Wednesday, June 24, 2020                                                                                          Issue # 68



Happy Wednesday to you and thank you again for keeping VMG open and in the lead on providing the right care to our patients and keeping our patients, staff, and practitioners as safe as possible.


National, State and Regional


News from Texas, Florida and Arizona is not good. It is now clear that at least in these states that reopened early or never really took effective measures to prevent spread, there is not only a steep rise in average 7 day new infection rates, there is also a steep rise in hospitalizations. And yet you still see images of crowds, not wearing masks, and packed together shoulder to shoulder at rallies, meetings, and other events.


Seven states have reported record hospitalizations: AZ, AK, CA, NC, SC, TN, and TX. And the NYT reports that Tuesday saw the third highest single day total of new cases since the pandemic started. And 26 states are seeing rising rates of infection causing some public health officials and even Governors to say that they may be losing control of the pandemic in their areas.


New York, New Jersey and Connecticut are now requiring travelers from states with high coronavirus rates to quarantine for two weeks.


You can see Governor Baker’s remarks on the findings of the report investigating the debacle at the Holyoke Soldiers’ Home in handling COVID-19 here: “The report is devastating.” In addition to replacing personnel, the Governor states that he will implement all of the report’s recommendations for change.


There have been no significant changes recently in our region’s preparedness or rates of infection. The summer is just starting and places are opening with visitors still coming in to the state so rises in infections are still possible and maybe even likely. You know the best defenses.


I know that many of you are encountering relatives and friends who see the idea of wearing masks as an infringement on their freedom. I think we need, to the extent possible, to be educators about this. The key point is that wearing a mask may not help the wearer to avoid infection. But it does help to prevent the wearer from possibly spreading the infection to others. And it’s also important to let people know they can be spreading the virus even if they themselves are not sick or do not feel sick. And, here’s the thing. If we all wore masks and social/physical distanced, we’d reduce the spread significantly.




As Amy Rice announced this morning in her email, “an update has been made to the process for patients who are receiving care in the health centers.  The change is that going forward VMG will provide these patients with a surgical mask to wear while in the building.  Patients will still be required to wear their own face covering to enter the building and then will be given a surgical mask as part of the screening process.  


The access control policy has also been updated to include information for when it is appropriate for patients to use VMG bathrooms to collect a specimen.  


You should also have seen Mary Mitchel’s email this morning about our decision to move the NHC Eye Care Department to EHC this summer. As you may remember, when we had to create a “respiratory clinic” area at Northampton, the space the Eye Care Department and Optical Shop occupy at NHC was the best site for this service. The EYE Care Department at NHC was effectively closed as a result. At the beginning of the pandemic, Eye Care could not operate in person anyway because of the close contact required by the Optometrists and patients without a good way to protect both patients and staff. Eye Care at NHC is the highest volume Eye Care practice and we want to get it open again as soon as we can so the move to EHC, which already has space designed for Eye Care, is the best way to do this. To get this done, we will have to move some staff currently using that space to other offices. We have that space at this time due to the high volume of telehealth we’re doing and the low volume of in-person care in parts of the health center.


Mary, Colleen, and others are working out a transition plan now. The plan at this time does not include reopening the NHC Optical Shop. The AMC optical shop will continue to be available for our patients and staff.



OK for today. Here’s a video of an amazing performance of a song from “Wicked.” We’ve all changed each other for good……




·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Tuesday, June 23, 2020                                                                                                                  Issue # 67



It’s getting to be the same theme every day. It’s a beautiful day. You look outside and everything seems so ….. normal. Places are opening. Cars are coming back to the roads. Boats on the rivers. You can even get your hair cut, nails done, tattoos…..


And the numbers keep going in the right direction. The state sponsored “pop-up” testing sites last week and the results are in. Of the more than 17,000 tests done, only a 2.5% infection rate for those who attended demonstrations and protests in the days prior. And that’s pretty close to the general infection rate in Massachusetts.  That’s good. Or is it? We just don’t really know because there are a lot of things we don’t know still about the virus. Apparently you can get antibodies without showing a lot of symptoms. But how long to they last? And how long do they keep you safe? Should the quarantine period still be 14 days? Or should it be 28 days? Just examples of what we don’t yet know.


We know that other states are now seeing rising infection rates after they opened up.  Will we see that too? We think that sticking with masks and physical distancing will keep us safe. Why take chances then? Stay with what seems to be working. Amy Rice said today “it’s like going in the ocean and getting caught in the riptides.” You don’t see them until you’re caught in them. So let’s all “swim safely.”


National, State, and Regional


We’re waiting to see the “results” from places that have allowed crowds, indoor crowds, and have not required masks or distancing. It’s a 2-4 week wait now and we should know.


The state will stick with the reopening plan but some other states are having second thoughts and may step back. Some small towns in Kansas and Maine are reconsidering requirements for mask wearing as they either continue reopening or reverse for a while. And governors in Texas and Arizona (and to some extent, even Florida) are also trying to see if they can stay with their plans. A lot of uncertainty continues to be the norm.




Gina’s last email, sent on Sunday contains revised information on prioritizing care. The main changes are a change to the section for physical therapy (clinicians to decide which patients need in-person visits) and a change to the lab section about lavatory use for patients with transportation difficulties to use for specimen collection.


Mary Mitchel reports that she and others are continuing to work on creating and modifying schedules for outdoor and indoor care. Tents are up for all centers and work is being done to get organized in preparation for both types of visits.


Cleaning and sanitizing requirements continue to be adjusted. Custodians and cleaners are now working new shifts to cover our daytime needs as well as early evenings and Urgent Care coverage is being discussed.


Athena telehealth is about 85% rolled out. A few problems have been encountered but, in general, it’s going very well. We are also trying a new program/app for texting patients once they appear in our parking areas. This App also has capability to pre-fill forms on the web and get them into athena.


  1. Mary: Busy with discussing schedules for outdoor and indoor care.  Tents are up, work being done to get organized in preparation of visits.

  2. Amy:  Will provide full PPE report next Tuesday, June 30th.  Supplies good.  N95 mask alternatives for those unable to use them being assessed.  Ordering returned to health centers for specific supplies; details provided.  Greg: Work in progress for daytime cleaning schedules.  Jim Wood working on staffing workflows and needs for weekend coverage. 

  3. Lisa: No new updates.

  4. Martha: Continuing rolling out Athena telehealth – 85% completed.  A few glitches being smoothed out.  Program trial being run at AMC next week for texting patients and document communication.


That’s it for today.


We could all use a little bridge now….


Paul Simon and Art Garfunkel - "Bridge Over Troubled Water" (6/6) HD

From the DVD "Paul Simon and Friends" Buy the DVD here: Lyrics: When you're weary Feeling small When tears are in your eyes I will dry them all I'm on your side When times get rough And friends just can't be found Like a bridge over troubled water I will lay me down Like a bridge over troubled water I ...



·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Monday, June 22, 2020                                                                     Issue # 66



Welcome to a new week. I hope everyone had a good Father’s Day weekend.


Face coverings and face masks have been in the news again with “positions” being taken on “both sides” of the argument. One position is that personal freedom is more important than “conforming” to someone else’s idea of what’s right. “I can choose not to wear a facemask since I’m willing to take the risk.” The other position is that wearing a facemask is a “public good;” it protects others from possible harm. You can see both sides of the argument. But should you?


There are now studies showing that states and localities requiring the use of facemasks are seeing lower incidence of new cases of COVID-19 after the requirement is enacted. One estimate is that anywhere from 230,000 to 450,000 new cases may have been prevented (Community Use of Face Masks and COVID-19: Evidence From a Natural Experiment of State Mandates in the U.S., Lyu, W and Wehby, G, Health Affairs, June 16, 2020). So while it is true that an individual could take the risk for her/himself, s/he may also be spreading the disease to others who did not get to make a choice. In times of increased risk and danger of infection, wearing a mask does not seem to be too big a burden to protect others and the freedom not to wear a mask seems less important.


National, State and Regional


Watch for changes in the CDC recommendations on wearing face masks and other public health measures to slow the spread as states including Florida, Arizona, and North Carolina see increases in cases. These increases are not just the result of more testing as they are also seeing more hospitalizations and a higher rate of positivity of testing.


Massachusetts continues to reopen in Phase 2. Restaurants can now have indoor seating with tables at least 6 feet apart and a limit of 6 people per table. The Governor decided not to impose maximum capacity limits (other than previous fire codes) as restaurant sizes vary. Bar seating is still not allowed. Offices can “repopulate” to 50% capacity. Hair, nail, and other grooming and self-care services can reopen with precautions. Key metrics will be monitored ahead of any decision to reopen further.


Regionally, our hospitals are still in good shape with capacity and with return of services in many areas.




Our plans for reopening continue as discussed last Friday. We’re continuing to see patients by telehealth (athena telehealth is still expanding with the goal to be through the whole company by the month’s end or early July). We’re continuing to see some adult and pediatric patients with hybrid, part telehealth and part in-person (limiting the time of exam room exposure).


Here’s a chart showing our charges by month (the green line is total for 2020 and you can see it is on the rise):

Summer is here and it’s getting hot out there. Thank you again to all those involved in our “outdoor care.” We’re looking into ways to do this better, including dealing with the weather, for staff and patients. It’s an important part of our safety plan to reduce the risk of infection during  this pandemic.



That’s it for today.


As always, please continue to be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Friday, June 19, 2020                                                      Issue # 65



“Do the best you can until you know better; then when you know better, do better.” ……Maya Angelou


On June 19th, 1865 General Gordon Granger and 2000+ union troops landed on Galveston Island in Texas. General Granger read “General Order No. 3” “The people of Texas are informed that, in accordance with a proclamation from the Executive of the United States, all slaves are free.” Celebration of Juneteenth (combining the words June and Nineteenth) began in 1866, one year and a day later. (From DeNeen L, Brown, the Washington Post, 6/19/20).


It’s important to understand that General Granger’s reading of the order took place two years after the Emancipation Proclamation was issued by President Abraham Lincoln. Some have said that the slaves in Texas didn’t know about the Emancipation Proclamation and that they were already freed. However, Texas slave owners had refused to acknowledge Emancipation and the end of the Civil War. Freed slaves therefore could not be free in Texas until they had the muscle of the Union Army with them on Galveston that day. And then what? “Between 1865 and 1930, more than 450 lynchings were recorded in Texas.” What have we learned? What can we do better?


That many Americans do not know about Juneteenth and its significance other than seeing a note in their printed calendars says something about where we are. However, most Americans of color recognized Juneteenth many years ago. It was not “made famous” recently. CNN reports that in 1997 a “Juneteenth Flag” was created by Ben Haith. “It is red, white, and blue in color to remind us all that slaves and their descendants were, and are, American.” “And while African Americans today are still fighting for equality and justice,” Haith said “those colors symbolize the continuous commitment of people in the United States to do better – and to live up to the American ideal of liberty and justice for all.”


I recommend an article by Adrian Walker in today’s Boston Globe, “What we celebrate this Juneteenth.” And here’s link to a New York Times article today for different views of Juneteenth:


To do better when we know better. That’s what we should be about. These ideals are easy to talk about. Acting on them is more difficult. But learning to be better should not be so difficult. It’s what we do, though not always with ease. On Monday, in a separate email, I’ll tell you about some beginning steps we can and will take at VMG to do better.


Please remember this IS a healthcare issue. As the rates of infection and hospitalization rise across the country, there is still a disproportionate impact on people of color and lower income. We’ll talk more about that in the coming weeks.


National, State and Regional


Across the country (literally across the country if you look at the map), we are seeing spikes and outbreaks in areas that were previously relatively unaffected. This makes sense since there is no immunity to the virus (no vaccine and it is a new virus for humans; that’s the meaning of the term “novel” in this case). For example, Florida just reported a single day increase of 4,000 cases; a single day record in Florida. And this is not just the result of more testing. Florida’s DPH is concerned that they may be the next epicenter; much like NYC in the early days of the pandemic. And Florida was one of the states that “reopened” quickest, despite the “numbers” going in the wrong direction.


Massachusetts is still going ahead with reopening. People will be out and about. But we will also see vacationers, family visits from other places, etc. And then some colleges have announced that they will be opening in person in the fall. Without a vaccine (which is not going to happen in the fall) we will see spread of the virus from students, families, staff and faculty coming from other parts of the country (and even other parts of the state). That will certainly affect all of us.


So this just means that wearing a mask, frequent hand-washing, physical/social distancing is going to be even more important. Please take care of yourselves and help others to do the same. Mask wearing (and the other precautions we talk about all the time) is NOT political. It may be life-saving.




If you have not yet read Gina’s email about “Safety First and PPE at VMG” please read it and remind yourself of the safety standards. In the whirl of work during the day, it’s easy to slip your mind.


Also from Gina:


Prioritizing care during phase 2 of Reopening Massachusetts and the current state of the pandemic is actively reviewed.  The VMG approach to slowly expanding care is described by our medical director, Dr. Esrick below.  In addition we have worked on the attached summary that provides greater detail, by clinical area, to expand care very slowly and safely at VMG.


Guiding Principles:


·         We do want to slowly open the doors to more in person care over the next weeks.

·         We want to continue our safety first philosophy.

·         We do not want to compromise our ability to maintain full social distancing.


Please review below for changes we will start to put into place:

Visits in the Health Center:


·         Almost all in-person visits that occur should be the result of a virtual visit.

·         In person visits should be done at car side or outside, when appropriate.

·         Each provider will be responsible for designating who they see in these in- house visits.


We will see how we do with these visits and slowly increase numbers as seems reasonable and as we learn to manage getting patients in from the parking lot, without waits in waiting area or patients grouping in hall ways etc.



Like jazz? Some jazz for Father’s Day, a live recording of Horace Silver’s Song for My Father:



As always, please continue to be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Thursday, June 18, 2020                                                               Issue # 64



Good afternoon.


Several media outlets and university models predict that the virus is now a growing problem in Florida, Texas, Oklahoma and other states. And we see pictures, even from places where the virus numbers are going the right way, of people out and about, in crowds, eating and drinking, without masks and without social/physical distancing. There should be a sign on restaurants and bars: “No Vaccine, No Treatments -- No Mask, No Distancing, NO SERVICE.”




It seems so obvious. The virus is not just going to go away because we don’t like it. Or because we are tired of it. Why would people hold a huge rally in a crowded auditorium in a city where the cases are spiking and the hospitals are nearly filled? Or a non-COVID example: why would people with no medical contraindications refuse vaccinations that have been well-studied, have minimal if any side effects, and saves lives (especially when in other societies younger people see it as a duty to older people to get vaccinated and not put seniors at risk)? (And, BTW, when there is a COVID vaccine, you can bet that some percent of the population will refuse that too, even after it is well-studied). Excluding any possible political motivations, why?


Let’s go to the oracle: the nation's top infectious disease expert Dr. Anthony Fauci says that anti-science bias in the country is causing problems. "One of the problems we face in the United States is that unfortunately, there is a combination of an anti-science bias that people are — for reasons that sometimes are, you know, inconceivable and not understandable — they just don't believe science and they don't believe authority," "So when they see someone up in the White House, which has an air of authority to it, who's talking about science, that there are some people who just don't believe that -- and that's unfortunate because, you know, science is truth," said Fauci, director of the National Institute of Allergy and Infectious Diseases.


Fauci, who has served six US administrations so far, was seemingly referring to his appearances in White House press conferences during the coronavirus pandemic.


"It's amazing sometimes the denial there is, it's the same thing that gets people who are anti-vaxxers, who don't want people to get vaccinated, even though the data clearly indicate the safety of vaccines," Fauci added. "That's really a problem."


Here’s another reason. Something bad happens. Its cause can’t be seen. It’s relatively rare but it causes pain and grief. Someone comes up with a theory about something that can’t be definitively and easily disproved quickly. The theory propagates itself or is promoted by people in pain who feel something must be done (and people who want to capitalize on their pain). And then some people who should know better pass it on. Sound familiar? It’s hard to convince people in pain and grief that the theory, any theory, is just not right because something must be causing their pain. And if we don’t have good science to be clear about the cause……


OK. So we work in a field based on science and accumulated wisdom. Sometimes we, or the science, is wrong. We learn new things from careful observation, new experience, experiments, etc. Open minds. That’s how science works. That’s how we went from masks don’t help much to masks are essential (in a very short time).


But here’s the thing right now. We do know that promoting people being in crowds, without masks, indoors or even outdoors, without social/physical distancing, shouting, singing, is going to promote the virus. That’s for sure. There is no doubt. Some people will get lucky and not get the virus. Others won’t be so lucky. All will pass on their virus to others who were not exercising their freedom to go to the rally or bar without the right precautions.


This is not a matter of personal freedom. I can choose to wear a mask because I am free to do so. This is a matter of promoting public health because of the way the virus spreads. You may not care if you get sick, or you may be willing to take the risk, but what about the 10-20 people you pass it to? What’s their choice? And then the hundreds they may pass it to?


OK. End of rant. I should try not to watch the news when I get up (at least some days). But as you consider going back to normal activities, please read the “guide” from yesterday’s Update for recommendations on how to do so as safely as possible.

And, in case you need more visualization to help talk with family and friends about the spread issue, Gina shared this:


Video by the National Institutes for Technology demonstrates high-speed visualizations illustrating a flow when breathing and coughing using home-made masks. Powerful to see the importance of a mask at all times at work and out in the community.




From the Washington Post today:


Massachusetts is setting an example on how to do contact tracing.

The state, the first to create a statewide contact tracing system, organized the Community Tracing Collaborative led by its individual insurance marketplace and its public health department. The collaborative has hired more than 1,000 people working on contact tracing who are supporting more than 1,000 additional contact tracers working through the state's 351 boards of health.

The collaborative consistently has fewer than 50 confirmed cases and contacts that are awaiting outreach, according to Jason Lefferts, communications director for the Commonwealth Health Connector. It has made more than 318,000 calls to cases and contacts, he said. “At this point, Massachusetts is able to keep up on contact tracing.”




Here are some photos of the AMC “Outdoor Office.” Thanks to all of you who have quickly set up these new “facilities” and are staffing them. They will really help us deliver on our promise to get patients the care they need while keeping patients, staff, and practitioners as safe as possible.








Our third patient newsletter is “in the mail” (email, that is) this week. If you didn’t get a copy in your email, it will be on our VMG website soon.


We will soon begin piloting a new texting platform for communicating with patients at the time of their appointments. It will eliminate the need for patients calling from and to the parking lot when they arrive and it will allow the completion of documents and forms in advance of the visit. It’s from a company called “OhMD” (we’ll take suggestions for a better name later) and it’s HIPAA compliant. We’ll pilot at one health center to prove that it works and that it’s an improvement from what we have now. This is not replacing our use of athena telehealth which is currently rolling out across VMG and is working very well.



That’s it for today.


As always, please continue to be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Wednesday, June 17, 2020                                                                                          Issue # 63



Happy Wednesday. There were no bats hanging around the entrance when I came in this morning. Either they found other places to hang or they can’t afford the copay.


At first patients were reluctant to seek care due to anxiety about catching the virus in healthcare facilities. With time passing and with healthcare facilities taking actions to reduce risk, we’re now finding indications across the country that many patients are delaying seeking care because they are concerned about deductibles, copays, and about getting laid off and losing insurance, or both. In Massachusetts, that may not be as big a factor as health plans have communicated that they will suspend most copays and deductibles, at least for COVID-related services, but patients may still have that worry.




Anthony Fauci, the nation's top infectious-disease expert who hasn't been put in front of the public lately, told NPR that vaccine development efforts are proceeding but will take time to meet reasonable scientific standards. And he warned against the idea the United States is in the midst of a second wave, when the first wave isn't over yet. “When I look at the TV and I see pictures of people congregating at bars when the location they are in indicates they shouldn’t be doing that, that’s very risky,” Fauci said in an interview with the Wall Street Journal. “People keep talking about a second wave,” he added. “We’re still in a first wave.”


British scientists say the 60-year-old drug, dexamethasone, reduced the risk of death for patients on ventilators by a third, and reduced the risk for patients on oxygen by a fifth. That’s encouraging news because the drug is in plentiful supply (now), cheap, and proven safe. More details about the studies are needed because so far this is just a press release.


We will probably see reports, press releases, in the next few weeks about possible other drugs that may be effective in treating COVID-19. We’ll want to make sure that the research is valid and that the data is published and not just in the form of a press release.


For now, we need to remember (and help our patients, families and friends remember) that there are not available proven treatments and no vaccine.  So the virus will continue to spread.  Which makes it important to avoid high risk activities.


Here’s an article from the Wall Street Journal summarizing what is generally known about how the virus is actually transmitted. Close, sustained and unprotected contact with infected people is the main way to spread the virus. Cleaning high touch surfaces, especially in higher risk areas, can still be important, but “unsafe contact” (unprotected, as in not wearing masks) in enclosed spaces with poor circulation of air (and fresh air) for longer periods in larger groups or crowds is most risky. We need to minimize time in these situations.


And finally, from The Atlantic magazine, “the theme of the next chapter of the pandemic, then, is choice: Local and state governments are now presenting Americans with a menu of things they can do again. But should they? Because different parts of the country are (and will continue to be) in different stages of their outbreaks, there generally aren’t yes-or-no answers that apply nationwide—in general, it’s better to err on the side of caution. But there are guidelines that can help you think about the safety of everyday activities.”


Here’s that link to a very handy guide, by type of activity, as to what’s risky and what’s relatively safe:    




From Gina:


We are now in the second week of Phase 2 reopening of the state, with additional openings on June 29th.  The state is pushing to maximize testing by offering free COVID-19 testing for people who have been in large group gatherings in the past two weeks.  Tests to be done on June 17th & 18th – Please check Gina’s email sent yesterday for locations.  Massachusetts also maintains a robust list of testing locations on DPH website.


In operations news, the first day in the ASPC went well thanks to excellent work in planning reopening. 


A call with Baycare confirms that VMG is in-step with colleagues in our area re: providing care with VV and gradual approach to opening.


We continue to develop a summary of reopening by department; to be available soon. If all goes well, we may potentially have 30-40% of care in health centers returned by fall. 


We are continuing with the plan to transition Pedi visits to each health center by July. 


VMG Outdoor Offices are continuing to roll out The EHC tent was set up this week. The NHC tent should be set up by the end of this week or the next. We are also working to have BP clinics under the tents. The Outdoor Offices are being used by nursing for immunizations, some treatments and other nurse visits. Some of our specialties are also beginning to use the Outdoor Offices slowly.


Lab spaces outdoors continue to be advanced in their “set up” to provide additional safety and space to staff and patients.


We are continuing to roll out Athena telehealth across all departments. 


We are also working on processes for use of interpreters.


Massachusetts had the lowest number of new cases and deaths reported June 16th.






A little energy from South Africa:





OK. What will I say now? Please continue to be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Monday, June 15, 2020                                                                                     Issue # 62



I hope you all had a good weekend.


On Saturday, it was possible to get in your car on the Outer Banks of North Carolina and drive west to Los Angeles and never go through a state where the pandemic numbers were going in the right direction. And this is happening as we are “opening up” for the summer months, demonstrating and protesting in crowds, and contemplating opening of movie theaters (among other public spaces).


I heard a discussion this morning about what life was like prior to the discovery of antibiotics and vaccines. We built railroads, mines, and factories. We built and then densely populated cities. And we had a grudging acceptance that some numbers of us were going to die from diseases we could not prevent nor cure. What is different today is that we expect to be able to prevent, if not treat, communicable diseases so that we minimize mortality. Yet we are living with a virus that has no vaccine (the best prevention) and no cure.


So all we have is the litany of things under our control that will delay being inundated by the virus. You already know what they are. You just have to remember to use them. And that is the message again, and for quite some time. Even as we “open up,” even as the weather gets better, even as we are out doing more “normal” things, stay alert, stick with what we can do to prevent infection, and stay safe.


National, State and Regional


On the national scene, people are tired of the pandemic. “Quarantine fatigue” is now a thing. The weather gets better and people wish to resume normal life. The White House Task Force is not visible. Key leaders don’t wear masks in public. People want to bend science to meet public expectations.


Politico this morning reports that “52% of reported coronavirus cases in the U.S. are missing information on race and ethnicity.” Why is this important? “We’re flying blind until this comes in,” said Brett Giroir, Assistant Secretary of HHS and coronavirus testing czar. “It’s a flaw in the system. We can’t develop a national strategy to reach the underserved, or know how well we’re doing, until we have the data that shows us if we’re reaching them or not.”


Contact tracing is greatly underfunded but states are not waiting to reopen.


The good news is that there are now legislative efforts in Congress to make Telehealth a permanent tool in healthcare.


Massachusetts is currently one of the states where the numbers are going in the right direction. If you want to see the latest statistics in Massachusetts, go to the DPH Dashboard at:


Looking at statistics from Baystate and Cooley, our local hospital systems are not overwhelmed.




Our third edition of our VMG Patient Newsletter is going to be emailed to patients beginning tomorrow. The Newsletter discusses what we have all done to continue to provide care while keeping our patients, staff and practitioners as safe as possible.


Our Ambulatory Surgery and Procedures Center (ASPC) in Amherst reopened today for colonoscopy at a somewhat reduced schedule. The plan is to continue at a slower pace for a while and then open to increased volume as we prove we can handle that volume.


On the lighter side of things, a winged visitor was successfully removed from a vestibule at GHC today (he was just hanging around). Thank you, Randy, for your service.




Margit Walker sent me this chart of activities, ranked by risk level, from Yahoo Finance as you consider which activities to resume.

And, for those of you with children of the Sesame Street age at home, here’s a link to the ABC’s of COVID-19 from Saturday. It should help.



And again, please continue to be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Friday, June 12, 2020                                                                      Issue # 61



Good afternoon and happy Friday.


In a strange twist on what reopening means for certain providers in states that are “ahead” of Massachusetts, there are reports that doctors are informing patients that they “aren’t doing telehealth anymore because of reopening. So you can’t stay home.” I’m not sure how widespread this is, but it is clearly the wrong direction. I’m certain that we will be doing telehealth either instead of some visits or as part of hybrid visits on into the future. A lot will depend on whether the payers will support these visits but, even if they don’t’, we’ll be finding a way to continue to incorporate some forms of telehealth going forward.


National, State and Regional


More states (Massachusetts is not one of them) are reporting either “spikes” in cases of COVID-19 or hospitalizations. Most of them were in reopening phases and some never effectively shut down. Texas, Florida, Georgia, Arizona, and California are on this list. Utah is one of the few states that have halted its reopening plans, though others are considering. The key point here is that it is very difficult to go backwards once you’ve gone ahead too far.  It’s hard for businesses, the public and even healthcare providers to “yo-yo” on reopening once the door has been reopened.


I’m sure you already know this. Here’s what we know for sure. The virus is still here and “out there.” It’s still highly contagious and dangerous. There is no vaccine and no real treatments. And the good news is: masks really do help and social/physical distancing really does help. And this is more and more important as people “widen their circle of contacts” with reopening. That’s what we have for tools now. That’s what we have to use (and VMG’s plans for “reopening” rely on these tools). Please guard against complacency. And help your patients, family and friends to do the same.


Oh, and even the Queen of England is doing video calls. CNN reports today that Queen Elizabeth, age 94, conducted her first-ever virtual conference.


There have been some news reports on the use of “convalescent plasma” to treat or reduce the symptoms of COVID-19. To date, there have been no reliable studies indicating that this is an effective treatment. There are also news reports today that use of the polio and/or TB vaccines in patients with COVID-19 may amp up the immune system so that cases are briefer and/or less damaging. There are no studies yet to prove these theories.


Our state continues its reopening plan. We’ll know how well this works in 2-4 weeks. Our region, so far, has been spared the worst of the pandemic with very low numbers of cases per capita compared to the rest of the state.




We are continuing to redesign or modify our processes of care to reduce time spent in enclosed spaces in or buildings (15 minutes or less) and proximity for patients and staff, as possible. The “dream” of not having waiting rooms has been achieved by necessity.


We will continue telehealth and hybrid visits as much as possible and we should be bringing patients into the centers only for conditions and instances in which the clinicians and practitioners believe it is necessary for care.


Our goal is to do most in person care outside where open air helps to dilute the viral content. And when we do bring patients in, we have to guard against bottlenecks at the front doors, on the way to exam rooms, and on the way back out. That is why we are planning more hybrid visits: do whatever we can virtually pre-visit, limit time in exam rooms, and do virtual visits for post-exam discussions and recommendations.


We’ll be increasing the number of virtual wellness visits over the summer. These visits are especially well-suited for the current necessity.


We are working hard to increase our supply of necessary PPE for all clinical situations, the ASPC (which reopens Monday), and staff and patients. Thanks again to Val Felton and Amy Rice for all the work on inventory and supply management of PPE.


Some news from some of our sub-specialties:


Rheumatology is accepting new patient consults, virtually. They are also doing follow-ups and some injections for urgent clinical needs (while observing all the cautions for PPE, time in rooms, etc.). They are also seeing some patients in patient cars in the parking lot to get a look at inflammations, etc. when necessary.


Podiatry is also seeing new patients virtually as well as follow-ups. For patients with infections, pain, trauma, and for wound care, visits can be arranged in person observing all the cautions. EHC is their main location for now.


Sports Medicine is seeing new patients by virtual visit. Dr. Murphy is doing injections for patients in significant pain or, as necessary, after clinical prioritization and virtual evaluation/consult. He is only seeing patients in-person, when necessary, at EHC.


Finally, we’re hearing good reports about the video component integrated with athena. It provides better video clarity, seems more stable than some of the platforms we’ve been using and, for patients, no downloading of apps or programs are required. It’s been rolling out through primary care the past week or so and we expect it to be VMG-wide in the next few weeks. Once we are all up on athena video, it will be the only platform we’ll support. So, as your opportunity arises, please learn the steps to make it work (it’s pretty easy).



OK. Have a great weekend; the weather should be good so try to get outside.

Here are a few tunes, including one of my favorites, Brothers in Arms.



And let’s not forget Paul…..and friends….



And again, as usual but even more important now as things continue to open up, please be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Thursday, June 11, 2020                                                                                                Issue # 60



Good afternoon. We made it to Thursday again. The latest high level information on the pandemic, from Politico, follows.


“It’s too early to talk about the pandemic’s second wave: The United States has yet to emerge from its first wave of coronavirus.


Covid-19 has now spread to every state — and almost every county — in the country. About 5,000 to 6,000 Americans are expected to die every week from Covid from now until July 4, said Nicholas Reich, a professor of biostatistics and epidemiology at the University of Massachusetts, Amherst, who has been aggregating Covid forecasts.


Because the virus has been on the decline in New York, total Covid case counts and deaths in the U.S. don’t seem to be steeply rising. But in many places they are: New hotspots are continuously emerging across the country. Eighteen states are seeing an increase in Covid case counts, including sharp increases in Arizona, Florida and Texas, according to Covid Exit Strategy. Hospitalizations have been rising rapidly in at least nine states since Memorial Day. The country is rapidly approaching 2 million cases.”


I was on the phone with someone from Arizona this morning who said that people there are “complacent” and mostly acting as if nothing was happening. And yet they all know that their hospitals are being overwhelmed.


The key message is stay aware and stay safe.


State and Regional


Key metrics for reopening Massachusetts continue to move in the right direction. The Governor’s plan is continuing. You’ll see more road and foot traffic as the month goes on.




As we continue to slowly reopen (remember the SOCHO: provide the best care as safely as possible for patients, staff, and practitioners), it may get confusing about where we are in the process. We are working on a document that will list services by departments and their status at VMG. In the meantime, here are some current highlights.


From Steve:


Although schedules had been light in April and May, we are seeing significant increases in numbers. Overall, VMG family practice is booking about 90% of last year’s volume with some practitioners booking 125%. Coming up, there are 1400 virtual prevention visits scheduled June thru July –these were not being scheduled in previous months.


For the short term it is important that we all work to get schedules filled, practitioners working with assistants and reception to make sure all of our high risk and chronic disease patients are scheduled for virtual visits. Please make sure that our messages to patients about video and telephonic visits include the feedback from patients that they are helpful and productive for patients.


Lab volume is presently at 2/3 of last year and rising. Having labs available will

Continue to help make virtual visits more productive.


We are also working on developing Vital Sign stations in our VMG Outdoor

Offices. The availability of vital signs will also help make virtual visits more



From Gina:


As we continue to schedule virtual visits, it is very important to convey key

information to each patient with every appointment made:


     Video visits are preferred over telephone visits, and whenever possible, when scheduling offer video as the preferred appointment type.

     Please thank the patient for scheduling the video/telephone appointment, and state that their insurance will be billed as we ordinarily bill for appointment in the health center.

     If a patient were to have additional questions about insurance, you may share: “Most payers are not imposing cost sharing (copayments, coinsurance, or deductibles) for virtual visits.  However, please check with your insurance on whether your insurance has any cost associated with the visit.” Many payers have already communicated with their members about their copay and patient responsibility policies.


We are getting requests for many documents utilized in clinical care to be

made available on the internet for patient access.  Work is being done to

identify key document to be placed on line.


Finally, planning underway for the Lab Draw station to open in Greenfield at

7am for additional patient appointments.




OK. So let’s say you are tired of being stuck at home and you find a way to travel to a national park to observe wildlife. Here’s a piece from National Geographic with some advice on caution for these activities:


“By Rachael Bale, ANIMALS Executive Editor

The first day of summer is almost here, and people are eager to get out in nature. National parks in the U.S. are slowly starting to open, and that means wildlife once again will be sharing their habitat with tourists. Already some trails are crowded and people are behaving recklessly. And I’m not talking about a lack of social distancing from fellow humans in the parks. People aren’t keeping their distance from wildlife.

There already has been at least one injury this season because someone wanted to get up close and personal with a dangerous animal in a park: In Yellowstone last month, a woman was knocked down by a bison after getting too close.

With that in mind, please do not touch/feed/attempt to take selfies with wild animals. Squirrels look cute, but they won’t hesitate to bite. Bison look slow-moving, but they’ll charge in a split second. Elk will gore you, and moose will trample you. No matter how long you’ve been stuck inside your home, don’t greet alligators. And bears ... well, everyone knows bears can be dangerous.

To stay safe around wildlife, use common sense and give animals a lot of room. Remember, approaching an animal doesn’t just put you at risk—it puts the animal at risk, too.”



Here’s a different take on Imagine….


Finally, as usual but even more important now as things begin to open up, please be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Wednesday, June 10, 2020                                                                                          Issue # 59



We’ve all been coping with this pandemic for about 3 months now. It’s forced an enormous amount of change and worry in healthcare and across the country. And as you know, there are no great answers now to how we will “get back to normal.” We will go slow and steady, balancing patient needs with risks to patients, staff, and practitioners.


We’ve been coping with the economic crisis caused by the pandemic for about the same amount of time and we are now officially in a recession. And there are no clear answers to how long it will go on and to the best steps to improve the economy in a way that lifts everyone up and is as safe as can be for now.


We’ve been trying to cope with racism, overt and systemic, for the last 400 years and we know we have not solved that problem. We see it when incidents of brutality are caught on camera. We know there is more that we don’t see….unless we look. And we, as a country, are now looking. And we know it’s uncomfortable (though not nearly as uncomfortable as years of discrimination) but it must be done.


I watched video of the funeral of George Floyd yesterday and heard the sermons, saw the anguish, but also the possibility for hope. Martin Luther King Jr. said “God has a way of wringing good out of evil.”


The pandemic. The economy. Racism, policing. We can feel overwhelmed. We will feel overwhelmed. But we must not allow ourselves to stay overwhelmed.  There’s much to do. All the time. Steps are required. Small steps are better than no steps. Talking with each other is a step. Next week I’ll be sending you an invitation to a “VMG Community Forum” to discuss what we are learning and what we can do. I hope you will join me.


National, State and Regional

From the Washington Post:  More than a dozen states and Puerto Rico saw their highest new case averages since the beginning of the pandemic. In nine states — Texas, North and South Carolina, California, Oregon, Arkansas, Mississippi, Utah and Arizona — hospitalizations have seen an uptick since the holiday weekend.

Massachusetts continues its reopening plan in Phase 2. You’ll see more and more people out and about, hopefully wearing masks and keeping their distance. More retail is open. Movie theaters are talking about reopening in July. More choices mean more need to balance risks with economic improvement and comradery and enjoyment.

Locally, I heard that one of our hospitals had very few COVID-19 cases two weeks ago and now has 20 or so. We’re not certain as to whether this is just a random change or the beginnings of a more widespread uptick.



The third edition of our patient newsletter will be going out via email blast early next week. We will again be talking with patients about our availability to meet their needs balanced with our precautions to keep them, staff, and practitioners as safe as possible.


From Gina:


VMG has reviewed all the requirements for Phase 2 reopening and signs are going up attesting that we met DPH expectations.


Significant planning and preparations for ASPC reopening has been completed and the first patients are scheduled for June 16.


“The VMG Outdoor Offices,” tents, in each of our center’s parking lots is continuing to expand and proceeding slowly to expand care with nursing visits.  We are working on providing some cooling for the hotter days ahead.


From Debbie Bolognani:


Effective Monday 6-15-20, the EHC Phlebotomists will be located under the white and black tent in the front of the building.


  • There will be lab signs posted out front.

  • Patients will be directed upon scheduling and arrival to call the lab phone number x3808 (413-282-3808).

    • When scheduling a patient for MO-10(outside draw), please direct the patient to park in the parking space nearest the front of the tent on the other side of the handicap spaces.

    • Upon arrival patient will call 413-282-3808 and check-in with the phlebotomist.

    • Make sure that patient waits in their car until phlebotomist comes to get them.

    • Face covering is mandatory.

    • Patients picking up collection containers or dropping off specimens should use the same process.

  • Lab will continue to utilize drawing station to accession and process specimens.


There will be a bit of a transition with patients presenting to the front of the building because they were scheduled prior to Monday. Please be kind, and patient, and help our patients learn the new process.




Here’s a link to a WBUR (Boston) Town Hall on How America's History With Race And Policing Holds Us Back From Reform:


How America's History With Race And Policing Holds Us Back From Reform | Radio Boston -

As we continue our discussion about race and policing in America, we look at the issue from a historical perspective with Khalil Gibran Muhammad. He is a professor of history, race and public ...



Finally, as usual but still as important now, please be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Tuesday, June 9, 2020                                                                                                                    Issue # 58



We continue to “reopen” across the country while the virus is still here and there are no effective treatments and no vaccine. And in addition, what some have called the “urgent moral stakes” of our time is forcing many to make choices between staying safe (or safer) and participating in vital protests and calling for reform in public spaces.


Arizona and other previously “safer” states are now experiencing a surge in COVID-19. Probable cases have been undercounted in many other states. We have not yet begun to see the effects of the protest marches and responses to the marches on the rates of infection. Add to that the effects of tear gas and pepper spray on the lungs of protestors, and crowding of those arrested, and you have what Anthony Fauci calls the perfect recipe for spread of the virus.


Yet some hopeful things are happening. First we have the public protests and outcry to finally deal with racism and racial disparities in health as well as in policing. The governor of Kentucky, Andy Beshear, cited the racial disparities in health care that have been underlined in the state by the pandemic. 


“In our health-care system, the inequalities have been laid bare and exposed by this covid-19 pandemic and the results of inequality in health care have been shown in depth,” Beshear said. “By allowing this type of inequality to exist for as long as it has, we see African Americans dying at twice the rate that they make up of the population … it shouldn't have taken this pandemic or these demonstrations for us to commit to ending it." He is calling for providing health insurance to all black (and presumably all) residents in his state.


Around the country there is finally some acknowledgment of the effects of racism on health and mortality. Gaps of 10 or more year’s life expectancy in nearby or neighboring zip codes are not uncommon. Why? It’s what we’ve called “social determinants” and the “social gradient.” The social gradient in health is a term used to describe the phenomenon whereby people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged. There is good data that early child development and the future ability to function fully in society is related to poverty and the social determinants. This suggests that education, in our traditional view, is not enough. Early childhood education benefits all children. And the benefit for children in poverty is greater (and therefore a help in later efforts to take advantage of education).


A final sad irony: It’s been reported that George Floyd survived COVID-19 in April but died under the knee of police in May.


Some people are finding ways to protest more safely. In Oakland, the “caravan for justice” has protesters in cars gathering to be part of the movement. And many protesters are now wearing masks (after going without for a while).

So we have the pandemic, the economic meltdown (which affects minority neighborhoods and families more), and the realization of years and years of social injustice coming to everyone’s attention now.


What to do? Keep talking, keep activating whatever channels you have to not let this moment slip and finally, let’s consider restorative justice. Here’s an idea that’s been discussed before and may be closer to reality now. In South Africa they started a Truth and Reconciliation Commission after Apartheid. Here’s a link:  Think about it. Consider this approach (or something like it for the U.S.) and talk with your neighbors and your senators and representatives.


State and Regional


The state now has the capacity for about 30,000 tests per day but only about 8000 are being done. We’re not sure why, especially since we were an early “leader” in testing.


The governor is proceeding wit Phase 2 reopening. This is the second day. Across the Commonwealth, business owners are trying to consider all the steps in reopening as safely as possible. But there really is no roadmap in our times for this. We’re going to learn what works and does not work as we go. But it does seem certain that social/physical distancing will be with us for a long time.




Our SOHCO (Single Overriding Healthcare Communication Objective) remains provide necessary care as safely as possible for our patients, staff, and practitioners. Practically, that means staying vigilant for possible improvements and spotting problems as they develop.


Information for Gina:


Governor Baker announced Phase ll for reopening the State bringing additional requirements to health care.  These are being reviewed by the Senior Leadership Team and appropriate guidelines are in development.


ASPC is opening scheduled for June 15th. Patients are being notified.


Even though some parents are still hesitant to schedule Pedi Wellness visits we are ready for them. Both EHC & NHC are now ready for these important Pedi visits.

Mobile lab draws at AMC started yesterday and went well.  We are fine tuning lab station placement today.


Athena telehealth continues to be going well with EHC & AMC starting today. GHC will be next.




Please be careful and….


·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Monday, June 8, 2020                                                                                                                    Issue # 57



I hope everyone had a restful weekend. Massachusetts is “reopening” the economy today. We’re in Phase 2 of the Reopen Massachusetts Plan. You can see an extensive list of what’s allowed to open and restrictions here:


With everything reopening here and around the country, and with all the protesting and marches, it’s still very important to remember that there is no treatment and no vaccine. We all need to keep up our vigilance and avoid spreading the virus as best we can.


In an article in the New York Times on Saturday, Roni Caryn Rabin wrote that reopening is far more complicated than locking down. When we closed the economy, the rules were simpler. Stay home. Only go to work if you have an essential job. But reopening requires a lot of planning and thinking about decisions and things that used to be “automatic.” So she suggests remembering the 4 C’s to help think about what to do and what not to do:


  • Contact

  • Confinement

  • Crowds

  • And reasonable Choices.


It’s not unlike what we’ve been talking about for the last 7 weeks or so. For Contact, maintain social distancing, always use masks, wash your hands a lot and no handshakes.


Avoid sustained contacts (15 or more minutes) in Confined spaces. Use the open air wherever possible. If indoors and social distancing is limited, open windows and make sure air circulation and venting is good.


Avoid Crowds whenever possible. People like to go to restaurants and bars and the reopening plan permits outdoor dining now. But remember that we still have to think about how we interact and that alcohol tends to get in the way of judgment.


Finally remember that when you make Choices you’re not just choosing for yourself. When you make a choice to relax social distancing or get into crowed spaces, you’re also bringing that “choice” home to your families, neighbors and friends.



The Boston Globe released a brief video detailing how the virus spread in Massachusetts. You can see that video here:


There’s going to be a lot of pressure to get “back to normal.” Hundreds of thousands of people will be returning to work or out and about in cities across Massachusetts, New York and New England. Watch the video and let’s be more careful now.


National, State, Regional


There is still varied experience with the coronavirus across the country. Some areas, including most of the northeast, are seeing declines in new cases while others are seeing increases. We don’t yet know the effects of the mass protests on viral spread but we can expect it may be significant.


There continues to be talk about a “candidate vaccine” being ready for early 2021 but it really is too soon to tell how much of this is wishful and desperate thinking, how much is tactical marketing and promotion, and how much is scientifically feasible.


The focus has shifted in our region and across the state to bringing patients back to care as safely as possible (for patients, staff, and practitioners).




From Gina:


We are in the process of continuing to review Phase 2 requirement for healthcare organizations and for VMG.


Our Severe Weather Conditions policy will be revised to provide guidance for care being provided outside of the health centers and for steps to support safety for staff and patients at all times. The revised policy will be sent out as soon as revisions are completed.


We have developed a role for a Health Care Greeter to support main entrance screening functions and foot traffic control. This will be a temporary position for the summer months.



Finally for today, Anne Applebaum, writing in The Atlantic about how politicians and others have “collaborated” on supporting positions and actions that would have been considered antithetical to their beliefs. Here’s her final thought from that article:


“I leave anyone who has the bad luck to be in public life at this moment with a final thought from Władysław Bartoszewski, who was a member of the wartime Polish underground, a prisoner of both the Nazis and the Stalinists, and then, finally, the foreign minister in two Polish democratic governments. Late in his life—he lived to be 93—he summed up the philosophy that had guided him through all of these tumultuous political changes. It was not idealism that drove him, or big ideas, he said. It was this: Warto być przyzwoitym—“Just try to be decent.” Whether you were decent—that’s what will be remembered.”


Good advice, I think.


And now, this….


  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  •  Definitely wear a mask (it is not a political statement; it’s a public health good),

  •  Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Friday, June 5, 2020                                                                                            Issue # 56




We’ve reached the end of a very somber week. But not the end of our hope for progress against racism, health and social inequities, and brutality in all its forms. I was listening/participating in a town hall last night with some very angry young black men, ex-gang bangers. It was difficult to listen to the pain and despair. But then, in the midst of all the invective, you could hear the wishes to be a part of things, to participate, to provide for their families and children.  One of the key things talked about was health care access. And access to good food (“not the bodega on the corner filled with junk food”). And safe streets. And good, public education. Those are the hopes. Sound similar to your hopes? Can we find a way to help people participate in the promise of our society? Can we stand together?


Having participated in the 60’s struggles for equality, this all feels eerily familiar. But my wife has pointed out to me that there is something this time that does seem different. There are a lot more younger people, people of all races, involved. Maybe that will do it, move us forward. We’re going to find out. Let’s work together.


For those of you with young children (or even for those that don’t have young children at home), CNN and Sesame Street are presenting a Town Hall tomorrow morning, Coming Together: Standing Up to Racism. It’s on CNN at 10AM. I’d recommend it for all of us.


Paul Carlan told me about a story on NPR yesterday entitled Too Much To Lose: How A 'Very Strategic' Holyoke Protest Delivered Message Without Incident. There are ways to come together that work for all. Here’s a link to the story:


National, State and Regional


It’s been about 2.5 months since the pandemic “hit.” That’s enough time for the word to get out about the measures we have taken (social distancing, etc.) as well as for fatigue to set in with those measures. And then we have the more recent demonstrations for social justice that have, to a large extent, captured us all and led to many people “relaxing” the social distancing, mask wearing, precautionary measures against the virus. Here is the message again: stay vigilant. If you (or friends or family) are going to protest, stick with wearing a mask, try to stay at a distance wherever possible and help others to do the same, as possible.


We’re starting to see reports in the news about vaccine production starting. That’s good for the supply line getting established but the vaccines have not yet been studied enough and they have not yet been proved safe and effective. It will be many months before that is established. So, as a reminder, the vaccine producers are starting the supply chain hoping to be ready if and when they are proven. We can’t count on that yet.


In the meantime (or in “quarantine time” as Stephen Colbert says), across the country, the Washington Post reports that at least 1,864,000 cases have been reported; at least 106,000 have died. And the CDC Director testified that he is worried that Americans are not following COVID-19 advice whether because they are participating in rallies protesting racial injustice, crowding into pools and parties (as they did recently in Missouri) or watching the recent SpaceX launch together. “Public health messages on masks and social distancing are not resonating with the public.” We can do something about that. Talk it up. As gamblers return to Las Vegas, they are probably gambling on more than just their short term “fortunes.”


We’ll hear from the Governor tomorrow about whether Massachusetts will continue to Phase II of reopening on Monday. Cases and mortality numbers in the state seem to be going in the right direction for now. Our region is especially stable for now.




There is not much new at VMG today compared with yesterday. We are continuing our plans for slow and steady return of services and providing services in alternative, safer-in-a-pandemic ways. Another example from AMC about accommodations, from Amy Rice:


“As you know we are moving forward with our outdoor care in the back parking lot with Mobile lab draws starting on Monday June 8th.  The large Outdoor Office tent is also now up in the back, which has displaced Amherst Pediatrics from using the back parking lot.   As of Monday June 8th, Amherst Pediatrics will move to occupy 4 parking spots in the front lot. Amherst Pediatrics will have signs up on Monday designating their spots as their outdoor care parking spots.”


From Gina:


Staff across Valley Medical Group (reception, triage nurses, medical assistants and even practitioners) schedule appointments with patients. As we do this, in this new world of virtual visits (video and telephone) it is very important to convey key information to each patient:


  • Video visits are preferred over telephone visits, and whenever possible when scheduling offer video as the preferred appointment type.


  • Please thank the patient for scheduling the video/telephone appointment, and state their insurance will be billed as occurs with an appointment in the health center.


  • If a patient were to have additional questions about insurance (reception staff may hear this more often), you may share: “M


That’s all for today. Have a great weekend and……


  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


P.S. Here are a few videos. The first is something/someone we should all watch, listen and hear from time to time but especially now:


And finally, to another place:


Thursday, June 4, 2020                                                                                                                  Issue # 55




“So we beat on, boats against the current, borne back ceaselessly into the past.”

                                F. Scott Fitzgerald, the Great Gatsby


This is our tendency; over and over. We get activated, make progress, and then when we lose focus or “return to normal,” we lose that progress. This may be true of how we are dealing with the virus (see below) and it may also be true of how our outrage, concern, and commitment to make change about social injustice, racism, and inequality could get lost and be “borne back ceaselessly into the past.” And we have quite a past. This is our work now as part of our society: for both the pandemic and for social and racial justice. It’s all our responsibility to move forward and continue to move forward.


And again, there are continued signs of hope. “It’s a broken window, it’s not a life.” This is a headline in today’s Boston Globe. It’s a statement from a woman who owns a liquor store that was vandalized during the events of Sunday evening in Boston. Here’s how she described what happened (from the Globe story by Janelle Nanos):


“When the text message about the looting came, Hadley Douglas, who is white, stayed home with their kids while TJ, who is Black, drove from their home to the South End to check on the store. Then her phone rang: Someone had tripped the store’s alarm, and the representative from the security company needed a password to turn it off. Her mind went blank — they usually called TJ first — and the dispatcher told her she would have to call the police.

“You can’t call the police," she sobbed. Her husband, she explained, "is Black and in a broken-into liquor store the night after protesting and rioting. I need you to hear me when I say you can’t send the police,” she told the dispatcher. “If you call them, you have to understand what you’re condemning him to.”

The dispatcher was sobbing, too — she was torn, and had to do her job — when suddenly the alarm stopped.

TJ had arrived at the store and typed in the security code to disarm it. But the moment underscored the importance of the protests, Hadley says. And it helped inspire the message that she posted to social media that morning. “[W]endows are not lives. Dreams deferred cause rage. Our window is broken but the roots of this are in 400 years of knees on necks.”

The message resounded with Urban Grape’s customers, who responded on Tuesday with the store’s single highest day of sales in its 10-year history. It was one of several area businesses which, despite experiencing theft and damage during the protest’s aftermath, chose to use the moment to help amplify the message of the Black Lives Matter movement.”


So that we try not to let the current carry us back into the past, here are some resources sent to me by John Novo this morning:


75 things white people can do for racial justice:


Podcast By Malcolm Gladwell - I would also highly recommend his book Talking to Strangers:


National, State and Regional


Let’s start with international, actually. An epidemiologist in Sweden issue an apology for championing the “herd immunity” approach to dealing with the virus. You may know that Sweden was among the most lax governments in ordering social distancing (very little) and protective measures. It appeared for a while that it was working but in the last few days, there are indications that Sweden’s mortality rate is higher than its neighbors. A useful experiment, perhaps, but not a very good result. Elsewhere in the world, the virus is now spreading rapidly in Latin America, South America and the Middle East.


In the U.S., the number of confirmed cases is rising but this may be partially the result of increased testing. Another indication of how social policy can affect disease conditions, the number of testing sites available is lower in minority communities.


And while testing capacity is up, there are reports that not enough people are seeking testing. Maybe this is the result of anxiety, transportation and other issues, and maybe the result of the economic and social turmoil of late.


ER visits across the country have plunged but are now coming back slowly. This is almost certainly due to people being wary of going to the ER and getting exposed and the social restrictions on the ER use (no companions or visitors in places).


Another study confirms that Hydroxychloroquine is not effective at preventing COVID-19.


And finally, while time has gone by and social unrest has increased and the weather has gotten better and who knows what other factors are at work, there are places that were vigilant before that seem less so now. The virus is still there. Let’s not get “borne back into the past.” Stay vigilant.




From Gina:


  • AMC “Outdoor Office” tent in place as well as new tented space for lab draws; both behind the center.

  • Pediatric visits for children 0-2 years of age proceeding well in EHC and GHC.

  • It’s important for all services to work closely in each health center to discuss patient care and those entering the center to maximize social distancing upon entering the health center. 



That’s the update today.


  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone


Be well,



Be patient; be mindful


Wednesday, June 3, 2020                                                                                            Issue # 54




“Daddy changed the world.” Six year old Gianna Floyd, George Floyd’s daughter, spoke these words yesterday on national TV. (you can Google the video). It is a hopeful wish, one that I hope we’d all like to believe. And there are hopeful signs that this may be one of those moments; that we are at a positive tipping point.


There have been others, as well. We’ve seen nurses and doctors joining demonstrations and issuing their own “7 PM tribute” to protestors. We’ve seen police officers taking a knee and joining in walking with protestors. Nike, Netflix, Twitter, Disney, Facebook and Intel all issued statements condemning racism and brutality. President George W. Bush issued a statement saying that “achieving justice for all is the duty of all” and calling for an end to systemic racism. Ben and Jerry’s (btw, new flavor: Justice Remix’d) issued a particularly forceful statement that Mr. Floyd’s death was not just the result of a “bad apple,” but the result of the continued effects of systemic racism and brutality. In other words, these particular policemen on his neck and body is the immediate cause but the hundreds of years of history, inequality and discrimination that created the conditions for those particular officers to treat him this way is, what Michael Marmot, author of The Health Gap: the Challenges of an Unequal World, calls the “cause of the causes.” It’s not enough just to ask what caused a particular incident or condition. You have to ask what led to those causes and what can we do about those.


Marmot writes about class differences in key health indicators including life expectancy. There is a reliable and significant difference in life expectancy based on race and class in many “advanced” societies. Usually people agree on the data for these differences but then point to underlying causes, conditions like diabetes and obesity. But what causes, for the most part, those causes? Poor nutrition (“eating wrong”) may be one. But what causes poor nutrition (and “eating wrong”)? It’s not just about choices. It may be about not having affordable and reliable food sources somewhere in the neighborhood. You get the point. We have to learn to think differently about disease and the conditions that make those diseases more likely (it’s what we now call the social determinants of health). And then we have to think about how inequality and particularly historic and systematic inequality caused that.


Some telling data can be found at:


Closer to issues in our pandemic, so far the death rate for African Americans is about 23% but their percent of our population is about 13%. This is a public health emergency just as is the pandemic.


What to do? Today President Bush said “the only way to see ourselves in a true light is to listen to the voices of so many who are hurting and grieving. Those who set out to silence those voices do not understand the meaning of America – or how it becomes a better place.” So please listen, consider, and talk with each other, friends, neighbors and family. It’s a process and talking and listening and dialogue is important.


National, State and Regional


The original hotspots for the pandemic are all showing signs, for now, of improvement (meaning lowered 7 day averages of new cases and deaths). However, we are seeing increasing rates in places that were not as affected previously (mostly in the west and southwest but also in the heartland).


You’ve also seen pictures of police and demonstrators out without masks. They are outdoors but we don’t know what will happen to new cases of COVID-19 as a result. It seems that there will be increased transmission of the virus.


Anthony Fauci, M.D. is saying that we will have 100 million doses of a “candidate coronavirus vaccine” ready by the end of the year. That is good news but it does not mean that the vaccine will be safe and effective. The vaccine will go into Phase 3 trials (with volunteers) this summer. The news here is that the company/companies are going ahead with production even before the vaccine is proven so that it can be ready if it works. Hope is good, but be ready for the need for more time.


At the state level, the governor is still hopeful that Phase II of Reopen Massachusetts will begin next Monday (he’ll make an announcement on Saturday).




We are continuing to phase in services that have been reduced or postponed since the start of the pandemic. We need to make sure that you and our patients know that our overriding objective is to continue with necessary care while keeping patients, staff and practitioners as safe as possible. That’s the reason for the slow and steady approach.


An example of a changed but safer lab process, at AMC, from Debbie Bolognani:


“Effective Monday 6-8-20, the AMC Phlebotomists will be located at the back of the building under the white and black tent closest to the back door.


  • There will be lab signs posted around the building to direct patients to the reserved lab parking spaces.

  • Lab Check-in will be occupying the back entrance space at phone number x4317 (413-256-4317)

  • Patients will be directed to drive to the designated parking space in the back parking lot

  • Upon arrival, they will call 413-256-4317 and check-in with the phlebotomist

  • Patients will be asked to wait in their car until a phlebotomist comes to get them

  • Face coverings are mandatory

  • Patients picking up collection containers or dropping off specimens, should use the same process


There may be a bit of a transition with patients presenting to the front of the building because they were scheduled prior to Monday. Please be kind, and patient, and help our patients learn the new process.


Thank you in advance for all your help and flexibility during this transition.

Please let Debbie or Meghan Hart know if you have any questions or concerns.”




OK. That’s it for today. Here’s something from Alvin Ailey:


And, of course,


  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Monday, June 1, 2020                                                                                                    Issue # 53




I usually start by hoping that you had a great weekend. And I do hope that is true. But how to start our work following a week of multiple and ongoing tragedies? So here is my opinion.


I know that most of us were watching and reading about the events in Minneapolis (and across the country) this week. We were all affected: maybe disheartened, maybe anxious, maybe depressed, maybe heartbroken. The pandemic, the economic fallout of the pandemic, and now the ongoing and brutal effects of discrimination and its results gets to us. And yet we have to go on and do our jobs.


I was talking with my son this weekend. He founded and runs a non-profit, helping former gang members and felons in the Boston area to cope with life and re-enter the community focused on participating in society, working, and avoiding recidivism. His students, his “guys” he says, are not particularly angry right now. They just don’t expect much to get better based on history (the recent week, the past months, the past one hundred years).


As we were talking, I realized that not expecting better is almost worse than giving in only to anger or violence. They should expect better. We should all expect better. We are all affected. Not just by riots, arrests, and the economic fallout. It’s also the psychological damage. And the lost hope for better lives and a better world for all our kids, our friends and neighbors and our families. And that is another public health emergency and tragedy.


How does this relate to us in healthcare? At VMG? It’s a matter of public health. The

American Academy of Pediatrics, American Medical Association and American College of Physicians – this morning are all emphasizing that racism is a public health issue. Incidents of brutality and abuses of power are a public health issue. Lost hope and despair are public health issues (anybody ever thought something like why bother to exercise or “eat better” if….?). 


These are hard issues. But there are some great signs of hope even in the midst of the chaos. You might have seen them. There were police chiefs in several cities walking into crowds of protestors starting conversations, talking, and really listening. There were police officers “taking a knee” with protestors, marching with protestors. There were mayors inviting discussion while insisting on saving their communities from destruction.


Owners and managers of some of our biggest corporations are speaking out, with their employees, and to their customers to embrace change at a basic level and work against racism. Here’s an example from a letter to the employees of Nordstrom:

” This is a painful time for our country and for us. The events going on around all of us are heartbreaking and we want to share a few thoughts with you. 

Like so many of you, we have been deeply saddened and angered by recent events in our country. The senseless deaths of George Floyd, Breonna Taylor, Ahmaud Arbery and too many others reflect the deeply ingrained racial prejudice and injustice that still exists in our communities today. 

It is stirring many emotions, which it should. The unnecessary and unjust killing of anyone must not be accepted. The issue of race and the experiences of too many people of color cannot be ignored. We owe it to our employees, our customers and our communities to be very clear in condemning these acts of violence. They represent a disregard for basic human rights that has no place in our communities or country.”

What to do? Read President Obama’s piece published today for a start. This is not political. It’s human rights, basic and necessary. And necessary for public health and child and family development.


I’m happy to talk and hear what you are thinking, if you wish.


State and Regional


Our state is still on track with reopening statistics. We may see some spikes in infections as we go and the Governor is going to pace reopening based on the key numbers (average infection rates, hospitalizations, etc.). Social/physical distancing, wearing masks, handwashing, etc. are the key tools we have now and we know that they have helped so far (but as we reopen or as we abandon these tools in large gatherings, we may see some spikes, as well).


Locally there have been no big changes. We still see more fallout in nursing homes but the hospitals are doing well in keeping up with cases (and some hospital are actually seeing decreased admissions compared to a “normal” time).


News from Gina follows:





Here’s a piece of music that seems appropriate for now. Sting had been rehearsing with an incredible band at a property in Tuscany for a concert. They were ready to go the next day. The concert was scheduled for about 200 people. The date was September 11, 2001.


Here we are twenty years later. I hope we can all recognize how fragile we are and bring all our will and purpose together… together… to find a better way to be with each other, and for each other.



Be well,



Be patient; be mindful


P.S. Last week, Friday, I said that the Big E and the Three County Fair were canceled. I mis-read the article in the Recorder. Actually it said that planning was continuing but that they were continuing to monitor the effects of the pandemic on the plans.


Friday, May 29, 2020                                                                                       Issue # 52




It’s Friday and it looks like a beautiful weekend with lower temperatures and humidity. Please enjoy it.


National, State and Regional


The pandemic is not over and it’s not time to take off the parachute (see yesterday’s Newsletter). Some states are still seeing rises in cases and hospitalizations. Others are seeing slow decreases. The advice is still the same: No treatments yet, No vaccines yet, keep wearing masks and social/physical distancing.


The Boston Marathon, rescheduled to the fall, has now been cancelled (this has never happened before). The Big E and the Tri County Fair have also been cancelled. The Franklin County Fair is still scheduled but being considered.

The state is still in first phase, “Start,” of the Reopen Massachusetts plan. That plan guides our reopening as well. The Governor has just announced that, if the health metrics continue to look good, restaurants in the state could reopen for outdoor service as soon as June 8.


Locally, our hospitals are still in good shape with just a few COVID -19 cases. They are all considering and/or encouraging starting up high priority procedures and hospitalizations that were cancelled earlier or postponed. It’s too soon to know how many patients will want to have those procedures at this time.




We’ve just completed our second series of Virtual Brown Bags and I want to thank you all for participating. We’ve had some good questions and ideas and we’ll work on those going forward.


Diane Alpern shared a resource for food. Go to and click on “get help” to see a listing of available food resources for patients and others by zip code. Thanks, Diane.


Here’s our SOCHO (Single Overriding Health Communication Objective) for ourselves and our patients: we want to provide necessary care to those in need while keeping our patients, staff, and practitioners as safe as possible. Here is the plan, from our Medical Director:


We are slowly moving forward on bringing some patients and procedures back into the health centers. This process will move forward slowly and methodically.


We are still in Massachusetts stage 1 reopening- the emphasis is still emergent and semi-urgent care, we should not be doing routine procedures or routine in person visits.


We will be starting diagnostic mammograms for 6 month follow-ups this week.


We will likely be starting colonoscopy for bleeding or cancer follow-up mid-June.


We will see some non-routine eye care visits starting end of June.


All specialty and primary care visits should start with a virtual visit. Patients should only be scheduled for an in-person visit for a significant need such as persistent pain that cannot be managed by home/self-care. An example is ear lavage – not hearing due to cerumen impaction should be considered routine – encourage home care such as “debrox,” etc.  Significant ear pain which cannot be resolved virtually or with home care can be seen, if needed.


Another example: routine nail care even, if nails are quite big, can be considered routine care. However, toe pain interfering with the ability to walk, evaluated after a virtual visit, would be something which could be seen in-person, if deemed necessary.


These are examples at this stage of reopening. The principle involved is our SOCHO. We need to be balancing the risks of spreading infection with the necessity to deal with a condition that is significantly hurting or interfering with the patient’s life. Things will change at the next stage and as we gain experience in improving processes for care in the COVID-19 world.


An example of the complexity involved: as we open AMC to more radiology, more cases in the ASPC, more primary care, we’ll have more patients at the front door. There is also a pediatric and dental practice in the building. Prior to COVID we didn’t think much about foot traffic entering the building. Now we have to do screening and we have to manage the foot traffic so that patients are appropriately spaced coming into the building and not lining up and bunched for screening. And we don’t want patients in the waiting areas. This will require re-thinking how we space appointments and also allow enough time for exam rooms to be “refreshed” and cleaned. We have several work groups on this now. We’ll be ready. And thanks in advance for your help and ideas.


As an example of the work and complexity involved, I’m attaching a plan sent by Amy Rice for our Outdoor Office at AMC and all the changes necessary to make that work safely.

OK. That’s it for today. Have a great weekend and…wait for it….



  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone.


Let’s find our way together:


Outdoor care and back parking/entrance update



Be well,



Be patient; be mindful


Thursday, May 28, 2020                                                                                                                 Issue # 51


Here’s an analogy for you:


"The curve is flattening so we can start lifting restrictions now" = "The parachute has slowed our rate of descent, so we can take it off now". 


No. We can’t do that. Yes, we see the Massachusetts numbers improving with lower numbers of deaths and hospitalizations. But, no, this is not over, the virus is still here, and we have to help our families, friends, and neighbors understand the analogy. The most risky time is when we go on auto pilot, get back into routines without looking for risky exposures, and “not think about it.”


You may hear people say “but I don’t want to think about it.” “I’m tired of this.” We are all tired of this and I’m all for hoping we can get to a time where we are not always “thinking about it” but that time is not now. So let’s stay vigilant, help our families, friends and neighbors stay vigilant, and stay safe and well together.


Steve told us today that Mass. General did a prevalence study across the state and in our area recently and found the prevalence in our area as less than 1%. That’s low (and good). But remember Memorial Day weekend? Lots of activity with people, many of whom, not observing social distancing. Some visiting from other areas of the country. It will be a few more days or weeks to see what happens as a result. So, again, keep the parachute on until we touch down safely on the ground.


Here’s one last thought and opinion about where we are as a society and culture right now. You might  think about it as just a political statement. But as healthcare leaders and workers, we have a responsibility to speak out when we hear mistakes or, worse, lies about public health matters.


It’s hard to watch the news. We’ve hit 100,000 lost lives (and there will be more). It did not have to be this way. We have leaders who are more interested in their political survival than our real survival. First, pretending that this virus was “just a little flu” and would “go away” when the scientists who knew better were clearly saying this was not true. It was a calculated effort to keep popular. Then, making an issue out of wearing a mask, implying that this is just a matter of political correctness when all of the scientists and public health officials say it’s one of the only things we can do to protect each other is not only foolish and selfish; it’s also a public health hazard and bound to cost more lives. Keep each other safe from foolishness! Please think about that when you vote and talk with your families, friends and neighbors.


National, State and Regional


I’ve already talked about the national situation above.


The Massachusetts numbers continue to improve and the Governor is sticking with the phased reopening plan. It will be a few more weeks before “routine care” will be permitted. We’re on track to make judgments considering the Governor’s plan and our own assessment of when things will be clinically necessary and safe enough for our patients, staff, and practitioners as the state reopens.


Regionally, as noted above, the prevalence rate in our area is very low now. We’re watching to see about changes given the start of summer, the first phase of the Governor’s reopening plan, and the recent relaxation for the Memorial Day holiday weekend.




Updates from Gina:



VMG Patient Newsletter, Issue 2, will start going out by email blast (and be posted to our website) on Monday, June 1. Attached is the most recent draft.



Now for some quarantine humor (from, where else, the internet):

“Breaking News:  Wearing a mask inside your home is now highly recommended.  Not so much to stop COVID-19, but to stop eating.

I stepped on my scale this morning.  It said: "Please practice social distancing. Only one person at a time on the scale." 

Never in a million years could I have imagined I would go up to a bank teller wearing a mask and ask for money. (this is my favorite)

Coronavirus has turned us all into dogs.  We wander around the house looking for food.  We get told "No" if we get too close to strangers and we get really excited about going for walks and car rides. 

      I was in a long line at 7:45 am today at the grocery store that opened at 8:00 for seniors only.  A young man came from the parking lot and tried to cut in at the front of the line, but an old lady beat him back into the parking lot with her cane.
      He returned and tried to cut in again but an old man punched him in the gut, then kicked him to the ground and rolled him away. 
      As he approached the line for the 3rd time he said, "If you don't let me unlock the door, you'll never get in there."   

And, hey:


  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Wednesday, May 27, 2020                                                                       Issue # 50




Good afternoon and happy Wednesday.


I’m sure it’s occurred to you that the pandemic has changed many things, seemingly forever. Even after we have a vaccine that works, some changes will remain. But which ones?


Worldwide, we can expect changes maybe greater than what we saw from 911. Air travel will certainly be different, and not just from the sustained financial effects of the business interruption. More screening at the airport seems highly likely. Temperature checks, medical history questionnaires and screening, antibody certificate/passports? Cruise ships???


Schools and colleges will change for at least a year. For schools, consider how hard it will be to get second graders, for instance, on and off a bus while social distancing. And how about getting kids to wear masks? And what about the lunch lines?


Colleges will be challenged to pay their own bills and maintain their physical plants with fewer on campus activities and classes. What will students and parents be willing to pay for on line classes?


Most other institutions will be (or should be) forever changed. Think of Nursing Homes and other long term care. Jails and prisons have been crying out for change for a very long time. Hospitals are already changing as are our outpatient facilities.


Public transportation will need to look different with better service (to avoid crowds where possible).


The Governor got a haircut yesterday. Here’s his description: “It wasn’t a typical visit,” the governor told reporters. “I showed up at 7 a.m. They took my temperature,” Baker said. “The place where I got my hair cut had Plexiglas between the chairs. I had to wet my hair before I got there.” Baker said he wore a mask the entire time and the man who cut his hair also wore a mask and a gown. “I was out in 20 minutes.”


In medicine, telehealth is certainly here to stay, at least in some form (and that’s good – more convenient for patients, better access, and many providers really like it). How will it be paid and regulated? So far, because of the pandemic crisis, we have a pass on (most) restrictions. In time, will more telehealth mean that we will see sicker patients in the health centers? How will we orchestrate the telehealth and in person visits? A lot to think about and implement in a relatively short period.


How will we manage our specialties that require physical presence (think about PT and Optometry, for instance) with the patient over time? And for those that don’t require physical presence, under what conditions do we actually see patients (during and “after” the pandemic)?


I got an email today from Affordable Funeral Supplies asking if we needed to purchase PPE and Body Bags.

We’ve had dozens of emails about “contactless patient experience” platforms.

These are just some examples. Perhaps the biggest “system” that desperately needs changing is the way we finance and access healthcare. With job loss from the pandemic, millions of people lost employer sponsored health insurance. Many states were not ready to, or did not want to, expand Medicaid.


The debacle in supplying hospitals (aside from the political theatrics) is one effect of our uncoordinated, one person at a time, healthcare system. This pandemic should, if we are all paying attention, trigger a really serious look at a plan to create a coordinated health system at the national level.


This does not have to be controversial. There are dozens of models all over the world. Some are government run and some retain elements of private insurance (and even some employer payments). But they all are capable of coordinating responses and insuring everyone. Oh, and, they all get better results (clinical and financial) than we do. This is my opinion. But think about this as you think about voting. And whether you agree or disagree, get the facts and talk with friends and family. (If you want to read more about this, start with a very readable book written by T.R. Reid called The Healing of America. It reads kind of like a novel or investigative journalism. I have copies and I’m happy to lend them.




Remember our goals: provide the right clinical care at the right time in the right way while keeping patients, staff and practitioners as safe as possible.


We are continuing to work on developing “VMG Outdoor Office.” The “tent” is up in the main parking lot of GHC. You’ll see work on this at your health center soon. We’re already expanding lab draws outside. We’re already doing pediatric wellness visits and immunizations and we’ll be bringing back adult wellness visits soon. The ASPC has a tentative start date for high risk colonoscopy of June 15.


We want to see all of our patients in the best way possible. We have multiple groups working on this objective now.


We will be sending the second edition of our VMG Patient Newsletter on June 1 to make sure our patients know what we can do for them.


OK. That’s it for today. One last Goat Rodeo song, Farewell Angelina, a Dylan tune.



And, my usual message (and I really, really mean it), please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask (it is not a political statement; it’s a public health good), continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Tuesday, May 26, 2020                                                                                  Issue # 49




I hope you had a good holiday weekend.


Yesterday was Memorial Day; the holiday dedicated to remembering the lost lives of those who served in our armed services. The event is usually celebrated in many ways. A visit to Arlington National Cemetery has always been center stage…but not yesterday. Yesterday, only those who were visiting relatives were allowed to enter, all wearing masks, all due to COVID-19.


Beaches reopened. Picnics happened. Pool parties were seen on TV. Many people celebrated the traditional start of the summer season. People wanted to get back to normal. And that was, and is, necessary. And, we also should remember….


Let’s remember them as we start our summer because it’s what we do to go on living with purpose and appreciation.


National, State and Regional


Controversy continues to build across the country between people who want to continue precautions and those who want to “reopen.” The economic toll is pressing. The death toll is still rising. We all need to find the right balance between having life go on, work happen, and reducing infection rates, hospitalizations and deaths. It can’t be one or the other. And that’s why “reasonable precautions” need to be taken.


Wearing a mask has become a symbol of being cautious AND a symbol of infringing on liberty. There are those who still don’t believe in wearing seat belts but we have adjusted to that over time. We don’t have as much time as we’d like so we need to do our part to encourage reasonable precautions for preventing transmission of this coronavirus now. Our job is to think about health and safety and be good educators now: for our patients, our families, and our friends and neighbors. Please keep talking with people (while wearing a mask and social distancing).


The Governor has changed his stay-at-home advisory to a “safer-at-home” advisory. The Massachusetts key indicators continue going in the right direction. Reopening phase “Start” will continue. It’s too soon to tell what effect the weekend’s activities (and the reopening activities themselves) will have on the metrics being used to guide continued reopening.


Our region continues stable.




The pandemic has hit all medical groups very hard for revenue generation. Most groups are on the virtual visit journey and we are certainly there as well. Virtual visits have allowed us to continue to see our patients and keep everyone as safe as possible.


At VMG, Lab volume is growing. Primary care is about 86% of the visit rate at this time last year. Behavioral Health is now at about 96% of last year. We are planning to cautiously reopen our Ambulatory Surgery Center on June 15. The “VMG Outdoor Office” will be open soon. I’ll provide more data in coming updates but you can see it now on the COVID Dashboard on the intranet page under the Quality and Reporting tab (first link on the page).


Year to Date, with the combination of our work pre-COVID and our work in mostly the virtual visit mode since COVID, we are now at about 75% of the similar period in 2019. That’s pretty good for now given the major disruption caused by the pandemic. However, our budget was more aggressive this year even before the pandemic hit so we continue to need your help in filling our schedules for two reasons. First, there are lots of patients who delayed getting care when the pandemic broke out. They still need care now to prevent worsening of their conditions. Second, we need to get our revenue generation back up as soon as we can.


Our next edition of the VMG Patient Newsletter will be sent on June 1. I’ll have it attached to this newsletter when it’s ready (by the end of this week). If you have a topic or topics that patients keep asking you about, let us know so we can address it in a coming patient newsletter.




Here’s a link to one of my favorite pieces of music, a Welsh folk song usually sung as a lullaby. It’s a live Goat Rodeo performance, All Through the Night. Yo Yo Ma, Stuart Duncan, Edgar Meyer, with Chris Thiele and Aoife O’Donovan in a live performance at the Hollywood Bowl. Unfortunately, the video is not great. Start at about 3:26 for the song.



And, as always, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, continue to be in touch with and take care of each other, and help to educate everyone.


Be well,



Be patient; be mindful


Thursday, May 21, 2020                                                                                           Issue # 48



It’s almost the holiday weekend and I hope you are looking forward to some time off, time with loved ones, and some good weather.


Some of you may remember a TV show called Hill Street Blues. It was a groundbreaking, genre creating show that featured an ensemble cast, multiple story lines that continued through the show, new technology (for the time) (hand held cameras) that gave it a very different feel from other TV shows. And this was before cable TV and streaming, of course.


Hill Street was a police show set in a large city (take your pick, they never revealed it) and it was very gritty. It always began at roll call for the day shift (grubby room, shift commander at a lectern) with the sergeant (Phil Esterhaus) updating on what officers might face that day. At the end of the meeting, as everyone was getting up to get on the streets, he would always stop them by saying, “Hey, hey, hey, let’s be careful out there.” (BTW, if you’ve never seen the show, get it on Netflix –it’s really great).


So Memorial Day weekend is almost here. And I’m channeling Sergeant Esterhaus when I say let’s be careful out there. It is supposed to be great weather. We all miss the people we used to (literally) see all the time. We all want to and should stay connected. And we also want to resume “normal activity,” at least when we can. But please, please, please, stick with what’s kept us safe: make sure your mates are six feet apart (at least), wash your hands a lot, don’t, touch your face, keep gatherings small (10 or less), outdoors if possible, and wear a mask. Don’t let up.


Also it’s your chance to take a job you may not have “signed up for.” Be a health ambassador, coach, and if you have a friend or family member who is not observing the things that have kept us safe so far, talk with them about it. It does not have to be a confrontation, just a conversation beginning with something like “I’m so glad to see you and I’m also concerned about your and our safety in these unusual times, so please…..” This is especially true if you’re with people from another part of the country where COVID may not be as front and center on their minds.


Here’s an item from a CNN story this morning with advice on having Memorial Day gatherings in as safe a way as possible:


National, State, Regional


“There must be some kind of way outta here
Said the joker to the thief
There's too much confusion
I can't get no relief…


OK. I’ve gone a little wild about lyrics. Many of you will recognize this from the Dylan song, All Along the Watchtower. This is the state of our existence today. This is still true today. States are going in different directions even as the pandemic outbreak rises in some places and falls in others. It’s going to take months to see the results and many are worried that the results are not going to be good.


Devra First, a restaurant critic writing in the Boston Globe this morning, was saying the she is not ready to eat in a restaurant yet and was relieved to see that was not on the Governor’s phase one list of activities allowed. She has every reason to want to go back to dining in restaurants; it’s her job and her passion. But she can’t bring herself to think about anything more than take out. And for the reasons we’ve talked about. It’s a closed, usually small space, with lots of people in attendance, lots of comings and goings and all kinds of “opportunities” for viral spread.  And the virus can be spread by asymptomatic people. When will she (and we) go back? We simply don’t know yet. But just because we are allowed to do something does not mean we should do it or that we are ready to deal with it.


There is still not much change in our region which may be a good sign.




From Gina:


We have completed a review of all aspects of the Reopening Massachusetts guidelines, directives, and regulations. Signage is being placed, as required, in the health centers, posted for patients to see. We have also completed a Mandatory Safety Standard policy which is to be shared with all VMG staff and practitioners for review and sign off in ADP.


Gina continues to share the great care being provided at VMG via social media (Facebook). If you have a story to share in this regard let her know.


Radiology will expand services slowly the week of May 25th  to include diagnostic and high risk mammograms.


As plans to conduct care outdoor progresses, the name to be used will be ‘VMG Outdoor Care”. We are erecting a tent in the GHC parking lot today (see below).


Lab has increased capacity to draw more patients with a 2nd chair operational in the outdoor lab in Greenfield. 


From Tim Sweeney: “Especially now, I'm committed to helping folks make some comfortable, gradual changes on their way toward abstinence. Apart from epiphanies and miracles (which I love) almost all human learning occurs in small incremental steps. These aren't "baby steps," they're human steps. We all need to make this journey at our own pace and on our own terms.” Tim has continued to work “Quitters Win” on Zoom with great results. This work is critical in the COVID era. If you have a patient, send him a patient case.


The construction crew in the GHC parking lot early this morning setting up the first VMG Outdoor Office:







With the weekend almost here now, I’m recommending this Commencement Ceremony from the Berklee College of Music honoring several great singers, dancers, and musicians. It’ about an hour (so please don’t watch it at the office) and it’s filled with really great music and musicians.


If you don’t have the time, then here’s a different virtual choir:



And again, so important, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


p.s. no update tomorrow – day off – have a great holiday weekend.


Wednesday, May 20, 2020                                                                                           Issue # 47



Good afternoon. It’s my oldest son’s birthday today and my one year old grandson’s birthday was yesterday. So I started the day in good times. But then, thoughts turn to the news of the day and it’s easy to get a bit lost.


When I find myself in times of trouble
Mother Mary comes to me
Speaking words of wisdom, let it be
And in my hour of darkness
She is standing right in front of me
Speaking words of wisdom, let it be


Most of you, I hope, will recognize this as the lyric to Let it Be by the Beatles. I never knew the source or inspiration for the song. I had assumed it was vaguely religious. But it turns out that Paul McCartney had a dream and his mother, Mary (who died when he was 14), told him that despite his worries and concerns, things would be OK and just go on with your life. He was comforted by this (and of course the song did pretty well, too). Good to think on.


I think this is the position a lot of our patients are in: Troubled, times of darkness. Certainly many are broken hearted, having experienced a loss of family, friends, hope, etc. And don’t forget confusion. There’s lots of that as we try to evaluate what we hear from the news, politicians, scientists and pundits. We all want certainty, even those of us who like roller coasters.


Charles Duhigg, writing in The New Yorker recently, talks about the role of epidemiologists in these times. He says “epidemiology is a science of possibilities and persuasion not of certainties or hard truth. Quoting the Scottish epidemiologist, John Cowden, “being approximately right most of the time is better than being precisely right occasionally.” “You can only be sure when to act in retrospect.” Duhigg says epidemiologists must persuade people to upend their lives – forgo travel and socializing, submit themselves to blood draws and immunization shots (not yet)—even when there’s scant evidence that they’re directly at risk.” That’s our job too.


The CDC, in better times, planned for how to handle epidemics. It turns out that in addition to the science, in times of trouble, communication is key. One of most important things in the playbook is to have one person in charge of the message and the message is what they call a SOHCO (sock-O) which stands for Single, Overriding, Health Communication Objective. The Field Manual for the CDC says that it should be repeated at the beginning and end of every communication with the public. It’s important to have a message, to express empathy with people’s confusion and concerns, acknowledge what we know and what we don’t know and be as transparent as possible. That’s how persuasion should work. This is the business we are all now in.


So keep thinking not just about the clinical care but also about the messages we need to send, expressing empathy for the confusion everyone feels, and tell folks what we know and what we don’t know. They are looking for words of wisdom. You can help a lot just by being there! That’s what gets me in a better mood.  Let it be.


National, State, and Regional


The national scene remains chaotic with lots of opening up in many different directions. We’re going to learn a lot from these “natural experiments” within weeks.


The state seems to have stabilized with hospitalizations going down as well as deaths. Much of this has been achieved by physical/social distancing and good hand hygiene and wearing masks and staying at home when sick. However many people are still concerned that we are going too fast given that this is a new virus, there is no treatment and no vaccine. With the state beginning a phased reopening we’ll soon have a sense of what happens. An article in today’s Boston Globe by Jenee Osterheldt suggests that Congresswoman Presley has been saying that “opening the state could close more caskets.” And communities of color and lower economic status have been doubly harmed by the pandemic; medically with greater death rates and hospitalizations and, economically (loss of jobs and support programs). She is calling for slowing down until we have better social and economic supports to help all citizens be able to stay at home when necessary, social distance, stay out of crowds, etc.


Memorial Day weekend is upon us and we may soon find out if even this slow, phased plan is too fast. In the meantime, we need to keep with the things that have begun to bring the deaths and hospitalizations down: social/physical distancing, frequent hand washing, wearing masks, don’t touch the face, staying out of larger gatherings, staying home if sick, etc. Please talk with family and friends about observing these reasonable precautions.  The virus is not taking a holiday.




We are working on expanding our “Outdoor Office” initiative to reduce the chance of exposure and keep us all (patients, staff, practitioners) as safe as possible while providing important and needed care. That is our SOHCO.


We are “continuing to begin” to work on expanding services, slow and steady, to get back to most of the things our patients and practitioners need in a manner that is efficient and as safe as possible. We won’t jump ahead until we are reasonably certain it’s safe and in all our best interests. You’ll hear more about this in the coming weeks.


Val Felton and Amy Rice continue to work on acquiring and maintaining the right PPE for current services and for expanded services, when we get to them.


In the meantime, consistent with the Governor’s reopening plan beginning with Phase One on Tuesday, you will see signs posted on our entrances telling patients that we have met requirements for hygiene protocols, social distancing, training of staff and practitioners, and cleaning and disinfecting. If anyone gets an email or request from a state agency to sign a document about the above, please forward it to me ASAP.




OK, we’re heading for the weekend soon. I want you to see a photo of some of our clinical staff at AMC with a message to our patients and to all of us. We appreciate all your essential work. This is what helps to get us through. Here you go:

Finally, here’s James Corden and a surprise guest, in case you haven’t seen it before. Watch it through to the end (it’s a little long so you may want to watch this at home).




Once again, and this remains so important, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


Tuesday, May 19, 2020                                                                            Issue # 46



Good afternoon. I hope you are all well. I want to share one quick thought for today and then an opinion.


The quick thought is about innovation and, in this case, innovation that is based in necessity. An item on the news is about training dogs to sniff out COVID-19. There have been reports for years about dogs and cats in nursing homes being able to detect when a resident was about to die. Whatever the validity of those claims, there are now several projects training dogs to somehow detect people who have been exposed to the coronavirus and are asymptomatic. They would be used in airports, public gatherings (think sports, concerts, etc.). Who knows if this could work but the extension of the idea to try it is the key thing. At the end of this newsletter, I’ll provide a link to a Brazilian pianist who had to get creative to finish a piece.


My Opinion


Here’s the opinion part. Following up on my thoughts about healthcare disparities and COVID-19, two additional groups that are struggling are, not surprisingly, Native Americans and migrant workers. Tribal areas have been struggling with getting money due from the stimulus and relief packages to fund testing, care, and environmental modifications to support stopping the spread. That’s affecting care of COVID patients. And think of the migrant workers who pick our fruits and vegetables. While they are mostly working outdoors, many sleep in bunkhouses without many resources, social distancing and PPE. Now think about the workers in our meatpacking plants that have been ordered back to work without protective measures in place working long hours, shoulder to shoulder. We do need a clear and consistent approach to these populations on par with our more privileged segments of the population. They don’t have much choice or freedom in their environments.


Paul Krugman, a Nobel economist, has written that “Plato, prefiguring Dr. King by a few thousand years, wrote in “The Republic” that “any city, however small, is in fact divided into two, one the city of the poor, the other of the rich.” This is true today and we’re seeing the results in our state in the cities where density forces exposure. But what should we do about it? Not enough serious attention and discussion has happened to force innovation and/or the will to change.


Seeing access to better education as a key to reducing disparities in health and economics, in The Netherlands, schools are funded at a standard level per student, plus a 25 percent bonus for each student whose parents did not graduate from college.” Whether that’s the right metric for judging social inequity and disparity, and for improving, is up for grabs. But it is an approach to lowering the divide as education seems to be a factor for reducing inequalities. There are many others, I’m sure. But to find them we have to, as a society, look for solutions in places we are not used to looking and have the will to try.


In “normal times” in our democracy, if enough people raise ideas and start talking about them, and are willing to engage in private and public discourse and debate, we can change minds (and hearts) over time. This is not a normal time and we have a long and troubled history of ignoring “social determinants” and social injustices. Whatever your opinions, keep talking with friends and family. Every discussion can be a start of an improvement.


National, State, and Regional


There is mixed news coming out of states that have reopened at least a few weeks ago. There are some spikes in spread. However, even in states that have reopened, many people have not taken reopening as a sign to resume normal activities and that may be reducing the risk of transmission. We’ll have to wait longer to see what happens when the weather gets better and people decide for themselves about the social end to the pandemic. We know that the virus will still be there and that there are no treatments and no vaccine.


Governor Baker’s reopening plan is all over the media. There will of course be more to say about it but many large employers across the state are sticking with their work at home plans for now even with the reopening permitted. They and their employees are hesitant to risk further spread and the resulting possibility of another shutdown. Here’s a link to the Governor’s reopening plans:



Starting on May 18, the MA DPH COVID-19 Command Center will give updates on six key public health indicators. Before and during reopening, these metrics must continue to show progress to allow reopening to continue.


Nothing much has changed regionally. Mark Kerouac, CEO of Baystate Health, was on the news this morning as a member of the Governor’s reopening task force. He said that hospitalizations are not now in the way of reopening and supported the current plan with the important proviso that we all follow social distancing and wear masks.




Some current news from Gina follows. We are currently reviewing all aspects of the Governor’s reopening plans to ensure that VMG meets or exceeds the requirements of the plan when we do bring back services. However, we will still be making our own judgments, within those guidelines, about how and when we restart all our services.


GHC is preparing to see 0-2 year old patients.  Practice visits are happening today with first visits for patients scheduled for tomorrow.  GHC will install the first tent on the property to conduct care outside the health center and work through all the processes involved and then share with our other health centers.


Lab volumes continue to grow, especially in Greenfield, where schedules are booked solid this week with one “chair” operational. Work is underway at GHC to add a second chair.





OK. Here’s an example of necessity pushing innovation in a musical “experiment.”


Finally, here’s a great musical reminder about being together in a time of social distancing.



Once again, and this is important, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


Monday, May 18, 2020                                                                                                                  Issue # 45



Happy Monday to you. We’re back, aren’t we? So, here’s a Question for you:


Q: Why is the Racoon the mascot of this era?


A: They always wear a mask, they wash their “hands” a lot, and rearrange the letters of racoon, and you get corona.


Now that’s out of the way, there’s a lot of “reopening” going on and it’s going to get a bit confusing. As you know, we are beginning to bring back some services (like lab and pediatric wellness with immunizations) but in an “alternative way” (mostly outdoors). At the same time, states are reopening, including Massachusetts, in a limited and phased way.


Our two guiding principles at VMG are: provide needed care in the best way available now, and, keep patients and staff as safe as possible. It will still be several months, if not longer, before things begin to look more like they were.


More broadly speaking, things may never look exactly like they were and that will be both tough for all of us but may also present some opportunities for some positive change. In an article in The Washington Post over the weekend, Tom Frieden, former Director of the CDC, wrote that the “familiar stages of grief have been visible. At first, world leaders and even many experts in respiratory disease were in denial, hoping that the coronavirus would disappear. The pandemic provoked anger — at China, immigrants and the (essential) public health measures imposed to reduce spread. Some have tried to bargain, suggesting that the pandemic would be mild, harming “only” the elderly and infirm, or might even fizzle. Others succumbed to depression and considered giving up on control measures, hoping to magically achieve “herd immunity.


These responses are understandable. But the sooner people come to terms with the reality of the pandemic, the quicker we can prepare for lasting changes to the ways we work, learn, relax, govern ourselves and even treat one another.


But at this point it’s clear: Our lives will be altered by the pandemic for months or years to come. As a society, we may become more reliant on younger people and those already exposed to the virus, and more attentive to shielding the vulnerable. Caring for others and prioritizing the collective good could lead to a positive societal change: First by necessity and then by choice, we may come to accept that we are all in this together.”


Let’s hope and work toward that goal.


National, State, and Regional


States continue on the course of reopening with a few actually having met the federal guidelines. We don’t yet know what will happen for those who meet the guidelines and those who do not. With no treatments and no vaccine, we will have to watch carefully and be ready to close down again because the road to “herd immunity” is built on a lot of illness and death.


Today, Governor Baker disclosed the Massachusetts plan. In Phase One, called Start (great name, right), permitted to open this week are:


  • Construction sites

  • Manufacturing

  • Houses of worship


There will be restrictions on capacity and modifications to work sites and places of worship.


Starting May 25 offices outside of Boston can begin reopening at 25% capacity and also next week, other businesses like retail, hair salons (maybe I can get my haircut but will I be ready?), pet grooming. And beginning May 25 hospitals can resume some high priority preventive care. We are not yet sure what that means for our Ambulatory Surgery Center but it will take us a while to gear up anyway.

Outdoor activities including parks, zoos, and beaches can reopen in time for Memorial Day (did anyone else besides me forget that there is a 3 day weekend coming up?).


And then if all the metrics keep going in the right direction, we may enter Phase two which will include restaurants, more retail, some hotel space, playgrounds, youth sports and day camps for the summer.


Daycares will stay closed but the state is expanding the capacity of “emergency daycare facilities.” We’ll know more about what that means soon. The Governor said that plans for school reopening will be announced soon.


During all this, gatherings are still limited to 10 or less, citizens are still required to wear masks in public when they can’t keep at least 6 feet from others and people age 65 and older and with underlying health conditions are urged to stay home (except for going grocery shopping or visits to doctors and pharmacies).


It’s going to be a go slow approach and it may have to be modified or withdrawn if there is a rise in cases and hospitalizations. And of course, citizens will make their own judgments (within the Governor’s guidelines) about when we think it’s “safe to go back in the water” (remember when sharks were what kept people from the beaches?) and resume close to usual activities.



We are not yet certain about what all this means for VMG visits and services yet. Our Incident Command Team is meeting at least three times per week to review what’s allowed, what’s possible, and what’s safe. We are continuing on our current plan and we’ll go slow in considering what to do next. For now we want to emphasize the “worthwhileness” of our video visits (let’s encourage patients who can to use the video visits as opposed to phone) and our plan for safety and caring.


Gina reports that we are working on Outreach calls to support schedules, developing templates for increasing visits, continuing to work for providing outdoor care and continuing pediatric wellness visits by expanding to GHC with a practice run this week. We are developing guidelines for in-person visits when we can return to them for more services. In addition, we are continuing to work towards using one telehealth platform and, right now, that looks like the one that will be available in athena. We have three practitioners in the trial now and we see many positive aspects. 


Finally, this past Friday, May 15th, our first bi-monthly patient communication was sent to about 70,000 patients (it will take several days for all to receive them).



OK. I think it’s safe to say that our heads will be spinning in the next few weeks as the reopening of Massachusetts plan unfolds. We’ll work together on the healthcare and business part of this.


Personally, for getting centered in confusing times I look for guidance from others who have “been there,” often in other fields. Andre De Shields is a singer, dancer, actor, director and choreographer with a major contribution on Broadway and in film. Andre was one of five artists honored at the Berklee College of Music’s virtual graduation this year (I’m partial to Berklee; my son went there).His three rules for reaching your goals are:


1. Surround yourself with people whose eyes light up when they see you

2. Slowly is the fastest way to get where you want to be

3. The top of one mountain is (often) the bottom of the next, so keep climbing


Good advice, I think.


Here’s a link to the finale of that ceremony. I think you’ll like it:





And, as usual, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


Friday, May 15, 2020                                                                                                                       Issue # 44



Well, we’re heading into the weekend and the sun will shine again -- after the storms today. Ain’t that like real life now?


National, State, and Regional


The story continues to be “reopening” across the country. We’re going to see a variety of approaches and therefore a variety of unplanned experiments in how this virus will continue to affect lives. There is some hope that, for most of the country, who have taken social distancing seriously, there might be smaller and more delayed outbreaks. The forces for the social end of the pandemic (when people “decide” that the losses from staying home outweigh the risk of getting sick) seem to be pushing decisions forward. But there will still be virus and outbreaks and hospitalizations and deaths. We’ll know how this works soon.


Governor Baker will release the plan for reopening Massachusetts on Monday. He has said he wants to go slow and careful and rely on the scientific data to go further. We’ll get details Monday. I don’t expect to see major changes in this first phase, at least as they might affect us directly.


There is not much new to report regionally. Hospital systems are stable in our area (but taking very big financial hits – we don’t’ know the extent yet nor do we know what steps they may have to take to mitigate these losses).




I talked with several colleagues at other Groups and hospital systems in the last few days. We are “ahead” of others in the use of virtual visits and getting positive feedback from patients (see below). But, according to preliminary patient feedback collected across the state by the Massachusetts Healthcare Quality Partners (a quality improvement organization sponsored by health plans and the state), virtual visits work well for many with limitations for others. Here are some of their early key findings:


  • Medication reconciliation visits can be simplified because patients can more easily identify what is in their medicine cabinet when they are at home.

  • Some patients with certain conditions prefer telehealth. For example, one clinician reports that she has a patient with agoraphobia who is much happier with a telehealth visit and might not get care at all if an office visit was required. Another clinician states that her older patients with dementia find it disorienting to come into the office and seem much calmer in telehealth visits.

  • Telehealth visits are working better than in-person visits for some end-of-life discussions where members of a patient’s family who are located elsewhere (anywhere in the world) are able to join the conversation in ways they would not have been included before.

  • It is easier for some patients to talk about sensitive topics by phone or video from home where they are more comfortable and at ease.

  • It is easier for some clinicians to get to know some of their patients better by seeing them in their home environment, getting to meet their pets, etc.


At the same time, we have discovered some dissatisfaction with telehealth visits. Examples include:


  • Patients report concern that, since their doctor couldn’t do a physical exam or other tests that might have been performed at an in-person visit, they may not have gotten the diagnosis or treatment plan right.

  • Phone calls or video visits that use up patients’ limited data or phone minutes may not be viewed favorably, possibly raising some equity issues.


The key thing for us is to stay in touch with patients, see how well it’s working for them and make adjustments as we can. On the whole, telehealth is finally taking off and vital to our clinical work given the limitations imposed by the pandemic. And, I believe, even after the pandemic, it’s here to stay.


Here’s some feedback from one of Carol Carson’s IBH patients:


“I so appreciate that Valley Medical is providing such accessible mental health care right now. It is so important to be able to talk with someone who doesn’t judge me and offers real ideas to help me cope better. I actually really like talking with you on video!”



There are a few positive things that have happened as a result of people working together during this pandemic. Telehealth is one of them. Another is the advent and promotion of the “virtual chorus.” Here’s another example:


And now here’s James and family:


Thank you, Martha, for finding this.


OK. Enjoy the weekend and Hey, hey, hey, as usual, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


Thursday, May 14, 2020                                                                                                                 Issue # 43



Happy Thursday. Almost the weekend but there’s still a lot of “good to do” and you all are getting really good at that. We keep getting patient comments about how we are doing and almost all of it is, well, good. People are surprised and delighted at our being in touch, providing care and connection. Care and connection: both are really important now.


Julia Marcus, a Boston epidemiologist, discussing the need for people to restart their lives while staying safe has said that “what Americans need now is a manual on how to have a life in a pandemic.” That’s a recognition both of our current reality (that there is a pandemic, that’s its’ going to be a “long haul,” that there are things we must do to stay as safe as possible while accepting what we can’t change) as well as the probability that we will face this again and we need to learn how to change and adapt.


State and Regional


The Governor will release the recommendations from his reopening task force on Monday. He’s already suggested this is going to be slow and methodical (so probably no haircut for me yet) and based on data. What we might see are some restrictions loosening for different risk groups: younger people in lower risk occupations may be able to go back to work sooner than older people, older people may still be under a “stay-at-home” advisory, activities in the open air may be permitted by small groups, etc. There will likely be increased contact tracing.


In our region, relative to the rest of the state, there are fewer cases and deaths. Our health systems are still not overwhelmed and that’s good.


We are hearing about increased concern and demand for more testing and we’ll have to navigate that. The tests themselves are not “perfect” (whatever that means in the face of a pandemic) and there are probably still too many false results (positive and negative depending on the test). But they will get better.




From Gina:


Finally for today, as the man says, “keep taking another step, one day at a time, and we’ll get through this together.”


Thanks to Margit for suggesting this.


Hey, hey, hey, as usual, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


Tuesday, May 12, 2020                                                                                                                                  Issue # 41



Good Tuesday afternoon to you.


Here’s something to think about. Looking back at past pandemics (plague, smallpox, various flus, others) shows us that pandemics end in different ways. And the whole concept of “pandemic end” is an interesting idea.


An article by Gina Colata over the weekend in the NYT suggests that there are two types of endings: the medical end and the social end. We usually think about the medical end (when new infections wane and deaths rates go way down). But there is a social end when fear of the disease and all the consequences of that fear dissipate. And there is the time in the middle which may be where some people think we are now. In other words, comes a time when people “get tired” of not being able to do things and, in the absence of seeing the severe medical effects with their own eyes, they begin to judge the risks to be lower than the benefits of resuming life as it was. This may be what we are facing in the country now.


The lesson is, be careful in making these judgments about the pandemic “end” (sometimes they don’t end at all; we just learn to accommodate) and the reasonable things to do to preserve and resume life. And, we don’t think we are there yet.


National, State and Regional


Nationally there are certain groups of citizens especially disadvantaged and at risk in the pandemic. I focused on racial and socioeconomic inequities yesterday. Domestic violence rates and reports are increasing now as people are “shut in” with their partners and can’t easily get away (or don’t feel empowered to get away). We should be on the lookout and be open to hearing if this is the case with patients now. Nursing home residents are at risk both for illness and increased isolation from family. Prisoners and others who are confined institutionally are at risk while incarcerated and also as released (due to lack of resources and connections in the community for healthcare and other services). We’re also hearing about treatment facilities and programs for opioid users not being eligible for stimulus and relief funds – that will impact this vulnerable population as services are reduced.


One other national item of interest. Politico reports that you might think that cutting edge technology would be employed for national and state agencies in fighting the coronavirus. But that’s not the case:


“Public health departments are unable to share data on cases, persons under investigation, laboratory tests and person-to-person transmission with the CDC seamlessly — instead they are forced to rely on a combination of methods: antiquated pen and paper, faxes, excel spreadsheets, phone calls, and manual entry.” We have a long way to go.


In Massachusetts, the Governor has published an outline for how the state might reopen business. He’s setting out four phases: Start, Cautious, Vigilant and New Normal. He has not yet said which businesses and activities would come back first and there is currently no timeline released. It will depend on the medical data and a balancing of risk of an increase in infections and hospitalizations against the benefit of starting up.


Hospitals and health systems continue to suffer financially from lost procedure and admission revenues. It’s true that some additional revenue is coming in from treating COVID patients, but there are also additional costs for PPE, modifications of facilities, IT, staffing, etc.


In our counties, hospitals remain with capacity and PPE seems to be adequate for the moment.




We are trying out the new video capability within athena. Three practitioners are using “the platform” and providing feedback. We’re hoping this turns out to be our platform for the near and distant future.


Be aware that there is a COVID folder on our intranet page with lots of useful information and policies. It’s updated often.


I’m attaching a draft of a communication, fyi, to our patients (here). This is the first edition of a patient newsletter that will be sent by email every 15th and 1st of the month inviting patients back to the practice and describing our services. We’ll “feature” new and/or returning services and department updates, a few at a time. We’ll also use the newsletter as a basis for updating our web page and FB page.


There continues to be a lot of work going on for using spaces outside the buildings for clinical services that can be done more safely than in the buildings.




That’s it for today. Thank you once more for your dedication and creativity. We’re still, and especially, all in this together.


As usual, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


Monday, May 11, 2020                                                                                         Issue # 40



Good Monday afternoon. I hope you had a good weekend.


My Voice


I realize that in addition to updates about what’s happening in the country, the state, our region, and at VMG, I’ve been talking with you about some matters that are important to me in my role as the President of a regional healthcare organization but also about what’s important to me as a citizen. The Pandemic is forcing us to uncover some aspects of our culture and society we’ve either missed or failed to keep in focus.


First is the inadequacy of our healthcare financing system to meet the needs of our population and, especially now, during the pandemic. The fractured response to the pandemic, state by state, business by business, health plan by health plan, hospital by hospital and group by group is now fairly obvious (although hospitals and groups have rather quickly evolved their services to match new demands for care and safety). The other problem that has been re-exposed is the problem with paying for care service by service (Fee for Service) as opposed to by patient panel (capitation). If the patient doesn’t come in under a Fee for Service system, healthcare providers are not paid and the cost of maintaining the system is not reimbursed and new ways to see people don’t get invented and/or sustained.


The second “revelation” is that our public health systems have been too long neglected. We’re trying to cobble together a unified approach to contain the virus without the public health tools, systems and staff to support a unified approach. The controversy over testing is just one example. These issues will require a societal fix. It’s worth our attention (all of us) and we should demand more of each other and our elected officials.


The most uncomfortable of all revelations, I think, is that the hospitalization and death rates for this pandemic get worse as you go “down” the socioeconomic ladder. In Washington D.C., for instance, if  you take the Metro from the inner city out to Bethesda in the suburbs, for every mile you travel, the residents of that community lose 1-2 years of life expectancy (if not more). An article in The Boston Globe by Andrew Ryan and Kay Lazar on May 9 reports on a Harvard study showing that death rates, in this pandemic, by level of poverty dramatically increase as the poverty level goes up. The same is true when you look at rates comparing towns with higher share of people of color. Why did I say “uncomfortable?” We typically want to think that the virus affects us all equally and that we are an equal opportunity society. It’s uncomfortable when we are forced to think about how unequal we are in the conditions that lead to disease and burden of illness. And it’s even more uncomfortable when we think about what to do about it. Here’s a link to the article:


Let’s keep these realizations in mind as we talk with family and friends and with our leaders in our towns and state. If you want to talk more, I can host a zoom discussion or get you further information outside of this newsletter.


National, State, and Regional


As many states start to reopen, we are beginning to see a spike in infections. And although the current national infection, hospitalization and death rates seem to be holding steady that’s mainly due to the rates in NYC and NJ coming down slowly. Those rates are actually increasing in other parts of the country.


Massachusetts numbers for new infections seem to be declining slowly. Hospitals are seeing a slowing of admissions (current rate is down to 4%) and most still have capacity. Deaths are still high but deaths decline slower than admissions. Nevertheless, the pandemic is far from over and the pressure, as you know, is on for “opening the economy.” Many infectious disease experts are warning about going too quickly. Several have published a list (in today’s Globe) of what they believe healthcare organizations should do:


“· We must closely monitor any uptick in influenza-like illness in office and emergency department visits and hospital admissions.

· We must have clear criteria for when to reinstate restrictive measures for worrisome trends so we can act swiftly and decisively.

· We must expand testing and track new infections, following up with an aggressive public health response of contact tracing, testing, and, where appropriate, quarantine.

· We must secure adequate supplies of personal protective equipment, ventilators, and dialysis machines, assess the workforce and capacity at our health care facilities, and study how to protect our most vulnerable communities, including those in nursing homes and other congregate facilities.

· We should continue to build upon the successful expansion of telehealth visits, and not require patients to come to the doctor’s office for an appointment unless necessary.”




We are continuing to look at our workflows for safety and effectiveness as we consider “bringing back” services based on need. We want to encourage our patients who may have delayed getting care because of fear of contagion to come back for needed follow up and care. An email blast will be sent each 15h and 1st of the month with information about what we are bringing back, new processes, safety and access. The first blast will to out this Friday. We hope this helps to fill the schedules and keep our patients attached to VMG. We want patients to “stay safe, stay well, and stay in touch.”


In the near term, we don’t anticipate a lot of new traffic in the buildings but we do anticipate more literal traffic outside the buildings as we do more labs, wellness visits, and other services in the “open air” to reduce the risk of infection.


Most of our work continues to be virtual visits. Last week I showed you the chart for primary care. Below you can see the impact of virtual visits in a few other departments.





Here you can see some recovery of our charges since March. We expect this trend to continue (it looks like we had a lot of unfilled appointments in the last few days of last week and that is bringing the recent trend in virtual visits down).


A few of our services are actually doing better than last year. Behavioral Health, Diabetes Education and Nutrition are in this category (see below for these departments). And lab visits are on the upswing again.














I’ll show you the trends in other departments next week. But you don’t have to wait for this newsletter to see these charts. They are published on our intranet page under the Quality and Reporting tab.


Thanks to all the clinical staff and practitioners in these departments for creating this improved performance.


Finally, a messy reminder. We had a problem in Amherst this morning with a backed up sewer and septic system. Jim Wood emailed all about this earlier but I want to remind you once again. When the plumber got there, they found the sewer pump clogged with rubber gloves, plastic bags and baby wipes. Please remind all to keep these out of the toilets and drains.




Thank you again for all you do. We’re all in this together. Here’s another reminder (click on the Virtual Choir video in the article):




Oh and I almost forgot (well, not really). Please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


Friday, May 8, 2020                                                                                         Issue # 39



It’s Friday. I hope you will enjoy your weekend.


I promise there is an uplifting video link at the end of this Update but please stick with me first. I want a haircut. I need a haircut. It’s a free country, right? I should be able to get a haircut when I want to and the person who cuts my hair is going broke because she can’t open her store. If someone else doesn’t want a haircut, that’s their business. Besides, this virus thing is not as dangerous as “the government” says. Right? ABSOLUTELY AND COMPLETELY WRONG!


This virus is absolutely dangerous. It’s already killed more than 76,000 people in this country. Yet a bunch of “conspiracy theorists” produced a slick video with absolutely incorrect, vicious, yet persuasive (to some) arguments about the need to not only “reopen” the country but to distrust those who say otherwise.


To be sure, we are dealing with two major crises at the same time: the pandemic and the economy. Both are critical now. But we need to stay focused on the facts and the science. If significant parts of the country start (or continue) believing this pandemic is not real, people will continue to die. And the economy will not improve.


And now, back to me and my haircutting needs. I have a responsibility to you and every other citizen to deal with managing my needs in a way that does not threaten your health and life. We used to understand public health as a greater goal. And, in times of crisis we usually pull together. We need to again. And ironically, this is V-E day (talk about pulling together).


So I have a responsibility to speak out to anyone who is ignoring the truth of this pandemic. And so do we all. Please, if you know someone who is claiming this is not real or does not feel the need to safeguard us all as best we can, use the talking points I sent you yesterday (they are on the intranet page). We can all help out for our greater good. You don’t have to be confrontational. Just be calm and fact-based. Or send them the information if you don’t think you can discuss it.


National, State, and Regional


I’ve already talked about the national scene. The state may be seeing some continued improvement in rates of known infections and in hospital admissions. That’s good for now. We’ll wait to see if it really is a confirmed trend.


Regionally we remain stable with our hospitals open and not overwhelmed. Testing is slowly becoming more available. We’ll have more information on that soon.




The results of the trial of pediatric visits are generally positive. It’s a good start to resuming this important service. And testing in the open air is going well. On Monday we’ll share the trends for increasing business activity by department.


A reminder to observe social (physical distancing) in our common areas such as break and lunch rooms. You should soon see some reminder signs about the number of people who can be in these areas at one time. Please respect these safety steps.



OK. As I said, this is Friday. Here’s something to bring you up as you head into the weekend (thanks to Diane Fisher-Katz for finding this).



And here’s my Mister Rogers moment. You are all great and valuable and we really appreciate all your efforts on behalf of our patients and our communities. And again, Happy Nurses Week and now Happy Mother’s Day.


Please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.


Be well,



Be patient; be mindful


Thursday, May 7, 2020                                                                                                    Issue # 38



News reports this morning contained this headline: “Nursing home residents may account for up to half of all U.S. fatalities from COVID-19.” While you might say this could be expected given the average age and vulnerabilities of patients in these facilities, it is hard to think about this without feeling pained. And there are other inequities in the way the pandemic is being experienced in our country. I’ll be discussing that in an issue soon. In the meantime, please keep the residents of these facilities (and the staff) in your hearts and minds.


National, State, and Regional


As you know, the controversy about reopening states continues. The latest wrinkle is the abandonment of CDC guidelines and the conflicts between some mayors and governors.


Governor Baker is expected to put out a list of the types of businesses that might reopen “in a limited fashion” once the May 18 stay at home advisory is canceled. The seven day average of positive virus test rates had been declining steadily until yesterday so this is still a cautious possibility. He may elect to continue the stay at home advisory. That’s what just happened in Washington State. Everyone wants to “get back to normal” but that’s still up in the air.


And, as I think you already know, the Governor has mandated that, effective May 6, all Massachusetts residents older than 2 are to wear face coverings when out in places where social distancing is not possible.




We’re going to stay steady with our current approach until we think it’s safe to return to more typical operations. And then, we’ll be returning in phases. Here’s an example of our approach.


At EHC, we’ve piloted pediatric vaccinations and well visits and learned a lot about those new processes, limiting exposures for staff and patients, using our telehealth platforms to gather and give information and reserving contact time with practitioners and staff to the minimum necessary. We’ll be expanding to GHC next and then to other age groups.


We are looking again at our approach to reaching out to patients to let them know we are here for them virtually and/or in-person as needed and as safe. We are working on using our internet site (“”), email blasts, and FB page to get messages to patients about our status with common procedures, departments, and services as we are beginning to bring them back. We’ll be updating these methods twice a month with new messages. You’ll hear more about this soon. We will also want to engage you as ambassadors to your friends and families, as you feel comfortable.




There are so many people to thank for all your efforts to keep us running and safe. Everyone in the company is contributing. It’s really heartening.


Here’s something from one of our local hospitals:



Please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to take care of each other.


Be well,



Be patient; be mindful


Wednesday, May 6, 2020                                                                                                 Issue # 37



Good afternoon.


Around the country people are beginning to realize the impact of the pandemic and the tension almost every segment of society is experiencing. What began as a regional outbreak on the west and east coasts and then in the south in places like Texas and Louisiana is spreading to the entire country.


There is a very real toll on the economy with high numbers of unemployment and job loss. There is also the very real toll in lives lost and burden of illness and isolation. These are not easily reconciled and we will be living with this tension for many months.


There are now more people who are pushing the idea that this virus is no worse than the flu (which, by the way, is pretty bad in lives lost, illness, and jobs impaired). But the flu has a vaccine and there are some treatments to lessen the symptoms and shorten the course. COVID-19 is worse. The Boston Globe published an article today on “what to tell people who think this is no worse than the flu.” Here are the five things to say:


Five things to tell someone who does not believe the coronavirus is more than the flu.


“1. The coronavirus is more severe than the flu, more deadly than the flu, and it appears to spread more easily


2. Even with severe lockdown measures, the virus has killed nearly 70,000 Americans in just over three months


3. There’s still a lot we don’t know about how the virus behaves


4. It is true younger people are at a much lower risk of death from the coronavirus — but that doesn’t tell the whole story. They can still spread the virus and many are getting very sick (just not at the rates of higher risk populations).


5. There’s no proven treatment and no vaccine”


If that’s not enough, we’ll have to agree to disagree AND continue the policy of the Governor and public health officials.


National, State, and Regional


At his press conference yesterday, the Governor acknowledged that there is some potential good news. The rate of infection seems to now be going down. However, he warned, “we’re still very much in the fight.”


Regionally, our hospitals still have capacity despite a recent increase in admissions from nursing home (which seems to be resolving some now).




First, a praise passed along by one of our ICMP Care Managers (from the Medicaid ACO), Sara White:


“I noticed throughout my calls and chart reviews that you all have been very busy with virtual visits. I also spoke to one of our iCMP patients this morning who was raving about your drive-thru lab team, I believe at the Florence office. Way to go VMG!”


And another one from Sara Boisvert who was working with a patient on scheduling a virtual visit:


The patient wanted to thank Sara and everyone here at VMG – she said “thank you to all our healthcare workers for getting up every day and doing all of our hard work to keep all of them safe.” 


Sara was grateful to hear this from our patient and mentioned it even made her a little teary eyed!  We are doing great things and it’s always so nice to receive these sincere messages from our patients!


Department Updates:


Eye Care. The department is actively considering other models that would allow them to safely return to seeing some patients including some forms of barrier protection to allow use of their equipment. They are also considering (and have piloted) using internet tools to do some exams. Other things being considered are spacing appointment to allow for sanitizing equipment and rooms, changes in hours, and running the optical shops on an appointment only basis.


Ambulatory Surgery and Procedure Center. The Center has been ordered closed by the Department of Public Health (DPH) (as have all ambulatory procedure centers in the state) since the early days of the pandemic. We are now working with staff and the GI and Anesthesia consultants on an action plan for reopening once the DPH gives the OK. It’s a bit more complicated than other departments due the regulatory burden and oversight as well as the nature of the patients and procedures themselves.




Billing has told me that they are getting calls from some patients who are receiving statements (bills) for virtual phone calls and visits and who say that they were not informed there are charges for these services. We are seeing language in some notes saying that the patient was informed and agreed. However, it is not clear if the language was from a macro and discussed or not. So this is a reminder that patients should be informed that we will bill a virtual visit (either for a phone or video/audio visit) for services that qualify.

I’m sure that virtual visits will remain with us after the pandemic subsides and it will become more standard of care and “ordinary” over time. But for now, while patients still experience them as novel, please remember to make sure they understand these are services and will be billed as services.


The trial of pediatric wellness visits outdoors yesterday went well. Mary Mitchel reports that we have a few more visits scheduled to continue to confirm the best processes and then we’ll be in position to start scaling up.


Val Felton and Amy Rice report that we will continue to distribute face shields to staff requiring them and that we will have that done within a few days.


And now, this….





Thanks to the clinical staff at GHC for reminding us and our patients.


Remember that if you have a specific question about our processes or about COVID-19, you are welcome to use the “covidquestions” email address in the global address list.


Thanks once again for all you do for our patients, our colleagues and our communities.


I almost forgot. Please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to take care of each other.


Be well,



Be patient; be mindful


Tuesday, May 5, 2020                                                                                           Issue # 36



Happy nurses week to all nurses and clinical staff!


And thanks to all of you, who have donated PPE, crafted by you, or gifted from your relatives and friends.


National, State, and Regional


There ae some improving signs on the east and west coasts and social distancing has helped, but the hoped for steep decline in new cases and deaths does not appear to be happening yet. Instead, we are seeing them plateau while we are seeing hot spots appearing in the Midwest and south and in about 20 states numbers are still rising (though they are starting from a lower baseline).

And this is in the context of relaxing stay-at-home guidelines and reopening of activities.


Governor Baker yesterday said that May 18th is not the date to “reopen” the state though he will allow certain businesses to open to employees (unclear which). Rather that date is when we will hear from his task force on reopening and get their recommendations.  In the meantime, as he was making his public announcement, a few people attending the event were shouting “it’s a hoax.” They apparently have not been to the hospitals, ER’s, and morgues to see that this is not a hoax.


There is nothing new in our region overnight. We still have capacity in the hospitals and testing is available for symptomatic patients by appointment.




News from Gina: We are seeing the first three patients, ages 0-2, today for wellness visits including vaccines. We’ll see how the process works and scale it up as possible.


Seven infrared thermometers have been received and we are testing them to validate results. They should be in use for screening soon.


The lab is able to do mobile lab draws outside the centers for any labs ordered for patients.  All patients must have scheduled appointments. We cannot do walk-ins. 


Finally, work to develop criteria for the use of antibody testing at VMG is underway.  More information will follow.


Podiatry is seeing virtual visits and please refer patients as appropriate. They will also see in-person visits for patients with infections, wound care needs, trauma and severe pain, and for certain diabetic care. Contact the podiatrists or their staff for more information.


Sports Medicine is also seeing virtual visits and Dr. Murphy says these are good opportunities to discuss other methods of pain and injury management prior to considering injections. He is able to see some small number of patients with severe pain who have first tried other ways to manage.


Endocrinology is seeing virtual visits and using these for advice, consultation, and for follow-up. They are also doing some training and education virtually and they can point patients to internet resources and You Tubes for teaching and training as well. They can also see some in person visits for concerns about infection, new thyroid nodules, and new teaching for insulin and pump management.


Rheumatology is seeing virtual visits for new patients (with Dr. Maroun) and follow-ups. There are a few patients that may need to be seen in person for severe pain and injections, medical decision-making and/or for new medication starts and we are discussing ways to see them outside the building, if possible.




This is Mental Health month and this year it has special significance as the rates of anxiety and depressive symptoms climb due to the COVID-19 pandemic and the resulting isolation for many. is on line this morning with an article how to maintain your mental well-being during the COVID-19 crisis. They interviewed Ethan Seidman and Daphne Holt and got “6 tips” (including practicing mindfulness, adjusting expectations, being intentional, helping others, building resilience, and focusing on the moment) for “weathering this challenging time.” The advice on “setting intentions” seemed especially good to me. For those behaviors we’ve adopted to get by and deal with stress (like eating or drinking more) it means “feeling better down the line” and asking yourself “if this is what I do for the next two months, is that going to feel good? If not, how do I want to spend the next two months?”


Here’s the link:


And finally for today, if you know someone who’s been quarantined (or if you have been quarantined), here’s your anthem:


OK. Thanks once again for all you do for our patients, our colleagues and our communities.


And as my mother used to say, “you (meaning me) sound like a broken record,” but: wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to take care of each other.


Be well,



Be patient; be mindful


Monday, May 4, 2020                                                                                        Issue # 35



I hope you had a great weekend and were able to go outside and walk, hike, or whatever you like to do outside. Sunlight and exercise really do work to improve mood and perspective.


National, State, and Regional


Calls and texts to national hotlines about anxiety and depression have been increasing rapidly (one report said about 1000% this past week). Almost all of the increases are related to the COVID-19 pandemic and the changes to our activities and support systems.


Despite the “reopening” of several states, we continue to see new cases and deaths plateau in our state. One positive note, Massachusetts statewide hospitalization rates are declining and are now at 5%. The impact on Western Massachusetts is still not as severe with both hospital systems continuing to report that capacity is still available. The number of COVID-19 patients in the hospitals is however holding steady.


Please stay available to your family, friends and colleagues. We’re in a phase where we are “getting used” to things as they are and although that may help get us through our days, it does not mean that everyone is OK and accepting. Kind words and inquiries, zoom or other virtual contacts, walking outside at safe physical distances, really do help.




Below are some charts (thanks to Isaac Allen our Data Analyst) showing our business slowly coming back, mostly in virtual form. The green line represents total 2020 business (you can see the effect of the pandemic since about March 15 – the vertical dashed line) and the blue line is virtual business. We’re still way below 2019 and our budget but there is some improvement recently, particularly in primary care and a few other departments (where virtual visits have become commonplace – I can report on those next week).












We are, as you know, continuing to develop our capacity to do labs and immunizations outside of exam rooms (in the “open air” of the parking lot – to reduce potential concentrations of the virus) and to do other necessary in person visits in the least concerning way for patients and staff. Beginning tomorrow, we’re trying out pediatric wellness visits. We’ll see how well that goes and learn from this “pilot.”


We want to continue to be vigilant, be safe, and be effective in providing care. That’s the vision as we continue through this pandemic.




There are some interesting things going on to try to ease the loneliness and burden of hospitalized COVID patients. Here’s a story from the New York Times over the weekend with one approach:


And more locally, here’s something from Scott Meyers:


I am doing live “mini-concerts” on Instagram every week or two after work and on weekends. Next one is Thursday at 5:30PM. For folks who use Instagram (I imagine there are a few) they might enjoy “tuning in” at @scottmeyersmusic



I can’t say it enough. Thanks again for all you do for our patients, our colleagues and our communities.


And need I say this again: wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to take care of each other.


Be well,



Be patient; be mindful


Friday, May 1, 2020                                                                                              Issue # 34



Happy May Day! In some countries, May Day is celebrated by dances, parties, cakes etc. at large social gatherings to welcome spring. Well, we can’t do the large social gatherings, but please enjoy the warmer weather.


National, State, and Regional


There are more news reports today on many companies and countries involved in working on a vaccine. Some are skipping animal studies and going to human trials. Despite this, we are months and maybe years away from having a safe and effective and widely available vaccine. So, again, physical (social) distancing is the main tool we have to prevent spread of the virus.


There will continue to be tension between wanting to follow public health advice about slowing the virus and keeping safe on the one hand and “opening up” the economy (travel, restaurants, movies, visiting, shopping, etc.) on the other. We’re going to have to live with this tension for many months. By the way, this is why Harry Truman once said he wanted a one-armed economic advisor. His economic advisors were always saying “on the one hand….and on the other hand…”  


We all want clear direction and certainty. But we have little certainty with the virus now other than it is highly contagious and, in some cases, it can be deadly. So balancing this tension, we think continuing physical (social) distancing makes sense. This will be “the VMG way” until we feel that safety can be managed differently.


There was a great article in the Boston Globe this morning about why Massachusetts seems to be staying at a plateau in new cases and deaths. When the pandemic “hit” our state about 8 weeks ago, there was talk about a rapid increase in cases, a peak, and then a decline. Instead we have had the rapid increase and now we may be in a period of staying at peak with a slow decline. The writer explained this as a car with the accelerator stuck to the floor. It speeds off and the first step is to get it unstuck. We seem to have reached that point. Now we have to find a way to tap the brakes. The only tool for that for now is, you guessed it.




I think that many of us are “getting used to” working in this new way, wearing masks in the health centers and when out and about with other people. It may provide some sense of control and calm.


But there is another type of “being mindful” we need to observe. Let’s remember that we may find ourselves inadvertently disrupting physical distancing or doing things “the old way.” So let’s be certain that we realize that things we used to do automatically may carry some risks and keep finding new ways. This is particularly true about deciding to bring folks into the health centers. But it’s also true about small gatherings. The question to ask, is it worth the risk? Let’s reduce the chance for inadvertent risk. We’ll be working on that.


Next week we will begin piloting some pediatric wellness visits. We’ll be monitoring how it works and after a debriefing, make whatever work flow changes are necessary to do this safely and scale up as necessary.


Amy Rice received 7 infrared thermometers. We will be making sure they work well and then figuring out where to deploy them for screening.


We’ve received 250 additional face shields donated from Oxbow Design (300 total from Oxbow Design).  Distribution to clinical staff will take place next week so everyone will have their own face shield.  Proper care and cleaning instructions will be provided.


Greg Folta reported that we are seeing changes in telehealth reimbursements. This is good news. We are seeing some payers reimbursing at the same rates for phone visits as for VV.  These changes will be retroactive to March 1st. There is also good news with PT Dept. billing changes.



All of this change can certainly be very tiring. So we have a weekend coming up. Please enjoy the weather, go out for walks, “see people” at a distance or by phone, Face Time or Zoom, talk with family and friends, etc. Be socially closening while physical distancing. One of the morning news anchors was talking about her daughters missing their grandparents. So they set up a Yahtzee game over social media with the grandkids and grandparents. Maybe a tournament?




Oh, and hey, hey, hey, remember: wash your hands (a lot), don’t touch your face, maintain social-physical distancing (it works), and wear a mask, stay home if you’re sick/leave work if you’re feeling sick.


Be well,



Be patient; be mindful



P.S. Some ideas and thoughts:


Thursday, April 30, 2020                                                                    Issue # 33



Good Afternoon. It's the last day of April. Hard to keep track of time in this era.


We are still here and working. That’s good. We’re still innovating and finding new ways to do essential work. That’s good too. And I think we are learning that we can depend on our colleagues and that’s very good. So while we have a long way to go to get through COVID-19, we can rely on our strengths and each other.


We talk about “social distancing” a lot because it’s the main tool we have now. But Robin McKeon reminded me that term is not really what we mean. What we really mean is physical distancing – staying at least 6 feet apart and avoiding direct contact so as to reduce the possibility of spreading the virus. In fact what we need is more social closening (a term I wrote about in a previous edition). We need to continue to rely on each other, avoid getting and being isolated, and use our social supports to care for ourselves and others.


John Novo found this. Here’s a link to a WHO illustrated guide on Doing What Matters in Times of Stress.


National, State, and Regional


Testing is still the major issue at the national level. There is no one coordinated policy and set of resources in a time that we need just that. We have CEOs of major corporations beginning to speak up and that is good.


The Massachusetts trends don’t seem to be decreasing yet. That’s not good though there are some hot spots that are driving those numbers. The Governor has already announced that stay at home advisories continue until May 18.


Testing continues to be available at the local hospital systems by referral.




Here’s Gina’s update for today:

Highlights from Governor’s Office

     Closure of non-essential businesses, stay at home advisory and no gatherings over ten people extended by the Governor 4/18

     State updates available by text.  Text “COVIDMA” to 888777.  (charges may apply based on your cell phone carrier.

Operations Update: Highlights


On this last item, we met today and decided to continue to allow multiple telehealth platforms (Zoom, Doxy, Skype, Facetime, etc.) for the time being. And we are going to participate in a test of an athena version of telehealth very soon. That’s potentially very good news.


That’s it for today. Thanks for reading and thanks, as usual, for all you do.


Oh, and hey, hey, hey, remember: wash your hands (a lot), don’t touch your face, maintain social-physical distancing (it works), and wear a mask, stay home if you’re sick/leave work if you’re feeling sick.


Be well,



Be patient; be mindful


Wednesday, April 29                                                                                                             Issue # 32



Good afternoon. While it looks like a great day out there, maybe that’s what the dinosaurs also thought one afternoon. Asteroid 52768 (1998 OR2), first spotted in 1998, will pass within 3,908,791 miles of Earth today, moving at 19,461 miles per hour. That's still 16 times farther than the distance between Earth and the moon. So, OK, no dinosaurs will be harmed and neither will we. I hope you were not alarmed.


However, the novel coronavirus causing COVID-19 is still here and will likely be part of our human experience for many months and beyond. You know that it has radically altered the way we work and care for our patients.


There has been some progress reported in dealing with the virus but the headline is that it’s too soon to tell how it might alter the course of the pandemic. There are reports of human vaccine trials starting now in England and Germany and some in the U.S. but even if the trials show that the vaccine is safe and effective, it will take a long time to produce enough doses to essentially offer it to the world. There are very preliminary reports on some therapeutics that might work to reduce symptoms in hospitalized patients who are severely affected. There are also reports of testing becoming more available but not at the scale that we will need yet. And there are plans for contact tracing but it will take many months to scale that up too. So the best we can say is that there are some signs of progress and hope. 


We think that we will be working in essentially our current mode (social distancing, almost all visits by telehealth) to protect patients and staff for at least another 6 – 18 months. See below for what we are planning.


National and State Scene


Not much new to report. Some states are continuing to “reopen.” They are hopeful but the concern is that this will become a big natural experiment in how resilient we are and how persistent the virus remains. We’ll see the results in 2-4 weeks.


Massachusetts remains a “hot spot” for infections recorded and deaths attributed to the virus. Some of the increased reporting is the result of increased testing for the virus (Massachusetts currently has the second highest rate of testing in the country). We may be in an “extended peak or plateau.” No cause for reopening Massachusetts yet.


Our two counties in Western Massachusetts are still showing better than statewide results in numbers of cases and deaths. But we also have lower population density than much of the state so maybe this is a denominator effect (fewer cased but many fewer people compared to other regions of the state).


There is more testing available now compared with several weeks ago. We are continuing to refer testing for COVID to the local hospital systems.




Meghan, Steve and I have been checking in with colleagues and reports of health systems across the country and we are reassured that we are doing all the right things at least compared to other Groups and systems. In many areas we may be ahead of the rest of the country. That’s cause for pride in what you have accomplished. Of course, there’s a lot more to do in adapting to our new environment of COVID.


You already saw Stephanie Pick’s email about our work on CCM. She reports that we “broke our record” in March for number of CCM services. And this is, to quote Stephanie, “in spite of workflows being disrupted, work being done from home, and the many changes that have occurred in the past 6-8 weeks. You have been documenting the time you spend taking care of some of our more vulnerable patients. Well done!”


We continue to get praise and appreciation from our patients. Lisa Dumas in Radiology had this to say this morning: “I just x-rayed a patient who told me that she really liked her recent virtual visit.  She said, “That’s my kind of visit.  It was fantastic!”


As you know, we’re thinking of the need to begin bringing back services, but doing that in a way that continues to protect patients and staff as much as possible. We’re looking at using “temporary” structures (i.e. tents and car ports) in our parking lots for use for lab draws, immunizations, injections, and perhaps some evaluation and treatments. We’re thinking of this being a priority well into the fall and winter of next year, as necessary, especially when we start providing flu vaccine (more on that in days to come).


Another central idea is to find ways to reduce patient and staff time in exam rooms by doing whatever work can be done (gathering information and history, for example) by telehealth and reserving time in the building for when we actually need to see and touch patients.


Of course we’ll need to have adequate supplies of necessary PPE. Val Felton and Amy Rice have been doing a great job keeping a central inventory and reporting on the status of our supplies of masks, gloves, gowns, face masks, thermometer covers, etc. (We’re stocked adequately for now).


Jean Wilder in Billing suggested that it might be helpful to us and to the community to keep track of how VMG staff have been helping out in the pandemic (in addition to the work they are doing for VMG). If you have been making masks, headbands, working at food pantries, etc., and you are willing to share, please get me this information. We can compile and report on your efforts (we won’t reveal your names).




Although the emotional strain caused by the pandemic really is no laughing matter, it does help to be able to acknowledge it and talk about it, and sometimes a humorous approach makes it more acceptable to discuss. Here’s something that may help:



Thanks, as usual, for all you do.


And hey, hey, hey, remember: wash your hands (a lot), don’t touch your face, maintain social distancing (it works), wear a mask, stay home if you’re sick.


Be well,



Be patient; be mindful


Tuesday, April 28, 2020                                                                     Issue # 31



Good afternoon to all. 


Consider This


You’re going to be hearing a lot about vaccine development in the coming months and that is a very good thing. It normally takes anywhere from 1.5 to 4 years to develop and produce, at scale, a safe and effective vaccine. There are reports from the UK today that an Oxford lab may actually be able to prove a vaccine is safe and effective by September. That would also be good but we’ll have to wait for the trials to conclude and the results to be known. And then it will take time for production. In the meantime, we continue social distancing to keep our medical resources available and slow the spread of the virus and see if a safe and effective treatment emerges from clinical trials. And we, as a nation and world, need to devote lots of resources to testing.


So how could vaccine development have been different? Aside from the political “mistakes” of not paying enough attention to new viral threats, there are the wrong incentives “built in” to the funding of these efforts. In an article in the NY Times this weekend by Jennifer Kahn reports on efforts to create a panviral vaccine. This is a kind of default vaccine structure that could be relatively easily customized to fight almost any new virus. The biggest problem is that no one was willing to pay for it. Drug companies would have to spend millions on development of a vaccine that individuals would get once a year or not at all (in some years). Not much financial payback from that kind of use.


You might think that this would be a role for governments to take on rather than “the private sector.” But new diseases emerge “in other countries” and some never reach certain shores. And it’s all very expensive and which taxpayers want to pay for some previously believed remote possibility? Do you? I do?


In that article, Peter Daszak, a scientist presenting at a WHO conference is quoted as saying “we don’t think twice about the cost of protecting from terrorism. We go out there, we listen to whispers, we send out the drones—we have a whole array of approaches. We need to start thinking about pandemics the same way.”


OK. I’ll stop there. But think about it please. Especially as you prepare to vote.


National and State Scene


I’m going to pass on the national scene today except to say that testing is key and rather than having 50 approaches, one national approach would be better.


At the state level, Governor Baker has just extended the Stay at Home advisory at least to May 18. This continues the order for the closure of all non-essential businesses and the ban on gatherings of 10 or more people. I think that’s a good decision and I would not be surprised if, as that time approaches, it was extended into June.  We all want to get out, go to the beach, the movies, restaurants, ball games, etc. but let’s be safe.




The Greenfield (and other towns) police and fire did a drive by salute to healthcare workers at VMG and elsewhere this morning. It was quite the scene (unless you are spooked by sirens) on Conway Street. Many of our staff were out there to return the salute. We’ll try to post the video on the intranet page (the file was too big to include here). We thank them for their recognition and we should salute them as well as first responders.


Gina prepared this concise chart of operations updates at VMG this morning. I’m passing it on here:








And Elsewhere


Here’s a link to a NYC nurses journal published in the New Yorker  to keep us aware.


And finally….as you are staying at lighten it up…..


Excerpts from an “Isolation Diary”


Day 1 – “I can do this. Got enough food and wine to last a month.”


Day 3 – “Strawberries. Some have 210 seeds. Some have 255 seeds. Who knew?”


Day 4 – “8:00 pm. Removed my day pajamas and put on my night pajamas.”


Day 6 – “Today I get to take the garbage out. I’m so excited. I can’t decide what to wear.”


Day 8 – “Went to a new restaurant called “The Kitchen.” You have to gather all the ingredients and make your own meal. I have NO clue how this place stays in business.”


Day 10 – “Struck up a conversation with a spider. Seems nice. He’s a Web Designer.”


Day 12 – “I realize why dogs get so excited about something moving outside, going for walks, taking car rides. I think I just barked at a squirrel.”


Day 13 – “If you keep a glass of wine in each hand, you can’t accidentally touch your face.”


Day 14 – “Watched the birds fight over a worm. The Cardinals lead the Blue Jays, 3 to 1.”


Day 15 – “Anybody else feel like they’ve cooked dinner about 395 times this month?”




Thanks once more for all you do.


And remember: wash your hands (a lot), don’t touch your face, maintain social distancing (it works), wear a mask, stay home if you’re sick.


Be well,



Be patient; be mindful


Monday, April 27, 2020                                                                                                  Issue # 30



I hear the phrase “new normal” all the time now. I heard this plane overhead near my house. We’re in the woods. Most airplane noise is distant but this was doing loops, engine stalls (sounded that way) and noisy. So what bothered me? Not the noise. It was the normalcy of it. This plane comes every spring day (and summer and fall), kind of like the bears. And the contrast between life going on and life mothballed was striking.


This is where we are. The normal things like birds, flowers coming up, trees budding and the “new normal” things like no traffic, no school, and (almost) no in-person patient visits. Not too hard to social distance when there are only 10 people on a floor of a building meant for 50-100.


Summer will be here soon.


And then there’s the tortuous political scene. Quite the contrast between the heroic and courageous “front-line” workers and the inept politicians, scammers and conspiracy theorists.


National and State Scene


Some states are reopening. We’ll see what the results of those experiments are. Massachusetts, as a state, is not reopening at least through May. We’re still near the peak of infections. Hospitalizations seem to be improving but we’ll know more next week.


Some communities are getting tougher. Somerville will be fining people $300 for being in a public space, indoor or outdoor, without a mask. On the other hand, they are also offering “on-demand” testing for anyone. Just walk in.


Testing, in general, while improving slowly, is nowhere near the scale it needs to be. Dr. Fauci is talking about at least doubling the current availability and rate across the country. Massachusetts is testing more than most other states and so our rates of infection may be higher because we know about and can see more. It’s probably higher still.




In Franklin and Hampshire counties, our hospitals are still reporting availability in ICU and other beds.


Drive in/up testing for virus is available now in both our counties through the hospital systems, still on referral and by appointment.




From Gina: “The VMG Lab Team has done an outstanding job of redesigning the work to be able to perform mobile lab draws, outside the health centers to meet the needs of our patients for urgent lab work.  The team continues to revise their procedures to ensure safety for all.”


Mobile lab draws are for urgent and semi-urgent labs determined to be needed by a practitioner and disease management labs for our diabetic patients.  All labs must be scheduled, no walk in appointments are available.  The phlebotomy team is also able to go to radiology or the respiratory unit as needed to draw a patient with urgent lab needs to minimize traffic in the center. We’ll be scaling this capacity up in the next few weeks and months as we learn what works and what does not work as well.


I continue to hear reports of incredible teamwork and devotion to patients. Reception was challenged today in Northampton due to staffing. Early this morning, colleagues from around the company got together, pitched in and arranged for coverage just in time. Thanks to everyone for coming together.


In Amherst late last week, the clinical team in the center that late afternoon worked together for a newly diagnosed diabetic patient who needed urgent treatment and training in managing his disease. In addition to bringing him in with the now “new normal” cautions, starting an IV, treating his ketoacidosis, providing medication and support, he also was taught the basics of caring for himself with his new illness. Staff stayed late (around 6, I think) to make sure he could go home safely. Because of everyone’s efforts, he was able to avoid an unpleasant ER visit. Thanks to everyone for coming together.




I saw an article on line in The Boston Globe over the weekend by Hannah Krueger. She was writing about, Liz Adams, from Alabama who drove north in this pandemic to take a position at MGH as a travel nurse. This is most of the article.


“My dad passed away suddenly last year. I watched the amazing care he got, and I’ve felt so empty since. I saw what was happening, and I realized I could be the person to treat a patient like they treated my father, especially because family cannot be with patients right now,” she said.


“I get chill bumps even saying it. As someone whose father was in their shoes, that’s everything to me," said Adams. "We’re not doing it to put on a show — there is no one there to even impress — we are doing it because it is the right thing to do.”


To date, with just 5,654 positive tests, the entire state of Alabama has registered fewer coronavirus cases than Suffolk County alone. Just 197 have died statewide. Adams admits that for many in Alabama, the reports out of New York and Boston differ greatly from their own experience, meaning “you can’t help but wonder if this is all being exaggerated.”


But now she sees daily consequences of a contagion allowed to spread and how quickly and mercilessly the virus can ravage patients. The ICU unit is full of worst-case scenarios and patients teetering on the brink. Those fortunate enough to recover even slightly are moved to step-down units and replaced by more dire cases. Adams’s Facebook posts double as a form of catharsis and a way to give her friends and family a voice they can trust. “I’ve seen sick. . . . This is different. It hurts me when people say this is just like pneumonia or it’s not that bad. Because no it is not. No the hell it is not,” she said, her voice shaky.


Travel nursing assignments typically last 13 weeks, but the length of COVID positions is contingent on the trajectory of the outbreak. Analysts at Mass. General believe that the crush of very sick patients at its doors is unlikely to get worse, but data still show 100 to 150 state residents dying daily from the virus. Adams, who added two weeks to her contract Monday, plans to return to Huntsville mid-May.”


More heroes in the world, speaking up, pitching in, coming together.



Thanks again for all you are doing for our patients, our communities, and each other.


And hey, wash your hands (a lot), don’t touch your face, maintain social distancing (it’s working), wear a mask.



Be patient; be mindful


Friday, April 24, 2020                                                                     Issue # 29



I’ll bet everybody’s glad it’s Friday. I am too.


Unfortunately, a somber note to start: fifty thousand dead in the country; 195,000 worldwide. So let’s take a minute to remember. We feel for all who have died, lost loved ones, or been wounded, physically or psychologically, by this pandemic. We go on though, because that’s what we do. We try to learn and we keep to our mission to help and heal. 


National and State Scene


At the national level, the most credible spokesperson, Dr. Fauci, is convinced that we will be dealing with COVID-19 come fall. The difference in the fall, and this is a hope as well as a plan, is that we will be better prepared: more tests (for antibodies as well as for the virus), more beds, perhaps an approach to contact tracing, and, in general, an improved public health approach at the national, state, and local levels.


Massachusetts cases are still growing, though our area remains in a plateau. Keep social distancing. It works and it’s all we have now.




You should see some photos in the local papers of lab staff working in their mobile station with some appreciative patients (Debbie sent them earlier). Good job all. I know we’re planning on scaling this up over the next weeks and months.


We’re also thinking about how we’ll be administering flu shots by the end of the summer or early fall as that will be even more important this year.


And a letter will be going out to parents of VMG patients about our plans to catch up with immunizations and pediatric wellness.




OK, it is the weekend now. Thanks for doing a “good job.” In case you didn’t see it last night, to take you into your weekend, here is some timely great music and video that captures our mood and our inspiration:



Be patient; be mindful


Thursday, April 23, 2020                                                                                                                   Issue # 28



It’s almost the weekend. Breathe. I hope you are well.


Why is the picture below scary?




This is the scene yesterday outside a beachside restaurant in Jacksonville, Florida. I see 3 masks in the crowd. And the crowd is pretty much shoulder to shoulder, within a few inches of each other. It looks like normal times at the beach town. But…these are not normal times.


Here’s my concern. Actually, two concerns. First, these folks are betting their health and the health of their families, friends, and co-workers on the theory that the virus is not going to get them. It’s a bad bet.


Second, people seeing this might start thinking “if they can do it, I can do it, and wouldn’t this be a great time to go to the beach in Jacksonville? OK, but when they come home, they may be bringing back more than just some sand in their shoes and sea shells in their luggage.


Let’s tell ourselves, our families, and our friends: stay home, stay safe, and protect our loved ones. Don’t travel (yet) unless absolutely necessary.


National and State Scene


The news on the national scene is about the above: maybe too much reopening on too little data. With no reliable, wide-spread testing, we don’t know the extent of the virus spread and where the next hot spot might be. We do know that the virus did not go away. And we know the history. Places that opened too quickly in the 1918 flu pandemic saw a rise in cases and deaths. History has a way of, well, predicting the present (in this case). A recent early study of NYC residents showed about 21% in the sample had antibodies for the virus (which means they were already infected).


ER visits are down in the state and across the country. It’s probably not that the “worried well” (whatever that means these days) are staying away. The concern is that people with conditions that might have brought them in for acute care in the past are staying away for fear of COVID-19. Potential heart attacks, strokes, and even acute psychiatric patients may be choosing to stay home, wait it out, and see what happens. Some are saying there are now two epidemics: the COVID-19 epidemic and an epidemic of COVID anxiety.


This just came in from the Boston Globe. ”Governor Charlie Baker on Thursday said the latest statewide death figures from the coronavirus are “staggering,” but he also urged residents to continue to visit hospitals for necessary treatment for other serious ailments and sought to assure the public that the health care system isn’t being overrun.”

“And in a Globe town hall on Thursday afternoon, Boston Mayor Martin J. Walsh cautioned against ending social distancing too soon, adding, "We’re probably in for another four, five, six weeks of what we’re going through today."


Regional Scene


Locally, our hospital systems are working on getting the message out that they are open and safe to care for non-COVID emergencies.


Our two counties remain at the low end of cases and deaths in the state. Our hospital systems are reporting they still have capacity for COVID and non-COVID cases. There are some models predicting that the peak of COVID cases will be next week in Massachusetts. We’ll see if anything changes locally. Social distancing and other cautions should continue.




Just to confirm how our clinical practice is now “inside out” (in a good way given the pandemic), here are the visit numbers for last week in primary care:



We still have room in our schedules and many of you are working on filling those slots with patients who need them. One EHC patient brought in a drawing of a heart with the words “thanks for being there for me.”


And speaking of turning the practice inside-out, a Gazette photographer visited NHC this morning (for a series documenting the effect of COVID-19) to photograph a few of our mobile lab draws in patient cars. (She got staff and patient permissions). The patient in one of the cars was highly complementary of our staff for their kindness and for finding this way to safely carry out this essential function.


Our nurses have also been giving specialty injections in the parking lots for endocrine patients in need of these treatments and there are plans to expand the types of injections and treatments in the mobile office (cars).


And then we’re repurposing some of our outdoor space to make it more convenient and safe for lab draws and treatments. In Greenfield, lab staff and maintenance staff have worked together to create new work processes to make this work outside our building (on the back porch, actually) for patients and lab staff. That site will begin operating on Monday.


Thanks to all the phlebotomy, clinical and nursing, maintenance, and reception staff involved.




Finally for today, if you are an Alicia Keyes fan, she’s premiering a new song on the CNN Pandemic Global Town Hall tonight at 8 PM on CNN.


Be well. Oh and hey, wash your hands (a lot), don’t’ touch your face, maintain social distancing (it’s working), wear a mask, don’t travel.



Be patient; be mindful


Wednesday, April 22, 2020                                                                                             Issue # 27



Welcome to Earth Day, number 50. I wish we could say things are better today than they were when Earth Day was first celebrated but this is forecast to be the warmest year on record. Some are hoping that the COVID-19 shutdown that has caused improvements in air quality might spur us on to make more permanent changes.


National and State Scene


As of today, more states are pushing to “reopen.” Some still are seeing rising cases. Here’s what happened in 1918 during the Great Influenza pandemic. In Denver, the mayor gave in to the pressures of “businessmen” and opened the city back up on Armistice Day (celebrating the end of WWI), presumably to allow citizens to celebrate. Denver had observed effective social distancing until then. They were not “celebrating” in the weeks and months that followed. Many deaths followed. That was 1918.


Today we see states like Georgia and cities like Las Vegas ignoring guidelines and history and moving to reopening (without adequate testing, contact tracing, treatment, or a vaccine). In fact, the mayor of Las Vegas said that they should open the casinos (? next week), let people come and smoke and gamble, and “see what happens.” I don’t think they teach this stuff in Public Health school (or any school) and I know that this bet is not a good one (even for Las Vegas).


As you know, our Governor has extended the state of emergency through the end of the school year. That probably means no “reopening” unless the situation changes. The city of Worcester has been identified as an emerging hot spot.


Regional Scene


Our local hospitals still have capacity and are not seeing a surge in cases (this does not mean we are in the clear; just that we don’t see a surge coming for now). Social distancing, reduced travel, community cooperation, wearing face masks in high density areas, and keeping folks out of the ER who don’t need to be there are probably helping. The local hospital systems continue to discuss bringing back some elective surgeries and other services in the next several weeks to care for patients who have been put off by preparation for COVID-19 patients.


Here’s a chart taken from a daily briefing at Baystate Franklin showing the “plateauing” of cases (I assume a chart from Cooley would look pretty similar).

Face masks are available in the community for those who need them

More information on face masks and coverings is available on our internet page and intranet page.




In keeping with the continued state of emergency, we are continuing our Work from Home efforts at least through the month of May. If you have questions, please contact your supervisor.  We may need to bring some people back as we gradually bring some services back.


Here are our latest guidelines and requirements for the wearing of facemasks in the health centers (from Gina’s email, earlier today):



  •  All patients who are going to be seen in the health center, receive care in the parking lot, receive care outside the center on the property, for all services, are to be informed at the point of scheduling they must wear and arrive for their appointment with their personal facemask/face covering.

  •  All patients must have a facemask/face covering when they present to the health center main entrance, care in the parking lot, receive care outside on the property, for all care and services.  A patient may not access the center or receive care if they do not have facemask/face covering.

  • When a patient presents to the respiratory entrance at GHC, AMC, NHC they should be wearing their personal facemask/covering, and will be provided a surgical mask to enter the respiratory unit.

  • When VMG is able to begin pediatric visits for children 0-2 years the parent/caregiver will be requested and required to wear a mask.


Staff and practitioners

  • All staff and practitioners are to wear their personal facemask/face covering upon entering the health center.

  • Following screening at the designated entrance, temperature being taken, and being cleared to enter the center, staff and practitioners will be provided one surgical face mask to wear for the day.



  • All vendors who need to enter the center, must wear their personal facemask/face covering to enter.


These guidelines will be adjusted as necessary.


We have now completed our “Virtual Brown Bags” for this month. Thanks to all of you who participates. We’ll get you information on how to listen to the recordings, if you wish, in the next few days.


Reminders about Coping


Tim Sweeney reported that there is a renewed interest in “Quitters Win” smoking cessation support. That’s good because we know that smokers are at increased risk given the nature of this disease in particular. The same can be said about overeating (or eating for “comfort”). Our dieticians can help with that too. Keep working those referrals.


There are several mindfulness apps that are “surging” in the app stores (and on Wall Street) now. Calm, Headspace, and an app called Ten Percent Happier. They are all similar and, depending on personal preference, all good for helping guide patients in mindfulness, meditation, relaxation.


So, Be patient; be mindful.


Thanks again for your continued dedication and work for our patients, communities, and each other.




Oh and hey, wash your hands (a lot), don’t’ touch your face, maintain social distancing (it’s working), wear a mask.


Tuesday, April 21, 2020                                                                                        Issue # 26



Good afternoon. I hope you are all well.


National and State Scene


We’re about to get a live experiment in what happens when social distancing stops without vaccine or treatment for a new virus. Georgia is about to reopen lots of businesses (even though their infection rates are still rising). This follows smaller re-openings of specific locales in places like Florida and Texas (or perhaps its failure to close in the first place).


In Massachusetts, Governor Baker today ordered the continued closing of schools through the end of the school year and day care centers through June 29 (the only exception being for daycare for children of healthcare workers and first responders). The Governor is responding to high rates of infection continuing, especially in the eastern part of the state.


Regional Scene


In our counties, ER and Hospital admissions and ICU beds remain stable. There are discussion going on about bringing back some services, and messages going to patients about seeking or returning to care, especially for the patients with conditions other than COVID-19 who may still be suffering or need follow-up of chronic conditions.


At VMG, we have workgroups going through lists of patients who need services for chronic conditions such as hypertension, diabetes, etc. and there are planning groups working to bring those services back in a safe and efficient way over time. Several people have asked about pediatric and other immunizations as an example of a service that we need to get back to and there are staff working on planning for this now.


We are working on continuing to accumulate PPE (our supplies are good right now) so that when we do bring patients back into the building for treatment, we can give them a mask to use if they do not have a proper mask of their own. (But for right now, please do not give out VMG PPE to patients).


For the few patients whom we are seeing in the centers, we’ve “discovered” a problem of having family members or partners or rides bringing patients in and then staying in our reception areas (aka “waiting rooms”). We want to avoid having unnecessary contacts for folks in the reception areas so we are asking to have patients told to have those providing rides to wait in their cars for the visit to be over. We can then call or motion for them to come and meet the patient. Where that does not seem possible (e.g. the patient and a companion are dropped off by the bus), please discuss with your Nursing Team Leader, Health Center Manager, or Reception Supervisor.


Our Patients Continue to Send Appreciation


We continue to get thank you notes from patients for the care and consideration they are receiving from staff and practitioners. One recent note thanked the medical assistant who spent a lot of time “walking the patient through” getting their computer set up so that the patient could do a virtual visit. Other notes of appreciation are less specific and say things like “you guys are simply awesome,” “are the gold standard,” for communication and helpfulness.  Thank you all for that.



That’s it for today.


And, hey, you know what to do: wash your hands (a lot), don’t’ touch your face, observe social distancing (it’s working) (even as others may be rejecting it), wear a mask or face covering and stay home if you’re sick.




Be patient; be mindful


Here’s a positive outcome of this pandemic….from our very own Dr. Scott Meyers:


Monday, April 20, 2020                                                                                     Issue # 25



Well this was going to be the beginning of a vacation week, the Boston Marathon, the celebration of Patriots’ Day. Not this year.


National and State Scene


You’ve seen the protests to stay at home orders and the calls of demonstrators to “reopen.” Much of that was happening in places that did not see much incidence of COVID. That’s a problem for them as they will soon see cases emerge. However, we’re now seeing those protests in some states where COVID-19 is more endemic. And that’s a problem for all of us as it can lead to a resurgence of cases where the virus has already “died down” as people travel. Most of us believe that social distancing should not stop yet and will need to continue for many months until there is better testing and contact tracing, treatment, and, ultimately, a vaccine.


Boston has been identified as a “hot spot” along with D.C., Baltimore and Philadelphia. Many of us know people in the Boston area. We should support and encourage them in social distancing.


For those who do not have health insurance during this time (because of job loss or for other reasons), the Massachusetts Health Connector is running a special enrollment period through May 25. Please spread the word if you know anyone to whom this might apply.


Regional Scene


Not too much new here and that’s relatively good news. ER’s are steady and handling the load (Baystate estimates that 22% of ER admits are COVID-19 positive here and across the state). ICU’s have capacity and the local systems are reporting what looks like a plateau in admissions. That’s good but it’s too early to tell so let’s not let down.


There is some expanded testing available in the hospital systems and we are taking advantage of their capability for now. Most of that testing is still for high risk groups, symptomatic patients, and health care and first responders. There is currently no testing for antibodies available.


What about non-COVID Patients?


Most Groups and hospital systems are thinking about and planning for bringing up some services that were stopped because of the pandemic. The services will have to allow for seeing COVID patients as well as these other patients because the virus is not going away. But also not going away are heart attacks, strokes, high blood pressure, diabetes, smoking, etc. With all the emphasis on social distancing (necessary), PPE, etc. will some patients “not want to bother us” or feel uncomfortable seeking care? Will their conditions worsen?


Dave Kaufman told me to read an editorial in the April 20 edition of New England Journal of Medicine by Lisa Rosenbaum, M.D. (I can send you a copy of you wish). It’s called The Untold Toll – The Pandemic’s Effects on Patients without COVID-19 and it outlines concerns of actual patients without COVID, and their caregivers and providers, struggling with decisions about care, sometimes critical.


Returning to the “normal world” of giving care is going to be long and difficult as we confront unprecedented challenges and decisions about how to bring back what worked to keep patients healthy or improve their conditions in the world with COVID. I know we are all “on this” and we’ll work hard together to find solutions.


Longer Term Untold Tolls


We know from learning about trauma that it’s not always visible right away but nevertheless there. Patients experience trauma in different ways and at different times. And with so much disruption, stress, pain, and loss, we know that psychological disorders and adjustments to life with and post-COVID will be difficult for many. We’ll see more signs of anxiety, depression, grief, and somatic symptoms as time goes on. We’ll have to remain alert for opportunities to be with these patients even while social distancing and when social distancing can be relaxed.


One thing we’re hearing from patients is that even though we’re not seeing them in person a lot, they really appreciate being listened to, heard, reassured when possible, and struggling together with us with the truth of their situation when reassurance is not possible. We’ll do some more work and training on this going forward.


And Now, This…


We’re going to keep social distancing because it’s what we can do and it’s the right thing to do now. Here’s a video from today’s Boston Globe on how staying home is staying strong. (You may have to click on the photo that you’ll see to start it).


Here’s a link, suggested by Scott Ackley, Amy Rice, and Diane Alpern, to help patients stay safe and strong by finding face coverings:




Thanks again for all you do for patients, community, and each other. Be well.


And you know what to do: wash your hands (a lot), don’t’ touch your face, observe social distancing (it’s working) (even as others may be rejecting it), wear a mask or face covering and stay home if you’re sick.




Be patient; be mindful

Friday, April 17, 2020                                                                                   Issue # 24



Good to be at Friday, right?


The National and State Scene


It’s now clear that state Governors will decide about when, how, and at what pace to lift stay at home directives and closings of institutions and businesses. There will be variation, but it seems that Governor Baker will try to align with the governors of RI, CT, NY and NJ in which case, though not yet announced, we’re talking middle of May at the earliest. I doubt that schools will reopen until the fall at the earliest and maybe later.


Social distancing efforts will continue/should continue throughout this year and probably into next year unless a vaccine is developed very soon and that probability is very low. And whenever a vaccine is developed, it will take many months to immunize all who need it (just about everyone for whom it’s safe).


In our areas it seems that social distancing has been adopted and observed reasonably well. That may be one of the reasons that our hospital and ICU admissions have stabilized relatively quickly and that our hospital capacity is so far doing well to the point that at least one of the hospital systems is now considering that we may not see a surge in cases here.


So if social distancing is one of the few tools we have (at this time) for slowing the spread of the virus, why are we hearing about areas in the country where people are openly violating stay at home directives and going back to large gatherings and social events? Aside from every action has an equal and opposite reaction (someone famous passed that law once), there has been such a mixed message at the federal (and some state) governments and not enough solidarity in Congress to set a clear and consistent course and stick with the message that social distancing works.


My daughter-in-law, who is from Texas (outside of San Antonio) tells me that even her friends and family back home, who should know better, are partying, BBQing, etc. and some still believe the virus is a hoax. It’s hard to believe that we can’t have agreement about this being real at this stage of the pandemic. So we have to be clear with each other, talk with any of our friends and relatives who may not be taking this seriously, stand up to and for them, and stay the social distancing course (this is, after all, an act of love).





We are working on prioritizing the clinical operations that we need to start up again sooner rather than later. Plans are in the works and you’ll be hearing about them soon. It will take continued creativity and perseverance (but you’re already getting really good at that) in how to deliver those services and we’ll be hearing more about some of this next week.


A final note about enabling this next phase of our work. You saw Gina’s note this morning about making sure we reserve the VMG supply of PPE (masks, gowns, gloves, shields, etc.) for VMG use. “These supplies are for VMG use only, and those patients we need to mask due to their clinical condition upon arrival to the health centers.  PPE is not to be taken home or provided for patients to use at home.”


Please observe this restriction. Our supplies remain adequate for our current needs and it is important for each of us to safeguard this resource as we go forward and expand in-person services in the weeks and months to come. Until there is a vaccine we have to remember that the virus isn’t going away and our PPE can’t go away either. Thanks for your help with this.




OK. It’s the weekend. Have a virtual rock concert if you wish, below, for your enjoyment (and you have to play through it to see Prince; go ahead, drop that mic or guitar).



Be well, and hey, hey, wash your hands (a lot), don’t’ touch your face, maintain social distancing (it works), wear a mask connect with friends and family. Have a weekend.




Be patient; be mindful


Thursday, April 16, 2020                                                                    Issue # 23




So much has changed, it seems, in such a short time. Yes, we are still here “seeing patients,” we’re still going (or staying home) after work, we’re still walking in the woods or in our neighborhoods, and maybe you can imagine our worlds coming back again to something like what we had before. I saw some neighbors planting a garden yesterday with their one year old while out for my walk after work. It just seemed “so normal.” And then there’s the news, the press briefings, the drone of news about COVID and Coronavirus. It seems so not normal. It’s overwhelming sometimes and surreal. But we go on. We get better. We imagine our way back and maybe even improved, better, more together.


What are we learning? About the things that drive us apart. About the things that bring us together? I think we all want to know how to improve. We’re learning about staying in touch with patients by reaching out, by video visits, phone contacts. We’re seeing patients in Behavioral Health by video and guess what? Almost no no-shows. Our Advanced Care Planning Committee (the Committee that plans and teaches us how to have conversations with patients about their wishes at the end of life, among other things) is continuing their important work, maybe even more important and immediately meaningful now. Our telehealth visit rate continues to increase, as it should, but we didn’t know we could do this just 6 weeks ago. We’re standardizing plans for “parking lot care” including safely administering injections and drawing blood. We’ll be working on giving recommended immunizations again to children.


What other things can we learn in good time? What other things can we imagine and “bring to life” now that we have the need? Keep your eye on what you’ve learned. What can you do now that you didn’t know you could do?


Steve talked about us being in a kind of “maintenance phase” right now in our work during the pandemic. Rates of ER visits, admissions, seem to be flattening out (for now). Hospital ICUs are stable and continue to have capacity. We’re not ready yet to go back to “normal business” but it’s a good time to plan for “reopening” and what that might look like and we are working on that. We’ll be sharing more in the coming days and weeks. And we have to remain prepared for the possibility of this phase continuing; rates may slow but there will still be a lot of need and pain to cope with and adapt to. And if things calm down, return to a new kind of normal in the next few months, there may be a return in flares of the virus that might bring us back to what we look like now. We’ll need to remember how we are working and learn to improve.


Here’s note from one of our Social Workers at VMG working through our Medicaid ACO:


As an iCMP social worker I am contacting VMG patients daily to make sure they have the resources and supports they need. My team members are getting a lot of feedback from our patients - how they are so grateful that they are able to have medical appointments via phone or through virtual visits.


As you know, all of iCMP Pts have Medicaid insurance and the majority are low income. Many patients we work with will share their experiences of trying to access good health care. They often feel marginalized and judged when they don't follow through with recommendations by providers. Often this is due to economic issues of not being able to afford healthier food to make better food choices. Many of our patients struggle with mental health needs. They will often report "not wanting to bother" their provider or not wanting to go to a health center and wait around to be seen or be around other people.


Now that providers have had to restructure appointments, including changing to virtual and telephonic appointments, many of our patients are reporting being "surprised" that their providers are providing this additional service to them. It is often described as a "personal touch." 


I just wanted to share this with you as I think it is important our providers know that what they are doing is making a difference. I started an email chain with my team to say, we aren't together, but let's remember to say hi every day and encourage each other.


She also pointed me to this:



Be well, and hey ….., wash your hands (a lot), don’t touch your face, maintain social distancing, wear a mask.




Be patient; be mindful



Wednesday, April 15, 2020                                                                                                   Issue # 22




Let’s start with some patient feedback. One of our Greenfield staff passed along this comment of appreciation yesterday:


“Just wanted to share more thanks for us all from a patient today. She called specifically just to let us know how much she appreciated Dr. Reeves going above and beyond during a recent VV with her. She really appreciated his help. She wanted to thank all of us for the work we're doing here and wanted me to let everyone know.”  


"You guys rock!" (I’m not sure if this was from the staff member or the patient, but either way, you guys rock!).


Local Scene


Both hospital systems in our area are reporting they still have capacity, including ICU beds. Admissions seem stable for now. There are plans for surge capacity, if necessary.


Cooley now has testing up for patients on referral from PCPs and other staff. There are criteria for which patients will be tested but they appear to not be very stringent.


There is also testing available at The Big E (but I’m not sure about who is running the site and about criteria).




The Governor of New York is saying that state may be past the peak infection/admission rate now. However, the ICU’s are still full and people are still dying. New Jersey, however, is still reporting increasing infections and admissions. Massachusetts is still seeing increasing admissions and infection rates though the Governor reports that the curve may be flattening.


“Reopening” the Country


Several governors are talking about plans to reduce restrictions and stay-at-home orders in phases. They are weighing the possible benefits against the costs of increasing infection rates again and subsequent additional spikes in the disease. When that occurs, and in the absence of a vaccine, we’d have to start over again with more restriction.


There are still areas of the country where infections were reportedly low but it is probably more the case that there is not enough testing to confirm and that they have not begun to see the effects from the spread of the virus to their locales.


We believe that it’s going to be at least several months before we’ll see enough reductions to feel comfortable and safe in reopening our businesses to “look like normal,” whatever that definition becomes.


The best case scenario is that we have an effective (proven) vaccine available for the whole population and proven, effective, and safe medications to treat those who do become sick. That is at least months away if not a year or two.


In the meantime, we are beginning to discuss plans for a phased reopening at VMG, depending on local trends, the Governor’s lifting of restrictions, etc. These are just beginning discussions to prepare. We’re still at least weeks away.


A Few Words about “Herd Immunity”


The definition of herd immunity is “the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination. The level of vaccination needed to achieve herd immunity varies by disease but ranges from 83 to 94 percent."


You are probably beginning to hear about “herd immunity” on the news and in the media. Some sources are suggesting that promoting herd immunity (presumably by letting people get infected) is a “preventive” health measure in that people who survive will be immune. That is not a preventive health measure (what about those that do not survive?). Rather it’s an outcome of not having an effective vaccine and good treatments to prevent the worst outcomes (death and disability) as well as an indifferent attitude to preventing infection (by, you guessed it, hand-washing, social distancing, etc.).


So, let’s keep focused on slowing the spread of the virus by the measures you know very well by now.



Thanks again for all you do. Be Patient; Be Mindful



Tuesday, April 14, 2020                                                                            Issue # 21




Happy Tuesday. I hope you and your families are well.


Testing News


Baystate Health is doing limited testing in our area. Baystate will be providing testing to patients referred by a practitioner, by appointment only, in Greenfield and Springfield meeting the following criteria only:


  •          symptomatic patients, age 65 and older

  •          symptomatic patients between the ages of 17-65 who have significant chronic conditions


Turnaround time will be between 24 and 48 hours. New sites are being planned for testing in Ware and Westfield by next week.


Some Words About Testing


The testing being done is called RNA testing. It’s done vis nasopharyngeal swabs and it determines if the patient, at the time of the test, has the coronavirus. While this is a good thing, it does not mean that the patient does not have the virus; just that at the time of the test, the virus was not detected. Some patients might need more than one test, over time, to be more certain of the result.


The other type of test is what’s being called antibody testing. It’s a blood test that looks for antibodies created by a patient’s immune system. If antibodies are detected, the test is suggesting that the patient already had the virus. It is currently assumed that having antibodies detected implies that the patient may have immunity to future infections by this version of the virus. These tests are not yet available, though they are being developed and validated.


Ultimately, we want to have both types of tests available to patients, and eventually, to broader populations. The idea is that we want to know if a patient has the infection and is infectious and we also want to know if the patient may be immune. Testing, when broadly available, will help in determining future hot spots (places of high infection probability) as well as when it is safer to resume ordinary activities. Without testing, we as a society will be making “best guesses” about these changes to our lifestyles, hopefully as suggested by epidemiologists and other scientists. Of course, what we also need is a vaccine to prevent infections as well as good therapeutics (medications) to treat infections once they occur. Work is proceeding on both. It will take more time.


In the meantime, and you know what’s coming: wash your hands (a lot), don’t touch your face, stay away from people (social distancing), don’t come to work or go out when sick, wear a mask.




Since we want everyone to wear a mask when out and about and we want to conserve our medical single use masks, we’re working to put together people who are making cloth masks (washable) for use when going shopping or out in general with people who need them. Gina sent an email about this earlier this afternoon.


Here is some information on helping to keep people, including ourselves, well from our Physical Therapists.




The Value of Exercise in Dealing with COVID- 19

Exercise advice from the Valley Medical Group’s Physical and Occupational Therapy Team



At a time when we need to protect ourselves by staying at home and practicing social distancing, how can we use physical activity to enhance and maintain our health?


… make up your own  routine to music you enjoy that uses major muscle groups and raises your heart rate……CDC Guidelines



What is physical Activity? 


According to the World Health Organization “Physical activity includes all forms of active recreation, sports participation, cycling and walking as well as activities you do at work and around the home and garden.  It doesn’t have to be exercises or sport – play. Dance, gardening, and even house cleaning and carrying heavy shopping are all part of being physically active.”



Set the timer on your phone or kitchen timer every 45 minutes to remind you to walk 2-3 minutes -Diane Gray, PT



It is important for people of all ages and abilities to move and be active.  Walking, stretching, getting up from sitting and taking short walks, adding a few squats every time you stand up from a chair, all contribute to your well-being.


The Benefits from Physical Activity



“Take care of your body, Take deep breaths, stretch, or meditate.  Try to eat healthy, exercise regularly, get plenty of sleep…”, Advice on delaying with stress from the pandemic.



According to the American Family Physician, regular exercise maintains strength, decreases the risk of depression, and cognitive decline, and helps to maintain a healthy body weight.  From the WHO,  “Regular physical activity benefits both the body and the mind.”   The list goes on. It can: reduce high blood pressure, reduce the risk of heart disease, stroke, type 2 diabetes and various cancers.  Activity improves bone and muscle strength, increases balance, flexibility and fitness.  For older adults it can help to prevent falls and injuries and in children it enhances healthy growth and development.


How much Physical Activity is Recommended?



…. Do some muscle strengthening activities such as lifting weights or improvise using full bottles of water or simply use your own body weight.., make it fun, such as dancing to music….  WHO Guidelines



The American Heart Association recommends 150 minutes of moderate activity or 30 minutes of activity 5 times a week.  If you are not used to doing this level of exercise you should contact your health provider to see if this is appropriate for you.  Moderate activity is defined as walking cycling, gardening and housework.   It might be an exercise class on TV.  It might be light weight lifting with water bottles.



How do I get started?


Spring is here, get outside and garden, even small tasks can be a good activity…, Michelle Kofler, PT



 From the WHO:


“Try and reduce long periods of time spent sitting, whether for work, studying, watching TV, reading or using social media,...take short 3-5 minute breaks, simply stand up and stretch or even better , take a walk.”


“Set up a regular routine to be active every day, by planning a physical activity or exercise break by yourself, by joining an on line class,... making a specific time to be active helps ensure you get your daily physical activity.”


“Be active with your family and friends, connecting with others can help you and your family:  in the home and elsewhere spend time together and be active” (Be careful to maintain social distancing and wear face masks when out in public)


“Set yourself goals”, by choosing specific activities, done at specific times, you will increase your chances of success.  Some folks find keeping exercise logs or lists of when and of what activities they complete helpful.


The bottom line is find something you enjoy, something you find peace and satisfaction completing, either by yourself or around others you care for.  In that way you can enhance and maintain your health.



If you have specific exercise needs please contact your Valley Medical Group Primary Care Provider.  The Valley Medical Group Physical and Occupational (Hand) Therapy Team remains available by referral during this time thru telehealth platforms by  phone, Face Time, Zoom and Doxy.





That’s it for today. Be Well.



Be patient; Be mindful


Monday, April 13, 2020                                                                                                  Issue # 20




I hope you all had a 3R weekend (Rest, Recharge and Rejuvenate). 


The National Scene


New “hot spots” are popping up around the country. We’re all aware of the effects of the pandemic on the NYC and the New Jersey areas. Boston, Philadelphia, Miami, New Orleans, Chicago, Detroit and cities in Texas are still not at their peaks yet. The West Coast may have reached their peak infection rates for now. But that’s not certain. The most likely scenario is a continuing rolling set of outbreaks and peaks across the country for several months.


There are reports in the news of multiple vaccine formulations and therapeutics being sent to clinical trials. There is still not reliable treatment or vaccine at this time. Without a vaccine and without therapeutics (medicines that have proven effectiveness and safety), the only tools we have remain techniques and processes to slow the virus and reduce spread. And these remain social distancing, hand washing, avoiding touching the face and wearing masks.


The Local Scene


Massachusetts confirmed and suspected cases continue to rise each day. Deaths also continue to rise. There is some hope that the curve in Massachusetts is beginning to flatten. The significance of this is that it will allow our hospitals and healthcare systems to maintain or improve supply and capacity for sick patients. It does not mean that people are not getting sick with COVID-19.


Our local hospitals are reporting that they still have capacity of some vital resources: hospital beds, ICI beds and ventilators.


Remember that our efforts are focused on keeping people out of the hospital and ER’s to help them maintain their capacity.




We are continuing to work on switching in-person visits to virtual visits. Here’s a graphic showing the recent trend.




You can see the beginning of recovering some of our business in the form of virtual visits (the blue line) though we are not at all close to where we were last year (the red line).


Ross Midler who retired but is doing some per diem work for us was at AMC last week. Here’s what he observed:  


“I was in AMC today for the first time since COVID 19 started. I was impressed how all the staff, and I mean everyone, has assumed "battle stations" and appeared very up for the battle. I always knew we had good people. This just demonstrates it.”



Finally, here’s a hopeful quote from a recent article in The New Yorker magazine (hopeful in the sense that we will eventually get there if we continue our social distancing and other measures):


“These next weeks and months will be demanding in ways that are hard to fathom. If New Yorkers are in hiding, the virus has shown a knack for seeking. But, with time, life will return to the city. Our city and your city. The doors will open and we will leave our homes. We will meet again. We will greet our friends, face to face, at long-delayed Easter services and Passover Seders. Children will attend class with their teachers. Sidewalks and stores and theatres will fill. Remnants of the crisis—a box of nitrile gloves, a bag of makeshift masks; containers of drying Clorox wipes—will be tucked away, out of sight and out of mind. We’ll forget a lot about our city’s suspended life. But we will remember what, and who, we lost. We’ll remember the cost of time squandered. And we will remember the sound of seven o’clock.”


Thanks again for all you are doing for our patients, our communities, and each other.




Be Patient; Be Mindful


Friday, April, 2020                                                                                                                                                                                           Issue # 19




It’s Friday. We’re all ready for the weekend.


The latest federal projections suggest that lifting the stay at home orders in the next 30 days would likely lead to a new spike in cases during the summer. I think we are going to hold steady with social distancing for some time to come even if we do see a peak in the next few weeks. And we can do that because…….


Gina tells me it’s now been one month since several of us looked at each other and said we’re going to have to go to another model of care delivery. By now, you’re all acquainted with how we are adjusting. One consequence of all this change is that we’re learning some new things which should eventually be helpful going forward.


First, we’re learning that seeing patients by video and even by phone is appropriate and appreciated by most patients in times of crisis and maybe even when the crisis passes. It’s hard to imagine now that patients will want to give this up entirely. Authors like Eric Topol have been writing about this for years but now, because of COVID, it’s actually happening at some scale.


Second, we are all capable of adapting, and adapting quickly, once we see and feel the need to change. The emotional weight of the pandemic (the world wide reports, the news coverage, the patient concern and illnesses, the loss of so many) and our commitment to the mission of health care work together to tip the scales to action. A patient wrote about how we shine in these times and I think that shine is as contagious as the virus. Amidst all the anxiety and hard work, it is invigorating to see we can thrive for the good of our patients, communities, and ourselves.


Third, as I read Meghan’s email yesterday, I thought when you’re in the thick of your work, you may not notice the incredible dedication and togetherness of the team. But this is a time when the team always wins and pulls you through. Please appreciate your contributions and each other.


I heard Andrea Bocelli performing the Ave Maria at his home on the radio this morning. He’ll be performing to an empty Duomo Cathedral in Milan, Italy, Sunday. This is the pandemic in action. The performance will be live streamed on You Tube. I’m sure it will be worth listening, no matter your religion. Solace: comfort or consolation in a time of distress or sadness.


Gina coined a term: R3, for Rest, Recuperate, and Rejuvenate. And here’s a fourth R - Rise up (suggested by Amy Rice).


So I wish you all R3 this weekend.




Oh, and hey: Be Patient; Be Mindful. And wash your hands (a lot), don’t touch your face, maintain social distancing (it is working) and wear a mask.


Thursday, April 9, 2020                                                                      Issue # 18



 One of the things about working in a time of prolonged crisis is that it can be hard to maintain focus and sometimes even harder to get the big picture. And then there can be the fatigue. I recently started thinking about a phrase: Every day like a week, every week like a month. Time can be distorted and the usual touch points we all have that get us through our days can be disrupted: going for your cup of coffee, a movie, shopping, haircuts, going for a walk at lunch time or break time, etc.


I’ve gotten texts, emails, and calls from places that didn’t used to “stay in touch.” Restaurants, dry cleaners, all the supermarkets, even hotels I visited a year ago saying they were sorry they haven’t “seen me.” Of course they know why and they just want to let us all know they expect to be back. It just gives me a sense of how much life has been disrupted. It can be depressing and lead to just getting through (which works for a while until doesn’t).


So, for now, take a deep breath and let it out (really). Download a meditation app like Calm and use it. It does not take much time and it does really help. And restore whatever touch points you can: take your walks, get your cup of coffee or tea. Call someone and check in. I’d say “smoke em if you got em” (a line from The Bottomless Lake, John Prine) but we still, even now, don’t do that. Right, Tim Sweeney?


The point is, we’re going to be in this for the foreseeable future so go back to the things you can do and try some new things to help you through.


Local Updates


We’re in touch with our local hospital systems, as you know, and they still have capacity. They are concerned about a possible surge and are planning accordingly.


There will be a few testing sites coming on line in the next few weeks. They will be reserved for first responders, front line health care workers (e.g., ER and Hospital personnel) and high risk patients. That will be a help. They will require something like an appointment. We’ll keep you updated.


We still think we will have to maintain our COVID status and precautions at least through the middle of summer.


We’re still working to convert almost all of our visits to virtual. Many patients are responding well to them and they are efficient and safe.


VMG Department Update: Diabetes Education and Nutrition


Diabetes Educators Sarah Anderson and Bonnie Grenier are working from home and able to do virtual visits using for both new referrals and established patients. They are also able to do telephone follow up and check in, (using CCM coding if appropriate) with any patients that have received Diabetes Education services.  Bonnie Grenier is able to continue to support our patients on Insulin Pumps via virtual visits.  Other proactive outreach is happening in the form of lists generated of patients with A1c >8.0, and generating referrals to DM education for virtual visits as appropriate.   PCP’s can continue to refer any patients who need Diabetes Education services, and we will find a way to work with these patients using telephone or video visits and follow up. 


Similarly, our nutritionists, Diane Alpern and Margie Sobil, are working from home, doing virtual visits, telephone follow ups and checking in on patients, and working with the A1c>8 (and BMI over 30) lists for their respective health centers. Some things that the nutritionists are noting from more recent patient contact since we went virtual, is that there appears to be a greater need than ever for people to get support around food and nutrition because of the additional stress that the pandemic is placing on them:  d/t food insecurity, people not knowing how to shop amidst shortages or because they have relied previously on takeout and dining out and lack cooking skills. They are finding that many patients’ weight reduction efforts are being sabotaged due to emotional eating, and probably diabetes patients' blood sugars may be increasing due to self-care challenges. 


For these reasons and many more, we encourage providers to emphasize and encourage Diabetes Ed and Nutrition services at this time, and continue to refer patients to the program.


Feedback from Patients


A patient’s wife called to say that she wanted you all to know what a wonderful job she witnessed when her husband came in to have his labs drawn. 

She was very worried at first. “Isn't it dangerous for him to come down?” But once she saw what “those ladies” were doing, “well I just couldn't believe it!”  “They were wonderful! They wiped down the wheelchair before he got in it, then after he got out. I though, WOW, they've really got it together, they've got this down!"


She was very very pleased with how we are "Just handling everything just so well! From you girls in the front desk to lab, nurses. We are there a lot, so we see how well you all work together!  I want them to know what a good job you all do!  And thank you for everything!"

 The receptionist who received this feedback said: **just thought, in these trying times, what a nice thing to bring to our attention.  Even during a pandemic, we SHINE~!!!**



That’s a good way to say good night. Get some rest. Be well and….wash your hands a lot, don’t touch your face, maintain social distancing (it is clearly working), and wear a mask (in VMG) and a face covering outside of VMG.


Be Patient; Be Mindful.





Wednesday, April 8, 2020                                                                                                                                                            Issue # 17




Hello! I hope you had a good evening. This is issue 17. It’s been three weeks of almost unbelievable stress, adaptation, and change.


We continue to be in touch with the local hospital systems to cooperate in planning and to learn about how the pandemic is affecting our communities. Both systems are preparing for a surge, in case that happens. There is the hope that the early and sustained efforts at social distancing might reduce the need to the level of the current capacity of hospital beds, ICU beds, PPE, etc. One of the hospital systems has reported the good news that of all the patients they’ve seen who tested positive for the novel coronavirus, up to 2/3 never needed admission or were discharged and recovering at home.


There are more reports in the media of COVID scams for equipment and “treatments.” There are no known and approved treatments at this time and there is no vaccine now (though there are trials being developed for some drug treatments and vaccines).


VMG Department Information


Here’s some updated information from Dr. Merlin, our Eye Care Team Leader and our Optometrists:

“During the COVID pandemic, eye care services are reduced to urgent care and consultation throughout the country. The same is true at VMG. 

The best way to contact us is through our technicians who are responsible for triaging cases. The technicians have the best ability to contact the ODs should the need arise. Or send us a patient case, urgent as necessary. We have two technicians at home constantly monitoring our inboxes.

At this time most urgent cases are being referred out to local ophthalmology practices for care. However, consults with primary care are always welcome.

So far the COVID virus has shown a very small incidence of a viral conjunctivitis that is indistinguishable from any viral conjunctivitis. It is unknown, but likely, that the virus is transmitted through the tears as well. There appears to be no other ocular manifestations at this time. Please feel free to contact us if you have any questions.

Thanks for all you do. We are proud to be a part of this community.”

Smoking Cessation Services 

While times of crisis sometimes have smokers clinging more tightly to their packs, the respiratory concerns of our patients have some of them ready to get serious about quitting.

Our Tobacco Treatment Specialist (aka Quit Coach) Tim Sweeney continues to serve our patients with a focus on flexibility. At no cost to the patient regardless of insurance, Tim provides: 

  • PRN phone coaching (Monday, Tuesday, & Wednesday, 7:30 am - 3:00 pm)

  • Text message support (2-3 positive messages/wk to 1300+ patients)

  • QuittersWin weekly meetings (on Zoom!). There's a video on the QuittersWin site that shows folks how to install and use Zoom.

Just send a case and Tim will reach out to our patients. He sends all staff his thanks and best wishes.


We learn to cope and survive sometimes just by getting through and we connect to our feelings when we can, sometimes by being mindful and sometimes by being “triggered.” Music works that way for me.


One of my favorite performers died of COVID-19 last night. John Prine was 73. Early in his career, he did gigs in the evening while he held his day job as a letter carrier in the Chicago area. He was sometimes known then as the Singing Mailman. Since then he won Grammy’s performed with many greats, and wrote songs covered by dozens of artists. He survived several cancers and kept performing almost no matter what.


Here’s a link to one of his earliest and, I think, best songs (supposedly inspired by his observations delivering the mail):


So just say Hello in there, hello, to all.


Wash your hands.  Don’t touch your face. Maintain social distancing (it works). Wear a mask (if you’re in our buildings) and a face covering everywhere else. Stay home as much as you can (though get out and walk or exercise in the good weather). Stay home if you are sick. Don’t fall for scams.


Be patient; be mindful And, be well.



Tuesday, April 7, 2020                                                                       Issue # 16



I hope you had a good night and got some rest.


There continue to be several “confusing” stories about the spread, impact, and trends for the pandemic on the national scene. But no matter which story you believe, it is clear that we have a long way to go in time, and, in dealing with the suffering and anxiety that this pandemic is causing.


It's still true that most cases will be mild to moderate. But there will still be some suffering. Although Hampshire (147) and Franklin counties (107) have fewer identified cases of COVID-19 compared to the rest of the state (except for the islands), we will see an increase and we have to assume that the lower numbers, to some extent, reflect less testing. The numbers of deaths from COVID-19 in our counties is still among the lowest in the state but we can expect those numbers to rise also. Those are just statistics. Behind the numbers are families and friends suffering losses and pain.


In terms of time, the safest assumption is still that we won’t see much significant “on the ground” slowing of the pandemic until mid or late summer. I say “safest” because what I mean is that we have to remain vigilant, cautious and continue the measures we know will work to slow the virus at least through that time frame. You’re probably tired of hearing/reading this, but they are:


  •          Wash your hands often!

  •          Don’t touch your face!

  •          Maintain social distancing (at least six feet apart no matter inside or outside)!

  •          Wear a face covering!

  •          And stay home if you are sick!


As of now, there still is NO medicine and NO vaccine against this novel coronavirus. Encouraging patients who are desperate and scared to try an unproven remedy is at best foolish and, at worst, very dangerous. We won’t do that! At VMG, we will continue social distancing and seeing almost all patients virtually. We will continue, through your efforts to innovate and change our workflows to keep our patients and ourselves as safe as possible. We will also continue to work in our communities to help out as necessary and to make sure that we will be available when the pandemic lets up and we can return to some new normal state of providing healthcare.


Some Words from Our Patients


Given how hard everyone is working to continue to provide care in a very changed environment, it’s good to hear what our patients think. Here are two comments from just the last few days:


The first is from one of our adult patients and she said she had her “first telemed appointment this week.  I was impressed with the organization and the quality of service.  One good thing to come out of this horror, Valley continues to provide great care”


Next is from a school age child who sent us a note to NHC. And he said “Dear vmg staff, thank you for keeping us all happy and healthy. I really appreciate your work. And he signed it with a heart.


VMG Departments: Endocrinology


Drs. Chipkin and Spitzer are seeing follow-ups and new patients and consults almost exclusively by Virtual Visits now. There may be a few situations in which they will have to see a patient in person and those visits will be consolidated at either AMC or GHC to lessen the risk.


Staff are coordinating the Virtual Visits, working inboxes, doing intakes and nurse advice and visits (virtually), getting information to patients on pumps and insulin, etc. We are working to develop work flows and practices for doing needed injections for certain medicine in the parking lots, again to reduce risks of exposure.


They are also working with reception to move patients scheduled in the future because of previous wait lists to current virtual visits to fill the schedules now.


Thanks for all your work to change the Endocrine work flows in such a short space of time (and need).


Coping in Unusual Times


Here’s a quote from an article in today’s Washington Post by Amanda Ripley. She began by talking about some patients who were “over-cleaning,” using bleach to “clean” things that did not need to be cleaned or cleaned with bleach. She writes about our responses to fear:


“Fear requires two elements: a perceived threat and a sense of powerlessness to defeat that threat. Since the feeling of fear is distinctly unpleasant, most of us will try to counter it in the days to come — by turning down the threat level or by amping up our sense of control.


In the first category, we might convince ourselves this is all an overreaction. I did this in the beginning, I admit. The whole thing felt like a giant snow day, or so I told myself. The Internet is happy to help with this, as is the brain. Denial is the most common human response to all kinds of disasters, from fire to floods to pandemics. We might also use food, drugs or alcohol to take the edge off the threat. (My current preference is chocolate chip cookies.)


In the second category of options, we might try to reclaim some sense of control over the threat. This is the beginning of an excellent plan. (Take back the blight!) But it can also backfire, as it did for the bleach patients. It’s easy to overcorrect in a time of high anxiety.”


So, what to do. Ginny Chandler, who is a professor at UMass College of Nursing, published a piece in the Daily Hampshire Gazette yesterday recommending ABCS (Active coping, Build strength, Cognitive Awareness, and Social support).


The first question when stressed is to ask yourself “Am I actively coping?” What do you need to do to cope better? Consider a walk, music, reading, tackling a problem.


Build Strength. She states that we more readily focus on our vulnerabilities and weaknesses rather than what we do well. Make sure that if you are focusing on areas of weakness that you also consider your strengths. “Write down what you do well” and focus here too.


Cognitive Awareness. If you find yourself “catastrophizing,” stuck on the worst possible outcome and misses, give yourself a break and get perspective.


Finally, social support. Don’t isolate, find a friend, family member, and talk or share an experience.


Check out Ginny’s column in the April 6 Daily Hampshire Gazette:


Here’s a term you don’t hear much anymore: Steadfast. The definition is “firm and unwavering in purpose, loyalty and resolve.” I think that describes what you all are doing for our patients, our communities, and each other. We thank you for that.


Have a good night. Be Patient; Be Mindful.




Monday, April 6, 2020                                                                                                                                                                    Issue # 15




I hope everyone had a good weekend. We all need to recharge.




Here’s a link to a Washington Post article on “smart solutions to mitigate the effects of COVID-19. Some of these seem like winners.



The Boston Globe had a graphic over the weekend showing cases of COVID-19 on a state map, county by county. (I tried to copy it here but it would not copy – you can check for it in copies of the Globe on Sunday). It was striking and showed that neighboring counties were much higher than our two counties. Of course, we don’t know why that is (it might just be a matter of fewer tests being done in our counties). Death rates also were less.


That our counties report fewer cases might be seen as some “good news.” But please do not let down on your/our social distancing, masking, hand-washing, “don’t touch your face efforts.” We still have a long way to go before the pandemic winds down and we’ll need to maintain our vigilance for many months. Some projections now have the new cases winding down through June but that still means a lot of illness and potential loss. We’re working with community groups and the local hospital systems on preparing and participating in “surge plans” (helping out) should they be needed.


VMG Virtual Visits


I talked with Karen Brown, a reporter for NPR, this morning about a story she was doing on how the pandemic was affecting primary care. As we were talking it was clear that we have essentially turned our approach inside out in the span of 3 weeks (going from “we’ll see you in the office for that” to “we’ll see you by virtual visit and at your convenience”). That’s a lot of change in a short time. And we’re hearing that, in many cases, patients really appreciate it. Here’s a quote from John Prinzivalli, DPT about his experience in Physical Therapy:


“When I first heard we were doing virtual visits I was very doubtful about what this was going to accomplish and how effective this was going to be.  After doing this for a few weeks I have been surprised and pleased at just how much we can get done.  Certainly we have doxy, and Zoom but for those who are less tech savvy the phone and Face Time has proven to be clinically effective. To date I personally have treated an acute post reduction shoulder dislocation, a post quad tendon rupture and repair, patella femoral syndrome, low back and knee pain.  Certainly there are limitations by not having your hands on folks but with some creativity and time we can be effective clinically. 


I hope is some way you may find this reassuring about what we can still do; it's certainly opened my eyes to other treatment possibilities.”


Virtual Visits Compared to In-person Visits


Here’s a chart, prepared by Isaac Allen our Data Analyst, showing how our total Virtual Visits (total for all VMG) are increasing since we began. The thicker red line shows our face to face visits for 2019. The thicker green line shows our face to face visits in 2020. The thicker blue line shows our virtual visits this year since February. You can see quick and continuing increase of virtual visits as our face to face visits declines quite a lot.








This is a good trend because much of our FFS revenue comes from Office Visits. As they go down, we lose a lot of revenue. Virtual Visits are mainly paid similar to Office Visits so we are potentially replacing much of that lost revenue which, of course, we need.  We’ll have more information on how significant this is in the next couple of weeks as the bills get paid by the commercial and government payers.

Copays, Coinsurance, and Deductibles for Virtual Visits

Because of concern about social distancing and helping people to stay at home, the Governor’s Office and the Division of Insurance in Massachusetts have directed that most patient copay, coinsurance, and deductibles should not apply during the pandemic (for COVID related services and other healthcare services we offer as well). The same is true for Medicare. However, the health plans have not completed adjusting their systems for these changes yet and we’re hearing that some patients, after being told by us that they would have no patient responsibility for virtual visits, are being charged for some patient responsibility once their claims are processed by their health plans.

While we expect this to be resolved soon, we want to be clear that we don’t have the authority to “waive copays” so please don’t use that language. Look for a message from Billing on what to say and on the resolution of this issue. Patients can also always be referred to their health plans for coverage questions.

Services at VMG during COVID: Rheumatology

Our Rheumatologists, Drs. Brown and Maroun, are both seeing new and established patients and consults almost exclusively by virtual visits. A few patients with acute need are being seen in the health centers after being triaged by the practitioners and their staff.

Their schedules are being converted from previously scheduled in-person visits to virtual so they do have room (“there’s room for Rheum”) for patients and will welcome referrals.

General Reactions to Handling the Stress of the Pandemic and the “Learning Curve”

John Novo passed this graphic on to me. It shows how people move to adjust to the stresses of working (and living) in the age of COVID-19 and how we develop and learn about our roles and “who we want to be.” It also helps to define some things about what it means to “be Mindful.” 


Good news is that we already see many of our colleagues and our Group moving in the right direction. We hear every day of how people are “jumping in” to help teammates triage, schedule, see patients, work lists, keep the buildings clean, keep the operations and finances growing and adapting, etc.

Finally on this note, here’s a quote from Fred Rogers:

“In times of stress, the best thing we can do for each other is to listen with our ears and our hearts and to be assured that our questions are just as important as our answers.”

And some good ideas from the Fred Rogers center for how to help children during this time:



Finally for today:

Bill Withers died last week (of heart disease, not COVID-19). Here’s a different take on what standing together means:


Be Patient; Be Mindful.

Thanks again,




Friday, April 3, 2020                                                               Issue # 14


It’s Friday afternoon and most of VMG will have the weekend off. We all need time to recharge, relax, distance from the pangs of social distancing at work for a while. The news continues to worsen, as expected. The scammers are out there selling miracle cures, “game changers,” and the hoarders of needed equipment, supplies, food (anyone seen a chicken recently? They’re not all crossing the road).

Despite this, maybe because of this, we’re seeing a remarkable coming together by all of you, our communities and services, and it is heartening, fulfilling, and reinforces the values of healthcare. A quote from a New Yorker article by a NYC doctor, Dhruv Khullar, working as a hospitalist in an unnamed hospital:  

The “burnout-inciting frustrations of billing and documentation and electronic medical records have, for the moment, receded. Now, when I’m in the hospital, the focus is so singular, the mission so clear, that nothing else seems important. There is nowhere that I, or my colleagues, would rather be. There’s an odd sense in which the pandemic has made the practice of medicine into what many doctors hoped it would be.” He also goes on to talk about concerns about being able to sustain and that is a real concern for everyone. But coming together, having a unified purpose, and talking with each other and offering support and “being there” will help.

Local Initiatives

There are a number of task forces getting together in our communities to plan for and cope with “surge” concerns. The latest status of our hospitals is that they have capacity now. Steve is participating for us in meeting of the Hampshire County group today. We’re also participating with Baystate Franklin in some “emergency credentialing” in case we need to be available to help out.

Checking In is More Than Just That

One of our practitioners learned of a message from a patient in response to a check-in call by another practitioner. The patient said that she was moved to tears and also said “what medical group does this?” I’m glad it’s us.

Language about Virtual Visits

We were told that some patients don’t fully understand what we mean by a “virtual visit.” It’s a good shorthand for us but it may sound to some patients like a video game or something less than a healthcare service. We’re looking to change our language to patients probably to something like video or phone visit (that’s what they are, after all).

To Mask or Not to Mask

We are already committed to wearing surgical masks at all times in the health centers. We should probably also be wearing masks (homemade ones will do for the purpose) in public.

There has been some conflicting messaging about this since the start of the pandemic. But as information changes, so do the recommendations. There may be a national or state recommendation today or tomorrow.

The mask will likely not prevent us from getting the virus. But it will help to prevent us from transmitting the virus to others if we have it. So break out the creativity and fashion sense if you choose but mask up. And it is a sign of social solidarity which is also needed.

Lab Draws

Another sign of how quickly things change and how our staff are adapting. We are now doing a majority of our lab draws in the parking lot. Thank you to the phlebotomists and other staff involved in making this happen. You’re making everyone safer.

Department Updates

Eye Care: Our Optometrists are not seeing patients in their offices now for social distancing reasons. And the NHC Eye Lane and Optical Shop have been repurposed for our NHC Respiratory Symptoms Unit. However our Optometrists are available for consults to primary care and patients. We’ll have more information on the best way to reach them soon but, for now, please contact any of the Eye Care staff who are either working from home or in the centers working on managing in boxes and patient cases to the practitioners.

Podiatry: Dr. Erskine and Dr. Dinnall are both doing visits by video and/or telephone (aka Virtual Visits -- VV) in increasing numbers. They will both see urgent visits (infections, ingrown toenails, post-ops, wound care, etc.) in the office (though we may be consolidating these in person visits to EHC and GHC). All future visits for the next few months are being converted to VV. New patients are also being accepted.

Sports Medicine: Dr. Murphy is seeing more and more visits by video or telephone and finding many patients who really appreciate the opportunity to discuss their pain or other symptoms. He is also seeing new patients by video or phone. Please keep referring. Injections and other hands-on treatments will be postponed or scheduled for a few months out (or longer).


So it is now almost the weekend. Again, thanks for all you do, for coming together and showing your True Colors. Here’s a video of appreciation to take you into the weekend (you can skip the ads if you wish):

Be Patient; Be Mindful.





Thursday, April 2, 2020                                                                                                                                                                                  Issue # 13


I hope you are well. Those words, which only four weeks ago, were a simple greeting now take on even more meaning. Nevertheless, that is my hope for you.

Some Updates

With the expected peak in cases a few weeks away, the local hospitals and medical groups are getting together to talk about organizing a community wide response. This may involve some sharing of information (there are already conference calls to update people) and resources. We’ll know more in the next few days. We want to participate with others in keeping our communities as health as possible.

Expected Impact

You’ve heard a lot about the “peak” of the illness curve and that’s it’s expected in the next two to three weeks in our area. But what does that really mean? Practically speaking it means that we have not yet reached the point of all the symptomatic people with COVID-19 being identified to the healthcare system by being sick. Also getting to peak does not mean the illness and its effects go away. Individuals will still be getting sick and some will still be dying for weeks and perhaps months after peak.

Still it’s important to remember that not everyone who gets sick will get very sick. Most will not and will make a full recovery. And even most of those who get admitted to the hospital will recover well. Perspective is important.

Important Steps You Can Take To Keep Us All Well

Gina sent an email earlier today stressing the importance of a few things we can all do to keep us all well.

  • If you are sick, stay home. Your job is not threatened by being out sick. If you need benefits under the Emergency Sick Leave acts, please contact HR.

  • Wear your masks in the health centers even if you are only out walking in the building for a short time.

  • Social distancing is just as important in the health center as it is in the supermarket. Even when wearing masks, stay at least 6 feet apart from other staff and patients in the building.

  • You know what I’m going to say next: wash your hands often, don’t touch your face, cough or sneeze into your elbow.

  • Oh, and don’t try to drink coffee while wearing your mask (I tried. It doesn’t work. Twice.)

FYI, here’s the link again to the CDC Symptom Checker for COVID-19.

And here’s the link I sent earlier to a helpful article from the New York Times on things you can do to stay healthy.

Zoom Brown Bags

One of the things about social distancing is that it keeps us from visiting the health centers as often as we’d like. So we’d like to try something different.

We’ll be scheduling some Zoom Brown Bags in the next few weeks; one at each health center. We’ll structure them as Town Hall meetings and ask for questions in advance and discuss anything those attending have on their minds.

Look for the invitations next week.



Thanks again for all you do. Be Patient, Be Mindful. We’ll get through this together.




Wednesday, April 1, 2020                                                                                                                                                            Issue # 12


The VMG Board of Directors met this morning (virtually). All Board members wished to pass on their appreciation for all of your dedication, creativity, and willingness to step up during this public health emergency. Thank you from the VMG Board of Directors.

Regional and Local News

There is some cautious good news to share about social distancing effects, local hospitals and ICU availability. Some in state government are now saying that they are seeing early signs that social distancing seems to be working to slow the spread. It’s too early to confirm and they are still predicting the peak effects of the virus for mid-April.  As you know by now, the Governor has extended the Stay at Home guidance through May 4.

Local hospitals (Cooley, Franklin, Baystate) are reporting that they have increased their ICU capacity and have some room for a surge (so long as it is not a surge the size of NYC); they are not yet seeing a great increase in demand. We will keep trying to keep patients who don’t need it from the ER. Also, some area nursing homes are setting aside areas (floors or buildings) for COVID cases.

So while these are good signs about impact and readiness, we still have a long way to go. And there are still areas of the country like Florida (whose governor just now issued a stay at home message) and Texas in which the need for social distancing has not taken hold. That means that travelers, if there are any, could carry back the infection. It’s uncertain how big a threat that is to us but it is certainly a threat in those states. If you have family or friends in those areas, pass on the advice about social distancing. Maybe that will help.

Virtual Visits (VV) Increasing

We are seeing an increase in virtual visits in most departments. We are beginning to track them weekly and we can report on that by next week sometime. This is important for several reasons. First, we want to stay connected with our patients and virtual visits do bring in revenue. Second, almost all patients have concerns and anxieties about the pandemic and we can help provide perspective for them. Perhaps most important, our patients still have other (than COVID) medical problems with needs for care. Think of the folks with high blood pressure, diabetes, heart disease, for example. They all need monitoring and time to check-in, review medications and symptoms, etc. VVs are a good way to see them for now and most patients appreciate the opportunity.  

Behavioral Health and Integrated Behavioral Health Update

Here’s an update from John Novo and Suellen Walsh. All Behavioral Health and IBH providers are working from home providing regular therapy sessions over the telephone or telemedicine platforms. We are providing services to new and existing patients. Providers have reached out to patients who have cancelled and reception has been actively calling patients and converting already scheduled in-office appointments to Virtual appointments.

There has been a decrease in patient's flow for some BH providers. We are working hard to be flexible and accessible. Our goal is to support primary care and VMG in general as much as possible and to keep our schedules full. Please continue to make referrals and let us know of any problems in having access to our services. We are here to help and want to do our part to support our patients and the practice in this very difficult time.

Referrals should be made by instructing patients to call the usual behavioral health phone numbers (AMC 256-4441, EHC 282-3858, NHC 586-8400, GHC 772-3367) to leave a message. For IBH, a reception staff member has been designated at each health center to schedule virtual visits. Please contact them.



Ordinarily, this being April 1, I would think about adding some kind of “foolish thing” right now (These Foolish Things; great song). Instead, here’s a link to a video from students and faculty at Berklee College of Music in Boston. It’s really good and I think inspirational.

Thanks again for all you do. And….wash your hands, don’t touch your face, maintain social distancing.

Be Patient. Be Mindful.



Tuesday, March 31, 2020                                                                               Issue # 11


I wish we could all go back to a time when most of us didn’t know what “PPE” meant. But we can’t.

The news on TV remains difficult to watch. The concerns of front-line healthcare and first responders, the lack of necessary supplies and ICU beds, and of course the numbers of reported cases and deaths. We may want to ignore it all, but it’s hard. Reminders are everywhere (work, grocery stores, the UPS guy, etc.).

Our brains are usually able to compartmentalize difficult information and emotions and a certain amount of that may be necessary. But since we are in healthcare, we all have stories about how our patients, colleagues, and families are doing. We do our best work by relating to patients and their situations. It’s important to go on but it’s also just as important not to succumb to “compassion fatigue.”

So if you get to the point where you feel “a cloud” over your caring and concern for others and their situations, make sure to find someone to talk with, take a break, stretch, walk, and give yourself a chance to breathe and recharge. It happens to all of us. Remember to Be Patient and Be Mindful. You can also contact HR for information on the Employee Assistance Program.

Local Situation

Unlike the metro areas of NY and Boston, we may be a bit protected by our geography and lower population densities. But that does not mean we won’t see the effects of this epidemic here. We are seeing some cases in all of our communities of patients with confirmed COVID as well as presumed. Our hospitals are gearing up but are not yet overwhelmed. The ERs, for the most part, are functioning well. They are not yet overwhelmed. As of today, the state still expects the peak of the pandemic to reach Massachusetts by mid to late April.

We are doing what we can, as you probably know, to preserve the capacity and capabilities of our hospitals and ERs by seeing our own urgent patients as much as we can. Also, it’s important to remember that keeping in touch with our patients by Virtual Visits helps to provide needed medical advice and calm anxieties and perhaps prevent an unnecessary ER visit.

Updates from our Specialty Departments

During the “early” part of our pandemic work, we’ve been necessarily focused on primary care and our workflows in primary care. This week, Gina, Martha and I began to meet with our specialty departments to stay in touch, learn more about their work and needs, and make sure we could get information out to VMG about what they are already doing and what they can do for our patients and our staff. I’ll try to update on each department over the next several issues of this newsletter.

I’ll begin with some information on Physical Therapy. All of our therapists are working from home though there is someone in the buildings on a daily basis or close by and on-call for any urgent needs that they can help with. They have geared up to do scheduled Virtual Visits by audio/video or telephone and their schedules reflect those changes.

Here’s some more detailed information:


·    Scheduled virtual Physical Therapy appointments are available from all VMG Health Centers. These are provided through an internet video application, easily accessed by a hyperlink sent via email to patients by Reception staff. Virtual appointments are also available by telephone, which are also scheduled by Reception staff.  


·      Virtual Physical Therapy evaluations may include:

o   A detailed injury and medical history

o   Postural, mobility, gait, and balance assessment

o   Range of motion and strength assessment

o   Neurological assessment

o   Special tests and measures

o   Home safety assessment

o   Discussion of findings, establishing goals, and determining treatment plan.


·      Virtual Physical Therapy treatments may include:

o   Selfcare training, e.g. RICE, activity limitations, etc.

o   Postural awareness training

o   Stretching and strengthening training

o   Mobility, gait, and balance training

o   Soft tissue/fascial mobilization training

o   Vertigo, BPPV CRM training

o   Other specialized treatments

o   Review and progression of written home exercise program.


·      Virtual Physical Therapy treatments do not provide:

o   Manual therapy treatments

o   Mechanical spinal traction

o   Clinical modalities


·      Advantages of virtual Physical Therapy:

o   Decreased Covid-19 exposure risk

o   Access to treatment for patients with shelter in place or quarantine restrictions

o   Therapists are available for questions via the patient portal or email as needed between visits

Thanks to Jeffrey Reed and the PT department for the information above. Please consider sending patients to virtual PT and contact a PT Team Member for any questions about suitability for treatment.


Once again, thanks to all of you for stepping up in this public health emergency. Wash your hands, don’t touch your face, and observe social distancing.

And, Be patient; Be Mindful.




Monday, March 30, 2020                                                                                                   Issue # 10


Happy National Physician Day to all of our physicians! And, more generally, Happy VMG Practitioner and Staff Day. This healthcare crisis could not be managed without all of you. You are all appreciated.

We are now beginning the fourth week of our operations under COVID conditions. I know it seems both like an eternity and also just the beginning. There is already a lot of change and there will be a lot more coming before we return to a new, normal state. This is an evolving situation so what we say today may have to change as conditions change. The Governor’s office said today that the peak in Massachusetts is now expected in the middle of April, but we don’t know. We’ll have to remain ready.

What has not changed is the following: wash your hands, don’t touch your face, continue to social distance but do find ways to stay in touch with family and friends.

Social Distancing Efforts Continue

The Federal Government has advised continuing social distancing through April. I think these efforts will need to continue several months after that. But for now, we will continue our social distancing efforts in keeping with national and state policy.

Work From Home Agreements

In keeping with the above, all current work from home agreements will now be continued through the end of April (according to the conditions in those agreements and assuming we have work for those working from home). However, please keep in mind that as conditions change, we may need to recall staff to work in the centers.

Certain Services Remain Closed or Limited to Reduce the Possibility of Spread

Our surgical center in Amherst remains closed by Department of Public Health order until further notice. Most staff has been reassigned and patients are being cancelled and rescheduled for after July 1, at this time.

At this time, we’re providing only urgent and necessary services in Radiology and Lab as determined by practitioners and medical staff. All routine imaging such as mammography remains unavailable. Lab patients have been cancelled though mid-April. We’re seeing about rebooking after April 30 but we will still need to find a way to see patients who need lab draws. More to come on this later.

Access for Our Patients in the COVID World

We still need to provide access to care for our patients for all the usual reasons. Right now, because of COVID, we are avoiding scheduling visits in the health centers unless practitioners decide otherwise. We are doing Virtual Visits (VV) so reception staff continues rescheduling in person visits to VV.

Triage telephone volume is growing. We are working on moving some of those triage calls to VV with practitioners as a means of preserving triage availability and keeping our schedules filled. Triage will take calls and, where appropriate, offer and schedule a VV with a practitioner.

Keeping Patients Out of the ER (Where Appropriate)

We expect that at some point soon, our local ER’s may be overwhelmed (we’re not NYC but we have fewer ER resources). It’s important for us to do what we can to keep patients who don’t need to be there, out of the ER. So again, we’ll offer urgent care and VV to those patients we think are appropriate. We want to do our part to keep the ER and Hospitals available for more critical patients.


Over the weekend, I heard someone say that “the delivery man is not the enemy; he’s a hero.” This was in response to questions about whether it was safe to get food (or anything else) delivered. It’s a reminder to keep perspective and to also appreciate those who are out in the community, day after day, doing what they can to keep us fed, supplied, and meet our needs.

Thanks again to all of you for stepping up in this public health emergency.




Friday, March 27, 2020                                                                                                                                                                                   Issue # 9


The weekend approaches. I hope this communication finds you well.

You’ve probably seen the latest news that the virus is continuing to spread with stories out of Michigan and, specifically Detroit. It should be clear that this will not be over anytime soon and that state-by-state efforts at social distancing will need to continue. No one knows what the signs are for “reopening” but they clearly have not been seen yet. So let’s continue to be patient with social distancing measures. We have not seen the peak in the curve of COVID-19 yet.

You may have heard this afternoon that Governor Baker has issued guidance that visitors from outside Massachusetts are instructed to self-quarantine for 14 days effective immediately. The Governor’s advisory specifically exempts healthcare workers; healthcare workers from neighboring states can still come to work in Massachusetts. The order is an effort to slow the spread of the virus that may be “carried” by travelers from other regions of the country.

Martha reminded me that when we hear news of viral spread, testing, new cases found, and illness and death, we often have a gut feeling that the worst is upon us. And the situation is worsening. And we also need to keep perspective. This is called “the denominator problem.” When a report comes in that 25 new cases were found in a town, we naturally think this is a huge problem. We don’t stop to think that this may be due to a number of things including that testing is expanding. And, the denominator: 25 out of how many? In an example we found it was something like 25 out of 20,000 (much less than 1%). That’s a problem but not as big as you might imagine until you know the size of the town. This does not mean that things are good. Only that you need perspective to judge how bad.

Rumors Spread as Easily as Viruses in Times of Crisis and Fear

With all the confusion and uncertainty in our communities, you may hear rumors about what’s happening here at VMG. We have heard rumors about VMG closing (UNTRUE) and AMC closing (also UNTRUE). It is true that some other non-VMG specialty practices have reduced their size of closed for now. That’s not true here.

We will keep you up to date about VMG. That’s one of the purposes of this newsletter.

VMG is Open

During the first few weeks of learning about the pandemic locally, we were freezing schedules, cancelling routine appointments, and we did close the surgical center at AMC (due to an order from the Department of Public Health closing all ambulatory surgery centers across the state). We wanted to move as many appointments as possible from our buildings (to observe social distancing) to virtual visits.

We are continuing to convert in-person visits to Virtual Visits (VV) and Reception is going through schedules to do that. We are also going through lists of previously cancelled appointments to offer VV. We will continue to see patients with respiratory symptoms after triage by our nursing staff and practitioners in our respiratory teams and we will also see other patients (non-respiratory) with urgent needs for visits when that is necessary.

VMG is Open to New Patients

Not only are we open to our patients but we are also accepting new patients. These appointments will be by Virtual Visits. New patients are welcome at all our centers. Primary care is getting to be more scarce and primary care will be needed now and as the pandemic resolves even more than before. So it’s important to know that we will see new patients. Our website and Facebook page have been updated with this information.

Guidance on Emergency Sick Leave and FMLA: Families First Coronavirus Response Act

Lisa sent all staff information about the Families First Coronavirus Response Act earlier today. This is the result of new federal legislation offering additional resources and protections for employees.  The information describes the benefits as well as the qualification for benefits. Please contact HR (via the new ) email address for questions.

From the New York Times: What You Can Do About Coronavirus Right Now

The Times has made coronavirus coverage available free to anyone. Here’s an article on steps you can take around your home and much more to try to keep safe. The embedded instructional videos are also very good.

I hope everyone will enjoy the weekend. Go outside if it’s nice (and maybe even if it’s rainy, if you enjoy that sort of thing). Keep perspective, keep connected and be well. And thanks again for the incredible things you do.


Be Patient. Be Mindful.


March 26, 2020                                                                                                                                                                                                  Issue # 8


I was at a virtual get-together with a group of friends and neighbors yesterday evening. All are in the midst of coping with businesses that are at risk, uncertainty and confusion about their health and healthcare in the face of the virus, and doing the best they can to stay in touch with friends and family.

This is literally a world-wide crisis as well as a national crisis. New Orleans (one of my favorite places) is now an epi-center and trying to cope. The reality of the scope and massive disorganization caused by the pandemic is hard to fathom. You’ve seen pictures of empty streets and public places all over the world (which, in a way, is a good thing as people take the need for social distancing seriously or maybe it’s more out of anxiety). We’re not at all certain about “where the bottom” is and how long it will take to get there. So, we will keep on coping as best we can, adopt best practices and adapt our work based on evidence as it exists, and good sense where there is no evidence. And, I’m saying this again: we’ll get through this together at VMG and in our region, country and world.

And what are our tools (for now)? Mostly, right now, it’s hand-washing, masking, and social distancing! In the future we’ll have some treatments and a vaccine but that’s at least months away.

Recent Changes at VMG

We’ve changed our approach to the use of masks, as you already know. All staff are now given a mask to use for the day when they enter the health center. FOR PATIENTS: only patients with fever, cough, and those proceeding to care in our respiratory symptoms unit are being masked at this time. We do have adequate supplies of surgical masks for now.

VMG Lab Changes

As I think you all know, our lab is a central part of our Group for clinical and financial goals and also for patient convenience and engagement (patients love not having to go someplace else to get excellent lab service). Due to the pandemic, we’ve had to change how we do lab business.

Please see Matt Spitzer’s email from this morning for more details. Basically, for now, we’ve stopped all routine testing to reduce the risk of exposure to patients and staff. We will still do urgent labs, as identified by our practitioners. And we have the ability to do urgent “car draws,” as necessary (thanks to all of you involved in that process for making that possible).

We are doing only a very limited number of COVID-19 tests (we only have about 20 kits) and they are only done with the request and approval of the primary care team leaders. We are relying on the public health and hospital systems (as they come on line) to do acute and population screening for now.

As we believe that the flu season is “essentially over,” we are not doing flu (or strep) testing now except in rare circumstances (and then only in cars by our respiratory teams). Again, we want to avoid exposure risks for patients and staff.

Emphasis on Filling Our Schedules with Virtual Visits (VV)

We still have patients with needs and we still have to keep our revenue streams as much as we can. Many of our patients have appreciated our Virtual Visits (by video as well as by phone) both for their clinical value and for their ability to ease patients’ concerns and keep them connected with us.

Reception (and practitioners and clinical staff) are working to reach out to our patients to schedule Virtual Visits. Health Plans (including Medicare and Medicaid), recognizing the need for social distancing and slowing the spread of the virus, are all beginning to reimburse for most of these.

So we’ve changed our messaging to patients on our web site (and we’re in the process of changing that on the portal as well) and we are actively trying to move all currently scheduled routine and most f/u visits to VV as well as looking back in our schedules to reach out to patients to offer VV if they have no near future visits scheduled.

I just realized that I used the phrase “for now” several times in this update. That’s a new part of our lives and business. A lot will change between now and when this crisis subsides. We’ll have to get, and stay, used to that.


Because of the pandemic most artists and musicians are struggling to stay in touch. I’m a jazz fan. Jazz at Lincoln Center (in NYC) is one of my favorite venues and orchestras (with connections through artists like Wynton Marsalis with New Orleans). Every day they send a new link to what they call an archival concert for streaming these live performances. Without realizing it the last week or so, I go home and click into this more normal world for 30 minutes or so. It “transitions” me out of work and into home and family. So far, it works.

You probably have things like this you can do. I’d urge you to take the time for such a transition.

Once again, try to Be Patient and Be Mindful.

And be well. Thanks,




March 25, 2020                                                                                                                                                                                                  Issue # 7


I was just writing (last night) to an old friend (formerly a leader in healthcare in Kaiser Permanente, now retired). We were sharing family stories and developments and then we turned to talking about how our world has changed. And, how quickly! Just two weeks ago, we had plans to visit our kids in other cities, plans for travel, plans for meeting up for dinner, movies, etc. And now we are both essentially hunkered down, doing what we can do, and a lot of …. waiting to see what will happen and trying to plan for a return to some kind of normalcy in the future.

As to a return to some kind of normalcy, despite what some are saying at the top of our government, most of us believe that we have not yet seen the peak of this pandemic in our country and certainly not in our local communities or region. You probably saw the reports of what is happening in the metro New York and New Jersey area. That wave of illness and the preceding infections are probably coming here a few weeks following the peaks in metro New York. There will be no return to normalcy until months after that. I say this not to create fear and anxiety but to make sure we all are connected to what appears to be reality. If we can connect to reality, we can find ways to deal with it as best we can. We can have expectations. We can adjust as necessary. We can come together, share our experiences (even virtually), and we can cope. We need to be able to trust. And trust is based on being told the truth and sharing reality as it exists.

We will continue social distancing as much as possible. That’s the main tool we have now to slow the spread of the virus, gain time for the healthcare system to be ready to treat patients in greater volumes than we had planned, and, eventually, find some treatments that work and a vaccine.

You’ve already seen, and are participating in, what social distancing means at VMG. We’ll be announcing other measures and other procedures as we go based on evidence, best practice, and what we learn from other organizations, other regions of the country, and other nations.


New Federal Programs and Regulations for Emergency Sick Leave and FMLA

You’ll be getting some information from Human Resources on these new federal programs that will provide some greater security and comfort for sick leave for employees as well as caring for family members. The laws have been passed but the rules and regulations for implementing them are still being developed and getting clarified. HR will have that information for us as soon as it is clear. For now, just know that it is coming and please DO NOT call HR as they are very busy working to get this information ready.

Once shared, there will also be information about how you can ask questions and access the benefit, if necessary.


Current Changes at VMG


As you know, we are now screening all staff and patients upon entry to the building. We are taking temps and asking screening questions about possible symptoms. Entry to the building is dependent on these procedures.

Masks for All Staff and Providers upon Building Entry

Beginning Thursday, March 26, all staff and practitioners will be asked to wear a surgical mask upon entry to the health centers. The mask will be provided, one per day, by the staff doing temps and screening at the entrances. The purpose is to avoid the possible spread of the virus from asymptomatic individuals to others in the building.


I want to thank Val Felton, Amy Rice, and others who have worked on acquiring enough inventory of these scarce supplies.


It’s hard for me to believe, but I’m seeing the beginning of a whole new scam industry centered on people’s fears about the coronavirus and COVID-19. We’ve seen scams related to services to prevent and treat the disease, testing for the virus (there are NO mobile testing centers), financial scams to “protect” people from possible costs, and even hackers into telehealth platforms. If you see something that looks suspicious or too good to be true, pause and check it further. Don’t buy it.

Ongoing Planning for our Immediate Future

We are working proactively to anticipate how the scope of our work may change as the pandemic increases in our region. Everything from inventory of medical and business supplies, ideas for changing the shape of urgent care, processes for continuing to provide childhood and adult immunizations, drawing labs inside and outside the building for chronic disease management, further controlling access to the buildings, and collaborating with our community colleagues and more will need to be reexamined for best practice and optimal functioning for managing the pandemic as well as our “usual work” in caring for people.

You’ll hear more about all of this as we make decisions and confirm what we can do in the near future.

Thank you once again for your caring for our patients, our communities, and each other.




March 24, 2020                                                                                                  Issue #6


One of my all-time favorite movies is Nobody’s Fool based on a Richard Russo book about friendship, family, distress and adaptation (I’m happy to lend a copy of the book or the movie). Toward the end the lead character is trying to comfort his work mate of many years after an intense conversation about how their lives have changed and the work mate says “you know what I wish?” “I wish we could go back to working together like we used to.” I’m sure many of us are thinking that about now.

But I have two thoughts about that. First, although this is all intense and at times difficult and we are all, of necessity, social distancing, we will rely on each other, do our best to stay connected to each other and our patients, and we will adapt. Let’s keep track of what we are learning about our work and ourselves. Be Patient, Be Mindful.

Second, I think we are all learning something about confronting our fears and worries, courage and inspiration in hard times. Here’s a link to an article in Monday’s NY Times by Don Berwick. We’re in the midst of a lot of change and it’s sometimes hard to see where we are going and it can be hard to see our values in action. But they are there. Take a look:®i_id=3975868720200323

Changes at VMG

  • To better protect our patients and ourselves, beginning tomorrow, we will have a system in place to control access to our health centers for patients, staff, and practitioners. Please read the emails sent today by Gina Campbell and by Mary Mitchel for new procedures

  • We are continuing to see primary care and our specialty departments accelerate the use of virtual visits with patients. These allow us to continue to provide care to our patients. But they also allow us to stay in touch with our patients. Patients really appreciate this and I have to think it’s also good for us as staff and clinicians

  • There is a lot of work going on “behind the scenes” (the folks you don’t see every day that are not patient-facing) to allow all this to happen. Operations Coordinators, IT, Billing, HR, Facilities, Couriers, Payroll, Finance, Health Information, Informatics, and others (I hope I didn’t leave anyone out) are working to enable the work of Reception and the Clinical staff and practitioners

  • Many staff have taken on new tasks as these have been identified to “fill in” until we can figure out new work processes


Thanks again for all you are doing. It’s appreciated.




March 23, 2020                                                                                   Issue #5


In order to slow the spread of the virus, Governor Baker has ordered all non-essential businesses in the state of Massachusetts to close beginning tomorrow at noon until noon on April 7. He is also directing the Department of Public Health to issue a “stay-at-home” advisory to limit all unnecessary activities, especially for those over 70. VMG is an essential business because continuing to provide healthcare services is essential to the public’s health, safety and welfare. For these reasons, we are staying open, though we have, in the space of the last 10 days, essentially redesigned a lot of what we do (more of that below).

Essential and Non-Essential


You’ve probably heard a lot about “essential” and “non-essential” employees. Whichever category your work is in, these terms do not mean that your work is not important to VMG. The terms are only used to designate which employees must report to our place of business to work during this public health emergency. Essential employees are those who are needed at the health center to allow us to continue to provide care to patients. These employees include, but may not be limited to, practitioners, nurses, medical assistants, phlebotomists, radiology staff, medical technologists, receptionists, custodians, couriers and most members of our leadership team.


At VMG we have been actively working to move our non-essential employees (as well as some of our essential employees who can be spared because we have reduced the number of patients we’re seeing in our health centers) out of the office in order to implement and maximize social distancing as a means of slowing the spread of the virus. However, not all of our patient care and work can be performed from home.


It’s important to remember that as we see more patients in the health centers (either because we are seeing more illness or because, in the future, we are returning to normal volumes) we will be moving employees who have been sent home to return to the office so that we can continue to provide needed services to our patients.


Recent Changes


Because of the growing spread of the virus, every patient contact involves a risk- benefit decision. For younger patients, if they visit the health center without urgent need, it increases the risk for practitioners and staff. For older patients if their need is not urgent we increase their risk. We need to make sure that bringing a patient in for a visit will urgently make a difference in their health so as to be worth the risk.


For this reason, we are now seeing almost all patients by Telemedicine; virtual visits by Zoom, Doxy, other platforms or, in some cases, by telephone. The only exceptions are urgent patients who have been through triage and were told to be seen in person by triage nurses or practitioners. All normal, routine follow-ups, wellness visits, and physicals, routine labs and routine radiology are not being seen in the health centers. This is to reduce risk to other patients and staff and to slow the spread of the virus by social distancing. We are seeing urgent patients with respiratory symptoms in our designated spaces in the health centers by our designated teams.


Based on some new recommendations, we are now asking all practitioners and clinical staff in direct patient contact to be wearing masks.


New Federal FMLA and Other Benefit Changes


We have not yet finalized all the information coming from Congress and the federal government but we are aware of some changes to FMLA and other programs because of the pandemic. These will create some safeguards for both well and sick employees going forward. We’ll have more to say about these before the end of the week.

Anyone Feeling Stress?


Now that’s a stupid question. Here are some ideas:


  •          If you are spending a lot of time on social or other media watching the news or listening to people talking about the pandemic, stop! Listen to music, read a comic book, try a new recipe, talk with a friend, hang out with a pet, etc.

  •          Connect with others. There is a new word: “social closening.” Talk with friends and family, actually talk, by phone or by video (zoom, face time, etc.). Talking with others helps. And, try making sure that you are also talking about things other than the pandemic. Set a goal to talk with others at least once a day.

  •          Mindfulness. If you don’t have a method you are fond of or never tried it, use one of the free apps like Calm or Headspace. You can get these on your phone or on the web. Or just google mindfulness for other ideas.

  •          Exercise. Go for a walk, stretch, whatever your favorite is, do it often. It doesn’t have to be intense to get some benefit.


Here’s a quote: “The only thing more contagious than a virus is hope.”                                   

                  Admiral William McRaven


There’s been a lot of change at VMG and in our communities these last several days. There will be a lot more in the coming days and weeks. Believe in each other, take care of each other, and, that Hope thing. We will get through this.


Thanks again for all you do.




Friday, March 20, 2020                                                                                                                                                                                                   Issue #4


With all the talk, press, TV, radio, rumor, about COVID-19, it remains difficult to keep perspective on this illness and how it will affect us as a company, a staff of healthcare workers, as parents, partners, spouses, etc. I know it’s hard to be patient and to take a breath with all the concern. Keeping perspective is hard but helpful. Here are a few key things to remember, as of now, as we try to keep perspective:


  • The illness will be with us for some time; at least 6 to 18 months

  • We will all know someone, or be someone, who has the virus

  • Not everybody with the virus will be symptomatic (at least, not right away)

  • Once symptomatic, most cases of the virus will be mild and people will make a full recovery within two weeks (the estimates are 80-95%, so far)

  • Some cases may be severe and these will usually be in people age 70 or older with significant medical problmes or people age 60 and older with significant underlying illness like diabetes, lung disease, and heart disease and even many of the hospitalized patients will recover well

  • As you know, there have been deaths associated with the illness but there have been no deaths for people under the age of 20 and even for people over 60 the death rate is still very small


The more we know, the better we are prepared for the months ahead. Information will change and we will keep each other informed. It’s important to remember why we are here: to help patients stay well and to comfort and treat patients when sick. We will save lives by sticking to this mission. We will need to continue to support and comfort each other as we go.


We have taken all the reasonable measures we can take so far to keep ourselves, our staff, and our patients as safe as possible. Personal protection starts with frequent hand-washing and sanitizing our areas.


Social distancing will help slow the spread of the virus and the illness for our patients and staff. But the main point of social distancing is to slow the spread of the virus and illness and preserve our health care system so it is not swamped by an abrupt spike in cases that outnumber our medical and hospital resources. This is what is meant by “flatten the curve.” That’s why we are seeing the non-critical cases in our centers. Every case we triage as appropriate for us to see preserves an ER visit, hospital bed (and scarce PPE) for those who most need it: mainly the very sick and the elderly with underlying conditions.


So far, our methods for social distancing are the ones you’ve heard of:  maintaining a distance of 6 feet from others, directing patients with non-urgent conditions to visits by telehealth triage, evaluations and virtual visits, and directing patients with respiratory symptoms on a different route through the health center, having respiratory symptom teams to triage and treat those patients, and having “non-essential staff” (those staff not immediately needed to organize and provide care) work from home.


Earlier today you got an email with the EMR Newsletter from Martha describing “Working from home: what we are doing and why.” I know there have been questions about this and the Newsletter should help answer those.


During this COVID-19 pandemic, other industries are beginning to retool and ask staff to do new things. A few of the major airlines are now carrying freight in what used to be passenger planes (because many fewer passengers are flying). Leading designers of clothing are now beginning to make surgical masks and gowns (without their expensive logos, I hope). Distilleries are now making hand sanitizer (hand sanitizer is, after all, almost all alcohol). We’re going to see a lot of that which will both produce medical products that are scarce and preserve jobs.


As you know, we’ll be asking some staff to start performing other necessary duties now that most of our visits are converted to virtual. It’s a way of continuing to be able to provide needed care to patients and preserving our business for the long term once the pandemic subsides.


Progress at VMG


Just in the last few days we have:


  • Markedly increased the number of virtual visits with patients

  • Designed and implemented a Respiratory Symptom Triage Evaluation Team (“Respiratory Unit”) at AMC, GHC, and NHC

  • Arranged to have scrubs for staff and practitioners on those teams so they can change clothes before going home

  • Changed our messages and signage for patients about how we are focusing our services

  • Begun to cross train staff to take on other necessary tasks

  • Continued our social distancing initiative

  • Placed barriers and/or markings in reception to create greater distance between patients and reception staff

  • Practiced and completed a few lab draws in patient cars preparing for more to come


This is just a brief list. There will be more.


Once again, thank you for all you are doing to keep our communities safer. Please have a good weekend. “See you” on Monday.




March 19, 2020                                                                                                  Issue # 3


We are just a few days into the escalation of the pandemic and the work to care for patients affected by the pandemic. While there are lots of things we are not yet clear on, there are a few things that are very clear:


1. it’s not easy to keep up with the information about the virus and the pandemic and the measures being taken to keep our patients and ourselves well.

2. This is emotional work, with ups and downs daily and sometimes hourly.

3. Your work, our work, is more important than ever. We will have, and we are having, a real impact on patients’ lives. As this goes on, I have no doubt that we will be saving lives. And, that’s why we are in healthcare, right?


I want you to know that no matter how confusing and emotional the work gets, we appreciate what you are doing for our patients and communities. As this pandemic goes on, as the impact of the disease increases before it eventually wanes, we will have to learn new skills and tasks, stay focused, be patient and support each other through this.

The Latest at VMG


We have created separate work areas and entrances for patients with respiratory symptoms. This is important as we want to reduce the risk of spreading the virus to others in the Health Centers.


We have worked to come up with procedures to draw perform tests for patients in their cars in our parking lots. This is also a measure to prevent spread.


We have messages to patients going out by portal and email informing them that we are there for them with virtual visits, and for some, with precautions, for sick visits as well.


Tim Sweeney, our Smoking Cessation Counselor, has switched his meetings/groups to all virtual visits.


We still do need staff to work in the health centers, though some of you may be asked to take on other tasks, as necessary. We are also continuing to work through the policies and procedures for Work from Home to meet the needs of our social distancing efforts to slow the spread of the virus. Some staff has already been moved to work from home for identified tasks from their own department or other “new work” (for example, tasks that are important to our quality and service efforts). We have also asked staff in high risk groups (related to age and possible underlying health conditions) to work from home. We’ll have more information on this soon. If we’ve asked you to work from home, we’ll have you sign a Work From Home Agreement which list the requirements and the contact you will need to maintain with your department and supervisor. If we ask you to work from home, your pay will be just as it was in the Health Center. We will also re-evaluate all of these efforts as April 1 approaches.


Once again, I hope you and your families are well. Remember to be patient, be mindful, and wash your hands (a lot).




March 18, 2020                                                                                                  Issue # 2


I hope you and your families are well. I know it’s a confusing time. Here is today’s update.


Hand Washing and Social Distancing


I know you’ve heard this a million times by now. Hand Washing is our best defense. We should all be washing our hands with soap and water for at least 20 seconds before and after every patient visit, before and after eating, before and after bathroom visits. AND after using a device such as a keyboard, computer, cell phone, etc. (I know that this is difficult to remember because of strong habits and because of how frequently we use our devices but the more we do it, even if not every time, the better off we are). You can use hand sanitizer (60% alcohol or greater) but soap and water is preferred and more effective.


Social Distancing is also a “best practice” defense against the spread of the virus and slowing its progress through our population. We are committed to doing as much as we reasonably can to observe social distancing.


Yesterday’s update (which is now on the intranet page) provided information on steps we are taking in the health center. We have made progress on many of those steps already (moving patients from in-person to virtual visits, “red lines” taped in reception areas, reception area and conference room chairs moved, etc.). Additional steps will be necessary and taken. If you are in a meeting with multiple staff, please try to observe a 4-6 foot distance between participants. We are moving many meetings to conference call/video platforms.


We are working on some modifications to our facilities and work flows to protect staff and patients from possible viral spread. As discussed yesterday, we’re moving ahead with finding a way to segregate respiratory illness patients from others (separate entrance, separate team of practitioners and staff, parking lot “holds” until asked to enter and escorted entry and exit via as isolated walk as possible). We are looking for ways to place additional protection in the form of a barrier of some sort at reception areas which do not have Plexiglas fronts.


Outside our Health Centers, I want to encourage you to also observe social distancing. Although we want to be with our friends and family (especially in crises like these), its best to follow the CDC and WHO recommendations including:


  • travel as little as possible, even locally

  • avoid gatherings

  • avoid unnecessary meetings and social events

  • avoid contact with people who are coming from/visiting from areas where the pandemic is most active

  • wash your hands (and have family wash their hands) before and after contacts

  • clean and sanitize high touch areas frequently

  • If you cough, cough into your elbow. If you sneeze, use a tissue and throw it into the trash

  • if you are sick with respiratory symptoms of concern (cough, fever, shortness of breath), stay home and isolate from others in your household as much as possible. If your symptoms are worsening, contact your primary care practitioner


Work From Home Initiative


In keeping with our efforts at social distancing, we are in the process of (and have already made some progress with) deciding on functions that can be done outside of VMG with staff working from home. The Management Team has developed a Work from Home Agreement for those staff that we ask to work from home. Staff will be paid as if they were in the health centers under these Agreements. We may ask staff to take on some functions and tasks not normally part of their jobs, but within their skill levels.


If You Need to Care for Children or Family Members Due to School Closures or Illness, our usual sick time policies apply. We hope you will be able to make arrangements for child care. If you can’t, you will first use PTO and, if necessary, unpaid leave. We are following the talk in the state and federal government to see if any additional help is being authorized, but right now we have not heard anything definitive.


If you get sick, you will use PTO/Sick Time as usual. We will have answers to questions raised about return to work protocols and the possibility of quarantine due to COVID-19 in the next few days.


As of right now, we are not encouraging staff to take unpaid leave. With the exception of staff we are asking to work from home, we believe we have enough work to do so that would be unnecessary now. That situation might change and we’ll keep you informed.




Because of the unprecedented nature of this virus, the federal and state governments, CMS and the Division of Insurance have loosened the restrictions on the use of telehealth and billing for telehealth services with patients. We are encouraging the use of virtual visits by telehealth platforms and services (for video visits) and, if video is not available, the telephone. We’ll be gathering information on which methods seem to work best and provide feedback to practitioners and staff as we get it.


Thank you again for all you do for our patients, communities, and each other.




March 17, 2020


This newsletter is intended to update all VMG staff about our current approach to caring during the pandemic. Information in this newsletter is current as of this date. It will change, often, going forward. We will try to publish updates at least three times per week or as the situation requires. We will also post these on the intranet. PLEASE NOTE: This is not a comprehensive summary of all we are doing. There will be further updates on these and other topics. I’m sure there will be more questions and some topics may require a separate “discussion.”


First, thanks for your service and dedication during this very confusing and difficult time. All of us appreciate your efforts to provide care and support to our patients and colleagues.


VMG’s Goals During the Pandemic


We have several overlapping goals that need to be balanced:


1. Care for our communities by taking whatever reasonable measures we can to limit and slow the spread of the virus

2. Care for and comfort our patients in the best way possible, given the limitations of the pandemic

3. Care for and comfort our staff and practitioners and afford whatever protection we reasonably can


Here’s how we are initially trying to meet these goals:


Slow the Spread of the Virus


The first priority is to limit and slow the spread of the virus. As of now, there is no vaccine and no specific treatment. Because of this, we anticipate that the number of infected and sick people will rise over the next few weeks and months. Our healthcare system including hospitals, labs, and providers will get overwhelmed and be short of needed resources if the disease spreads and peaks in a short period of time. If we can slow the spread (what is called “flatten the curve”), the system will deal with high, but hopefully less overwhelming, numbers at any given time.


The main methods of slowing the spread will involve seeing fewer patients in person, doing more phone and virtual visits, and social distancing in the health centers. Other approaches may be identified as we go and some of the information below will have to be modified or elaborated. The methods below are being implemented through April 1. We will reevaluate prior to then.


In Primary Care:

  • We are canceling/postponing all non-essential visits and procedures through April 1 (and we may need to continue beyond April 1)

  • We will continue to see sick patients, as needed, many of these by phone or other telehealth platform

    • We are working on creating separate areas to see patients with respiratory symptoms

    • We are also working on having teams of practitioners and staff who will see respiratory patients

  • We are currently working on special procedures for doing lab and other tests in patient cars, as necessary

  • We are working on maintaining and/or redesigning capabilities for “essential services” such as CSRP, INR/Coumadin management, etc.

  • CSRP patients are being notified that their prescriptions will be sent to pharmacies electronically during the COVID pandemic

  • Patients are being informed by signage in the centers, by portal, and via our web site


Ambulatory Surgical and Procedure Center (ASPC)

  • Massachusetts DPH has ordered ambulatory surgery centers to close until further notice

  • Patients are being notified and staff will either be reassigned, as appropriate, to other duties in the centers or will be taking PTO


Behavioral Health

  • Visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • Practitioners may still see some patients in the office if they decide this is clinically necessary

  • Integrated Behavioral Health will continue to work in primary care seeing patients, as necessary


Physical Therapy

  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients in pain, post-ops, and any others identified as necessary by our therapists or primary care practitioners

  • Practitioners will still consult with primary care, as needed


Eye Care

  • Visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients in pain, post-ops, and any others identified as necessary by our optometrists or primary care practitioners

  • Practitioners will still consult with primary care, as needed


Optical Shops

  • Optical shops will be closed to routine business

  • Patients with urgent/emergency needs for prescriptions, glasses, etc. can still be seen



  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients, as necessary, as determined by our rheumatologists and/or primary care practitioners

  • Practitioners will still consult with primary care, as needed



  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients, as necessary, as determined by our endocrinologists and/or primary care practitioners

  • Practitioners will still consult with primary care, as needed


Diabetes Education/Nutrition

  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • Practitioners will still consult with primary care, as needed


Sports Medicine

  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • Practitioner will still consult with primary care, as needed



  • Routine visits are being cancelled or postponed through April 1 or are being moved to phone or telehealth

  • We will still see patients in pain, post-ops, and any others identified as necessary by our practitioners

  • Practitioners will still consult with primary care, as needed



  • Mammography and Bone Density appointments are being cancelled or postponed through April 1

  • Mammography and Bone Density staff will be assigned to helping out with other modalities

  • We will remain open to VMG patients for plain films and ultrasound


Procedures are being worked out for implementing all of the above and may change as we find problems or better ways to manage.


Issues about staffing and possible “re-deployment” are also being worked out now and more information will be coming soon.


Social Distancing Measures


Here’s what we are doing to maintain social distancing for those in the health center:


  • We are canceling non-essential meetings and moving most other meetings to conference calls or other virtual meetings

  • We are trying to limit travel between health centers

  • We have moved and reduced reception area furniture (and some meeting rooms) so that chairs are separated appropriately

  • We are in the process of designating certain exam rooms and other areas for those with respiratory symptoms

  • We have placed new markings in reception areas indicating where patients should stand at the right distance

  • We are working on additional methods to offer the best protection to our staff and practitioners and we’ll discuss further as these are developed

  • Signs have been placed on our doors and information posted to our web site and portal, and email messages have been sent, telling patients with fever, cough, shortness of breath to call us instead of walking into our buildings

  • We are investigating ways to triage in patient cars in our parking lots, as possible and indicated

  • We have notified all non-VMG services (e.g., tai chi and yoga instructors) that we are closing their access to our buildings until further notice (with the exception of our tenants)


Moving to Work From Home, Where Possible


We are in the process of identifying VMG functions and staff that can be done “from home” during the pandemic. Managers and supervisors are working out start dates, equipment needs, policies and procedures now.


Staffing During the Pandemic


We recognize that some staff will have to take time to care for children and/or family during the pandemic. Schools and other institutions are closed and child care/sick care may be difficult to arrange. We will work with staff and supervisors to be as flexible as possible in taking care of family needs, without penalty. We will need to move staff around as carefully as possible to make sure we can staff our essential services.


If You Are Sick


We want you to stay at home and take care of yourself.


If You Are Not Sick


The best things you can do to stay well are the ones you have already heard about (a lot): wash your hands before and after any patient contact, before and after eating, before and after the bathroom. Wash for at least 20 seconds. Soap and water are best (more effective than hand sanitizer).


By the way, hand sanitizer is very difficult to get now. In order to preserve what we have, we removed some bottles of hand sanitizer from areas where there is easy access to sinks (soap and water).


There has been some confusion about other Personal Protective Equipment (PPE). Almost all PPE is in very short supply now. We are trying to use only what we absolutely need to perform our functions and to preserve the supply of certain PPE for very high risk areas in the community as well as in VMG (i.e., hospitals).


Routine use of masks is not recommended for staff. Since the virus is mostly spread by droplets, patients with active symptoms should wear a mask. Certain higher risk procedures will require PPE and we will have separate policies and protocols for those uses. You can get further information from Practitioners and Nursing Leaders in your health centers.


Covidquestions email


Thank you for sending your questions and concerns via this email box on our global address list. We are trying to reply as soon as possible but it is taking longer than anticipated because of the volume of messages and the changing information available.


This is an evolving situation. We greatly appreciate all your efforts. We’ll continue to update you on goals, policies and procedures as new information is available.


Please remember this phrase: Be Patient, Be Mindful. It’s going to require a lot of patience in this confusing and trying time. Patience with each other and with ourselves is vital. Be Mindful means be aware of your feelings, your goals, and intentions and how they influence your behavior.


Thanks again for all you do. We’ll get through this together.



Eggplant 3-11-20 Regarding Coronavirus

Valley Medical Group, P.C. Staff Newsletter           Vol XX, Issue 2, 3/11/20


By now, you are all aware of the coronavirus pandemic (according to the World Health Organization, a pandemic is the worldwide spread of a new disease and COVID-19 is now classified as a pandemic illness). Information about the impact of the virus and the disease caused by the virus (COVID-19) is changing daily. While the local impact is not yet severe, we do need to prepare as best we can for the likely spread of the illness and its effects. Here’s what we are doing at this time to keep patients, staff, and our communities as safe as possible.


1. We are closely monitoring the world-wide and local COVID-19 situation. We are following the guidance and recommendations of the CDC and the Massachusetts DPH as well as local public health authorities and we are staying in close touch with our local hospital systems to coordinate care and share ideas and expertise.


2. We have established an “Incident Command Structure” to better organize and coordinate our information flow and prevention and mitigation activities led by Gina Campbell, VMG Incident Commander and our VP for Clinical Operations. All decisions, actions, and communications at VMG related to the pandemic will be coordinated through this structure. The Incident Command Team and Leadership are meeting daily to monitor the changing information and situation and take appropriate actions.


NOTE: (You may not be familiar with the term “incident command.” It’s a term used in healthcare and other industries to designate a structure and communication process to deal with unusual crises. We have used a structure like this before, most recently with the Halloween ice storm of 2011).


3. In order to help slow the spread of the virus, we are notifying patients with symptoms of COVID-19 as identified by the CDC (fever, cough, shortness of breath, flu-like symptoms) NOT to come to the health center. Rather, we’re asking them to call first to speak with triage.

o   Patients are being notified by portal via email blasts, VMG website, and message on hold. There will also be a message on the appointment scheduling page of the portal.

o   We are posting signs on our entrances asking patients who have symptoms NOT to enter the building but to call (number provided) for triage


4. In order to help slow the spread of the virus, we will be requiring staff who have symptoms of flu and/or COVID-19 to stay at home until their symptoms resolve. We’ll have more information about sick leave and the use of PTO and “return to work” policies soon.


5. We are considering work from home policies and capabilities (for those whose jobs are suitable) in the event that we have to close or curtail our activities in the health centers.


6. We are reviewing and revising cleaning and disinfecting procedures at all of our sites and we are appropriately monitoring and providing supplies for cleaning and for personal protection, following the recommendations of the CDC.


7. In order to slow the spread of the virus we are identifying and changing appropriate in-person meetings to conference calls and/or cancelling/postponing meetings. We’ll keep you informed if a meeting you were to attend is cancelled or postponed. For now, all scheduled Brown Bags are cancelled until further notice. (We’ll arrange to round instead).


8. We will be providing appropriate education to staff and patients based on information from authoritative and trusted sources (mainly the CDC and Mass DPH) on a regular basis.


9. There is currently no test available locally for COVID-19.  We have been told that testing will be available in about a two week time frame. We will announce when testing is available as well as the indications and procedures for testing.


10. There is currently no vaccine or specific treatment for COVID-19. The emphasis now is on stopping/slowing the spread of the virus. Practitioners and clinical staff will use clinical judgement as to recommending “stay at home” and supportive treatment and or referral to other more intensive facilities.


11. See the fact sheet links below for the best advice on preventive actions and managing symptomatic patients.



Information and recomme