Club. Flight training is already prohibitively expensive, so our mission as a club was to encourage students to pursue aviation and help them in their journey by providing free ground and classroom training. Implementing a 1,000 dollar landing fee will only exacerbate this problem and fewer people will be able to have the vantage point of a pilot.

I have argued in the past that this breadth of perspective is vital to modern innovation. In fact, in a 1996 interview with Wired Magazine, Steve Jobs explained that creativity is about building a system to collect experiences—i.e. collect the proverbial dots—so that it becomes obvious to connect them in unique ways. Aviation is one way to explore the world and build these experiences.

Creativity is just connecting things. When you ask creative people how they did something, they feel a little guilty because they didn’t really do it, they just saw something. It seemed obvious to them after a while. That’s because they’re able to connect experiences they’ve had and synthesize new things. And the reason they were able to do that was that they’ve had more experiences or that they have thought more about their experiences than other people.

Steve Jobs

Making aviation more accessible, not less, is how we can endeavor to increase the number of creative innovators in the state. In fact, a number of innovations can be traced back directly to bringing principles from aviation into other industries, such as healthcare. For example, Dr. Atul Gawande, a surgeon-writer in Boston, pioneered bringing aviation checklists into the operating room. Before starting a surgery, the entire surgical team pauses and runs through the checklist: (1) Does the patient name match? (2) What part of the body is the operation on? (3) What is the specific procedure? This idea was put in place around the world by the World Health Organization and has saved countless lives since then. Bill S.2035 directly impedes our ability to make new connections across disciplines and reduces the possibility of innovation in Massachusetts.

Through this bill, you are making it completely unattainable to fly for those who cannot afford a 1,000 dollar fee and thus preventing the general public from experiencing the joy of flight in a small plane, while wealthy patrons can simply absorb the additional cost. The exemptions you have described for specific types of operations are limiting and simply not sufficient to outweigh the significant loss of general aviation. Ultimately, it is absolutely necessary to weight the benefits against the drawbacks of this bill. Discouraging private aviation by charging a landing fee will not work as you intended to address the climate burden.

As pilots, we are excited for a future in which flying is carbon neutral and does not contribute to climate change. However, implementing Bill S.2035 in any form simply is not an effective way to achieve this goal. We implore you to recognize and consider the immense value that general aviation provides to the Commonwealth and we hope that together, we can keep the pioneering spirit of general aviation alive.

Sincerely,

Sahil Nawab, on behalf of the Massachusetts general aviation community

Dossier

“An act to mitigate the climate impact of private and corporate air travel” S.2035, by Julian Cyr, February 19, 2021. https://malegislature.gov/Bills/192/S2305.Html

“Having a Fee Stroke,” by Thomas Haines, November 1, 2016. https://www.aopa.org/news-and-media/all-news/2016/november/pilot/having-a-fee-stroke

“Flying Sea Turtles (in First Class?)” by Sahil Nawab, October 23, 2020. http://www.sahilnawab.com/blog/flying-sea-turtles-in-first-class/

“The Basis of Modern Innovation,” by Sahil Nawab, January 24, 2021. http://www.sahilnawab.com/blog/the-basis-of-modern-innovation/

“The Drama of Flight, One Radio Call at a Time,” by David Mamet, February 1, 2019. https://www.flyingmag.com/drama-flight-one-radio-call-at-time/

“A Flight Plan for Hospitals,” by Charlotte Huff, May 3, 2010. http://protomag.com/articles/john-nance-a-flight-plan-for-hospitals

“From the Helicopter to the Hospital,” by Sahil Nawab, June 19, 2020. http://www.sahilnawab.com/blog/from-the-helicopter-to-the-hospital/

Friendly Skies Biennial Flight Review

Looks like a lot of fun!

The Real Reason Behind the WFCC Name Change

Early in 2020, we announced in the WFCC newsletter that the organization, the Worcester Free Clinic Coalition, was changing its name to the Worcester Free Care Collaborative. Recently, a new logo was also created by Sahar Peerzade to better reflect the mission of the organization, its ties to central Massachusetts and the greater Worcester area, and bring a modern look to the organization. Perhaps more subtly, it also aims to represent the concept of healthcare visually and symbolically so that patients who do not read English will still able to recognize our mission.

The heart and stethoscope motif is multifaceted and we wanted the logo to convey a sense of softness and warmth to invite the community together. Of course, it represents the human heart and by extension, health, but it also represents the City of Worcester and its place as the Heart of the Commonwealth. We hope that the heart and stethoscope motif will allow anyone, regardless of their understanding of English, to recognize the healthcare role of the Collaborative and its member programs. We hope that this reflects our renewed outlook well into the future.

Sahil Nawab
The new WFCC logo as of March 2021

Although my design was not selected, I also designed a logo for the WFCC and wrote about my creative process as well.

Going back to name change, there is actually quite a bit of backstory as to the reason for the change that deserves awareness and warrants further discussion by the community.

In some ways, one might argue, the original Worcester Free Clinic Coalition more accurately describes the specific role of the organization and its structure as a loosely associated set of independent free clinics. Although there has been a large push—especially since the 2019 Symposium—to integrate the clinics more tightly, each program nevertheless maintains its own set of volunteers, supplies, and location. The WFCC helps coordinate medical student volunteers and is itself primarily run by medical students from the University of Massachusetts Medical School.

John Romano, one the previous co-presidents of the WFCC, suggested the new name, Worcester Free Care Collaborative. It maintains the same acronym, which meant that at least some aspects of the prior identity could be maintained. One of the other suggestions that came from the community was the Greater Worcester Free Medical Consortium. A number of arguments were also had as to whether the organization is an “alliance” or an “association.” However, none of these names ended up sticking, likely due to the elegance of Romano’s suggestion. Ultimately, I think that the new name is excellent, if a little bit more vague as to the specifics of clinical care.

However, the question remains: what actually prompted the name change? The old name was, in the past, completely adequate and an effective descriptor.

The provoking incident occurred when the Worcester Islamic Center first opened their program in late 2019. After months of planning and discussion, the program opened to the public on Thursdays. In order to advertise the program to patients, a lawn sign was placed outside of the Worcester Islamic Center with the words “Free Clinic,” just like all of the other free clinics part of the WFCC. Ultimately, it was this sign that started the chain of events that necessitated changing the name of the organization.

Two weeks after that sign was placed, police officers knocked on the door of the Islamic Center. They explained that a passerby had complained about the sign and reported the program as they believed that it may not be a licensed medical clinic. For legal and liability reasons, their claim did have some merits. As a free medical program, it is staffed by volunteers, including licensed physicians and nurses, who donate their time and expertise in service of the community. Running only two hours per week and not providing any direct treatment themselves, it was thought to be unnecessary. The volunteers are simply advising patients about their conditions, just as if you were to ask a physician friend about a specific concern. It was especially helpful for patients who were visiting their children from another state or from abroad and only staying in the area temporarily. Their primary care physician might not be accessible for an appointment until they go back, but their health conditions persist regardless. “Free clinic” is still a good descriptor for lay people to better understand the general nature of the program and what services it offers.

Nonetheless, the police officers required that the sign be taken down. The clinic halted for the time being. The strange part is that this exact issue has not affected any of the other free medical programs in the area, many of which also have signs that use the wording “free clinic.” Why was it that only the program at the Worcester Islamic Center had issues with signage? It seems discriminatory in nature that only a free medical program opening at an Islamic Center, as opposed to a church or any other secular organization, would face such issues and complaints. Other programs with similar services, similar signage, similar outreach, and ultimately trying to serve the most vulnerable patients within the community, never had to face such problems. It stands to reason that any new “free clinic” should not be subject to such complaints.

The final result of all of this is that our language has changed. We no longer use the term “free clinic” and instead prefer to use “free medical program.” The WFCC changed its name to the Worcester Free Care Collaborative. While I do love the new name, it was born out of unjust circumstances.

Reanimation

“. . . one of the last independent scientists, . . . back when ‘scientist’ could be an entire job description rather than ‘botanist’ or ‘physicist’ or computational linguist.’ Someone who worked across disciplines on whatever they found interesting or whatever they were hired to do.”

This statement reminded me of the idea of the Renaissance Man whose broad knowledge base helped connect the dots. To me, this interdisciplinary role is the basis of modern innovation.

JetCAM

Telehealth for Free Medical Programs, Now and in the Future

Note: This article was originally published as part of the Q4 2020 issue of the WFCC Newsletter and is reproduced here with permission. See original: http://www.sahilnawab.com/wfcc/q4_2020.pdf

This year, we have seen radical shifts in the way that healthcare is delivered. Early on, the COVID pandemic forced many non-urgent medical visits to be cancelled, including at the free clinics, helping healthcare institutions reduce the strain on limited resources. Almost immediately, the WFCC embraced the idea of virtual visits by setting up a free telehealth program. This idea was born out of the need to continue treating patients who would otherwise be almost completely disenfranchised from the healthcare system. Their ailments and conditions did not simply disappear overnight. Instead, telehealth became a lifeline for the uninsured and underinsured population in central Massachusetts.

The gravity of the COVID pandemic has rendered telehealth a necessary compromise to in-person visits for the time being. Even as recently as last year, telehealth was seen as cold and impersonal. However, the rapid adoption of the technology has shown that the most important aspect of care is the depth of focus and quality of communication. This type of compassionate care is one of the hallmarks of free medical programs, where physicians are not restricted by administrative overhead and can instead focus on developing a warm connection with patients. Dr. Jessica Zitter, a palliative care physician, explains that “it’s not about the medium, it’s about the message, and the way it’s delivered.” Through the telehealth program, the volunteer physicians have been able to continue to reach patients despite the challenging circumstances.

In fact, there are a number of surprising benefits to telehealth. Dr. Emil Baccash, a geriatric physician, explains that physicians get most of the information they need from their conversations with patients. When patients are in a comfortable environment, such as their own homes, they are likely to be “more relaxed and feel less rushed.” Virtual visits allow physicians to interact more warmly, without having to don frightening personal protective equipment that would be necessary for an in-person visit.

Prior to the COVID pandemic, telehealth was seen primarily as a method to reduce costs. However, for free medical programs, telehealth should instead be seen as a method to increase access to care. It erases geographic boundaries and allows patients to not worry about transportation or scheduling time off from work or from childcare responsibilities. Looking at telehealth technology through this lens leads to a mindset that encourages the build-out of necessary infrastructure to reach patients and break down barriers to healthcare for disenfranchised populations. It becomes easy to justify the need to invest resources in public facilities, such as keeping public libraries open for longer hours or providing dedicated equipment and tutorials in multiple languages.

However, free medical programs in particular must face the reality that some patients face serious difficulties accessing healthcare services virtually. Some may not have a capable device or an internet connection, while others may not speak English or may not understand how to operate their devices adequately. Addressing this need is an intense area of focus for many organizations, including the Worcester Free Care Collaborative. However, this cannot be a solitary endeavor. It requires a concerted effort from local governments and organizations to invest in public infrastructure and encourage more flexible workplace policies that allow employees to visit healthcare providers and care for their children and families. Solving these root problems will immediately improve the healthcare of the entire population.

Ultimately, telehealth is not a substitute for in-person visits. While the circumstances may force virtual visits to continue throughout the foreseeable future, it is not sustainable for all types of conditions. Some simply cannot be treated through telehealth. Healthcare institutions should determine where telehealth can be an effective way to help increase care, for example, in treating conditions such as depression, hypertension, or diabetes.

“Telemedicine was a solution to an immediate problem,” says Dr. Ateev Mahrotra, but perhaps it can become part of the long term solution too. When in-person visits return, telehealth can be used to augment the care that free medical programs provide and get more patients access to the care that they need. To do so requires defining a comprehensive telehealth policy that addresses the needs of both patients and providers with the explicit goal of increasing access to healthcare. Patients who still require in-person care or do not have access to telehealth services can still come in. Others, particularly for follow ups where it can be challenging to get patients to come back, may instead opt for a virtual visit. Setting up the facilities to provide this level of effective telehealth services at the free clinics requires funding and up-front investment from the community, local governments, and other institutions.

Continuing the use of telehealth, even well after the COVID pandemic ends, opens many potential avenues to bring free healthcare to the people that need it most. With the help of the local community and government, it is necessary to commit resources to bringing the idea of digital health to as many patients as possible. Telehealth is poised to be a transformative technology to increase access to healthcare for disenfranchised populations. However, it requires commitment and investment to make sure that patients are not forgotten about or left out as a result of structural deficiencies. Taking this avenue requires the support of the community and policymakers to turn this vision into a reality.

Dossier

“Is Telemedicine Here to Stay?” by Reed Abelson, August 3, 2020. https://www.nytimes.com/2020/08/03/health/covid-telemedicine-congress.html

“The Evolution of the Robot-Doctor,” by Jessica Nutik Zitter, December 1, 2020. https://www.nytimes.com/2020/12/01/well/live/Telemedicine-Hospitals.html

“A Pandemic Benefit: The Expansion of Telemedicine,” by Jane E. Brody, May 11, 2020. https://www.nytimes.com/2020/05/11/well/live/coronavirus-telemedicine-telehealth.html

“Telehealth wasn’t designed for non-English speakers,” by Nicole Wetsman, June 4, 2020. https://www.theverge.com/21277936/telehealth-english-systems-disparities-interpreters-online-doctor-appointments

“Telehealth needs medical interpreters, broadband expansion to reach underserved,” by Kat Jercich, June 1, 2020. https://www.healthcareitnews.com/news/telehealth-needs-medical-interpreters-broadband-expansion-reach-underserved

Page 1 of 13

© 2017 - 2021 | Sapience Laboratories