Dr. Cynthia Zelis of MDLIVE: “Trust”

Trust: A good way to level set the care experience you are providing is to have a clear understanding of your clinical limits and what you can and cannot do within the scope of telemedicine. Trust your gut as you would in the office and know that part of your medical journey might be to […]

Thrive invites voices from many spheres to share their perspectives on our Community platform. Community stories are not commissioned by our editorial team, and opinions expressed by Community contributors do not reflect the opinions of Thrive or its employees. More information on our Community guidelines is available here.

Trust: A good way to level set the care experience you are providing is to have a clear understanding of your clinical limits and what you can and cannot do within the scope of telemedicine. Trust your gut as you would in the office and know that part of your medical journey might be to educate the patient to get a higher level of care that is outside what you are able to perform at this time.

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. Cynthia Zelis.

Dr. Cynthia Zelis, MD, Chief Medical Officer at MDLIVE​, has over 20 years of clinical leadership as a health care executive and practicing primary care physician. She played a pivotal role in scaling MDLIVE services to meet soaring demand during COVID and oversaw the rollout of the industry’s most comprehensive virtual primary care platform. Prior to MDLIVE, one of the largest telehealth platforms, serving more than 450 organizations and 60 million plus lives nationwide, she served as the Vice President of Ambulatory Operations and Telehealth at University Hospitals in Cleveland, with strategic and operational oversight of more than 50 ambulatory health centers and telehealth initiatives across the $4 billion health system; under her leadership, virtual visits increased by more than 80 percent.

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?

I grew up in healthcare, as the daughter of a family physician and a nurse in Sandusky, OH. I knew I wanted to be a doctor since I was in second grade. I was so committed to becoming a doctor that I completed both my undergraduate bachelors degree and my medical degree in six years. As a practicing family physician, I was trained with a biopsychosocial model, which focuses on a comprehensive care approach that goes beyond medication to understand the whole person including support systems, health care mental model, and social disparities that impact the patient’s care and outcome. This approach and years of direct patient care inspired me to become a greater voice for patients and providers. So, based on advice from leaders and support of family, I went back to school to complete my MBA so to enhance my opportunity to have a greater voice at the executive level. Interestingly, when my dad asked me take over his private practice just out of residency, I told him I wanted to focus on direct patient care and not the business side of healthcare. While he is physically not with us today, he would have gotten a good chuckle at the path my career took.

The most powerful element of my journey in healthcare has been the continued amplified ability to impact so many patients’ lives. As a family medicine physician, I had the opportunity to provide 1:1 patient care. As an executive at University Hospitals in Cleveland, OH, we touched over 1 million patient lives in Northeast Ohio. At MDLIVE, we provide care for over 60 million members across the nation.

Can you share the most interesting story that happened to you since you began your career?

Prior to graduating from medical school, I was fortunate to receive an 8-week elective with the Department of Health and Human Service Indian Health Service (HIS) agency in Nome, AK. In January and February IHS works in conjunction with Alaska Native Tribes and Tribal Organizations to provide health services to Alaska Natives. It was 1996, and under the telephonic supervision, daily caregiving was provided by native village members called health workers focused health care training post high-school education. Native villagers including pregnant mothers would receive routine primary care as well as prenatal care with supervision via radio would or telephone conversations with a doctor based in Nome. Serendipitously, that was my first exposure to telemedicine. One of my most memorable experiences during my time there were the scheduled clinical visits to support the regular patient care in the local villages.

For the villages serviced by Nome, all pregnant women delivered their babies in the Nome “city” hospital. Due to the travel time from their villages, mothers had to leave their families and arrive in the city weeks before their due date to ensure a safe and healthy delivery. There was one particular case of a mother who lived on an island in the Bering Strait 100 miles from Russia and wanted to ensure she was able to stay with her family so remained silent of her pregnancy. She prematurely delivered the baby on the island in a small schoolhouse and our Nome Medical team travelled by airplane and snowmobile to pick up the baby. Without an incubator, we had to improvise and use a Ziploc like bag to insulate as well as warm water bottles to keep the baby warm during travel. We had to intubate and provide breathing support for the baby the entire way back to Nome. By the time we arrived, a NICU airplane arrived from Anchorage because we didn’t have the adequate Neonatal Care equipment. It was a powerful experience that inspired me to pursue family medicine and understand the importance of human dynamics in healthcare.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

As a person of faith and service, I think often about the poem by Lucille Britt “The Dash.” It is a powerful poem that explains that the dash on a tombstone, the one between your date of birth and date of death, is what really encompasses your human life. If you look at different tombstones, the dashes may be varying lengths, signifying long and short-lived lives. But no matter the length, it’s what you did with that time that matters. The dash is a symbol of our story and how we chose to impact other people’s lives.

My father had too short of a story, but he really filled it with many moments of integrity, service, and love. He had this poem over his desk, and while there are several versions of the poem, the one he liked best ended with “…and I hope over my dash it says, “well done.”

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?

My father was well-known for bringing humor into medicine and it’s one of the things I inherited. As part of my practice, I often refer to the biopsychosocial model, which focuses on comprehensive care of the mind, body, and spirit. Medicine is about treating the human, and there can be some really tough times, but when appropriate you can inject a bit of humor. For example, female patients would often come to my office who weren’t feeling well. Along with medication and other treatments I would write a prescription that would say,” XX is unable to do dishes, must have control of the TV remote and receive foot massages.” I would sign it, and they would take it home to their spouse. More than once, I got a phone call from a spouse asking if the prescription was real. It was my way of adding light humor to remind the patient and their family to take care of themselves beyond just medication.

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?

I really like the concept of thinking about both the art and the science of medicine. From the art standpoint, there is a human connection that is involved that gives you the ability to be able to lean in and hold a patient’s hand when things are difficult. That human interaction is powerful and cannot be replicated with technology. That said, there is information that can be gathered during a telehealth visit that could augment an in-person visit. Video calls provide the opportunity to see a patient’s background and home life, that you normally wouldn’t see if they were in the office. For example, a telemedicine call could reveal environmental or social factors that contribute to a not so healthy lifestyle, unhealthy eating habits or perhaps the patient is by a social determinant of health that a local resource could help address.

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?

There are a few core challenges of not being in the same space as a patient. As mentioned earlier, the physical connection and not being able to sense the need to lean in and hold a hand when needed. Some have pointed to challenges with technology and older patients, however that challenge is becoming less and less relevant as more people become comfortable with the technology in their lives. While these issues may exist virtually, logistics are also part of the challenges of in-person patient visits.

However, on the connection front, technology actually improves access to and connection with a physician, rather than hampers it; patients could experience 30–60-minute wait times to meet with a physician or wait 2–3 weeks or more to see a physician in person. Once in the office, patients, and providers could have trouble connecting due to distractions in the office or even risk exposures if a patient in the waiting room is ill and some patients struggle in person to be open and honest with their physician. However, on a telemedicine call, patients and providers are face-to-face with very little distractions that would prevent them from flawlessly connecting and communicating.

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.)

Based on my experience as a telehealth physician, the five keys for physicians to support the best patient experience and health outcomes during a telemedicine appointment are:

Technology: Connectivity can be an issue from both a provider and patient standpoint during a virtual visit. While it may be frustrating to hear yourself echo multiple times, acknowledge the human issue, and reconnect.

Humility: Telemedicine is a new way of connecting, so it is normal for both the provider and patient to have their own apprehensions. It is important for the provider to provide reassurance and have the humility to say, “this is what we’ve learned,” and make the patient feel a part of the process by telling them that you’re working together to understand this new way of delivering healthcare, much like we’ve done with COVID-19.

Trust: A good way to level set the care experience you are providing is to have a clear understanding of your clinical limits and what you can and cannot do within the scope of telemedicine. Trust your gut as you would in the office and know that part of your medical journey might be to educate the patient to get a higher level of care that is outside what you are able to perform at this time.

Close the Loop: A telemedicine concern providers often experience is not knowing if they will see a patient again, so it’s important that you know when and how to close the loop. At MDLIVE, our virtual primary care practice has been developed to have a continued relationship with the patient. The platform has several lines of communication including a patient portal, patient messaging, an on-call nurse and patient engagement surveys that are all designed to help close the loop on care and provide the opportunity for the team to learn from the patient experience and provide even higher clinical care support.

Self-Awareness: Physicians are well-aware of the risk of practice fatigue and burnout; it’s been an issue in traditional practice and is no different in telehealth. That’s not a function of the technology, that’s simply physicians putting in long hours. As a provider, it is important have an internal thermostat and know when to take a break from work and find other outlets to take care of yourself. For telehealth, do some stretching, take frequent breaks from screen time, take a walk — all things you should be doing anyways to give your body and your mind a break.

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?

Telemedicine delivers convenient, cost-effective, caring, and contagion-free healthcare when and where a person is in need. In an unprecedented year that created extraordinary challenges for consumers needing to access healthcare for physical and behavioral health, millions of people accessed high quality care through telehealth in the convenience of their home and with average wait times for urgent care within 10 minutes.

Regarding dermatologic issues, images can be submitted at any time of day. The turnaround time for a diagnosis and treatment plan is once submitted is 24 hours on average or no longer than three days. Behavioral health appointments are available within 5–7 days on average, which is far less than the average 32 days for in-person appointments. Geographic barriers are also eliminated through telehealth.

The benefits of telemedicine have just as much benefit for many of the providers on the “other side of the screen.” Virtual care has also allowed providers to continue to practice even when physical limitations may have suggested otherwise. At MDLIVE, we have several physicians in our network who have experienced injuries and illnesses that prevent them from practicing medicine in a traditional setting.

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?

Healthcare technology has evolved tremendously to become more consumer friendly. For perspective, think about your grandparents first aid kit included items such as a mercury thermometer and rubbing alcohol. Today, that kit has continued to evolve into a digital health care kit which may include various home tests to monitor a patient’s blood pressure, pulse oxygen level and medication intake as well as at home testing. Patients now have the technology to take charge of their healthcare and can remotely monitor their conditions and share data this with their provider. This level of care allows patients to feel like they are an integral part of their care team and provides them with a sense of control, comfort, connection, and convenience.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

I think it’s important to acknowledge the advancement of telehealth and understand that over time, this system will evolve into a hassle free, frictionless model of healthcare. Fundamentally, this avenue of care will remove points of contact while retaining therapeutic integrity with a focus on patient compliance. As telehealth evolves, it will be important to keep an eye on the ethics part of this technology so there is a sense of air traffic control around the data collected and how it’s being used.

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?

Whether it is an in-person or virtual appointment, preparation is key. It is important for patients to be prepared with questions that they want to ask their provider; know the expectations that are looking for with the clinician visit and have a clear understanding of the providers recommendations and instructions as they pertain to any prescription medications, therapies and advice.

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 healthcare technology is rapidly evolving, it is important to acknowledge the evolution of the healthcare workforce. As we have seen the development of nurse practitioners, physician assistants, and care coordinators, health care careers of the future, particularly in the telehealth space, may not yet even have been designed

This past year has created a major change in medical education. Medical students, who often experience in person lecture and much hands-on learning had to adapt to virtual learning, which. While medical students are beginning to incorporate telemedicine education, my prediction would be that virtual care will become an increasing component of their advanced training.

What excites me isn’t a specific technology application, but they fact that we are continuing to explore how technology can be used to enhance the patient-provider relationship, reduce barriers to care, empower patients to live healthier lives, and reduce unnecessary costs.

Is there a part of this future vision that concerns you? Can you explain?

As technology continues to evolve, it is important to understand its limits and take stock of the lessons learned to improve the human side of care provided to patients.

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 could inspire a movement in healthcare, it would be to empower individuals to take charge of their care and really believe that they are the center of healthcare. Medicine is and should always be Patient-Centric. People are at the center of everything we do in healthcare and they should know that they have the power to choose their physicians, be knowledgeable about their medications and above all be prepared and supported to make their important decisions about their health.

How can our readers further follow your work online?

Should readers be interested in learning more about MDLIVE, they can visit: www.mdlive.com

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.

    We use cookies on our site to give you the best experience possible. By continuing to browse the site, you agree to this use. For more information on how we use cookies, see our Privacy Policy.