Tom Oldt: Practicing medicine in the age of COVID – The Ledger

Since completing his residency at the University of South Florida College of Medicine nearly a quarter century ago, Dr. Sam Korley has practiced medicine in Polk County.

Born in Ghana, raised in California, educated across America and kin to a number of other medical doctors, Sam Korley is an internal medicine physician and founding partner of the IMA Medical Group. He enjoys the rare distinction of having among his patients an unusually large number of other medical doctors a remarkable sign of the professional esteem in which he is held by his colleagues.

Since completing his residency at the University of South Florida College of Medicine nearly a quarter century ago, Korley has practiced medicine in Polk County. His patients have ranged from the reasonably young to the exceptionally old at the time of his death, the most elderly of his patients was well into his 108th year. The gentleman in question attributed his longevity to four factors: good genes, a great marriage, a positive attitude and the ministrations of Dr. Korley.

Q. Where did you grow up and who were the major influences in your childhood?

A. The people that influenced my career and my life the most were my parents who were both business-minded, very hard-working people. And I had a number of family members who were physicians. In total at this point, there are nine doctors on both sides of the family. But there were two in particular, one in California and another in Canada, who were instrumental in shaping my thoughts about which direction I wanted to go.

Q. Why did you go into medicine?

A. Because of seeing people suffering and feeling the need to be a part of the solution that and a love of science. From a very young age, I was always interested in the sciences.

Q. You had a solo medical practice for a number of years. You left that to become a founding member of the IMA Medical Group, which has 60 doctors across Central Florida. Why the change, and is the era of the solo practitioner over for all practical purposes?

A. Youre seeing this across the country. Its become more and more difficult to remain as a solo practitioner. The dynamics as it relates to insurance and everything else has made it more difficult to survive as solo practitioners, and thats true even in the sub-specialty groups nowadays. There are a lot of clinicians who are getting together in smaller groups or joining large groups mostly because of economies of scale really, just being able to survive because solo practice has become simply too difficult from a business standpoint.

Q. Of the diseases you deal with on a daily basis, which are the most preventable and why have we seen such an explosion in some of these afflictions?

A. Diabetes is one that comes to mind, especially among younger individuals. Obesity, the lack of exercise, our youth spending more time sitting behind devices, nutrition that needs to improve across the board those are some of the things that we as a medical community can make some headway on in terms of modifying the way people think and lead their lives. It is a difficult, arduous task since it requires a multi-disciplinary approach in managing diabetics, and its clearly a difficult condition that seems to be growing. In my practice, Im also seeing greater instances of hypertension, which is manageable by reducing sodium intake, increasing exercise and taking medicines regularly.

Q. Do you think people have become less responsible or more resistant to doing what is necessary? What are the dynamics youre seeing?

A. Its a combination of both. People somehow need to be reminded to do the basics. We have to be upfront with certain patients to help them recognize what could happen if these various diseases that lead to difficult complications are not addressed fully.

Q. How has COVID-19 changed the way you and your colleagues practice medicine?

A. The fact still remains that in clinical medicine, the history and the physical account for 70% to 80% of the diagnosis. So being able to sit a patient down and get a complete history is important and providing a clear, full physical examination is equally important. A face-to-face examination is extremely important.

As we all know, COVID-19 is an unprecedented pandemic and it is an evolving problem. It has ushered into our practice style tele-health, which has a number of advantages and disadvantages as well. Sometimes there are technical problems in reaching patients they may not have the ability to interact on their computer or their phone. There are patients who are hard of hearing, and thats a problem. If you have to examine a patient, there are drawbacks to telemedicine because you may not be able to get a clear view of their problem in order to provide a proper and adequate response. In those cases, obviously, we make arrangements to bring them into the office.

Q. Some people politicians mostly seem intent on downplaying the severity of the virus including its effect on the bodies of those who become sick but recover. And yet there is accumulating evidence that recovery can be very lengthy and not always complete for many people who contract the virus. What is your experience with the prognosis of those patients who have the disease?

A. Theres quite a bit of variability and a lot of unknowns. Patients who are otherwise healthy who contract the disease generally do well. There are exceptions of course patients who are immune compromised or above the age of 65 will most of the time end up developing complications, which makes it challenging.

Q. Have you had patients who have died from COVID-19?

A. Yes, unfortunately.

Q. Washing hands, keeping social distance and wearing a mask those are the three simple precautions that most infectious disease experts say, in the absence of a vaccine, are the steps most likely to arrest the pandemic. Why do you think a significant number of our fellow Americans find observing these rituals to be so onerous?

A. There are those who are, unfortunately, irresponsible. There are also a few people who dont believe that theres anything "going on." Nowadays more cases are among people between the ages of 18 and 44. To a certain extent, these people are healthier and are perhaps feeling less vulnerable. But I think that dynamic is going to change soon as the numbers unfold and people recognize that perhaps we should take this more seriously.

Q. Should a vaccine be developed, it is important that a large percentage of the population avail themselves of it in order for it to be as effective as possible. And yet there is a significant anti-vaccine element in this country that is prepared to launch a misinformation campaign aimed at thwarting its widespread use. If people do not trust the medical profession and the science behind the immunization program, will we be worse off than we are now?

A. The answer is clearly "yes." COVID-19 is serious and ought to be taken seriously. One thing that most of us in clinical practice and obviously infectious disease experts are hoping for is the emergence of a vaccine that is both effective and safe, and that is the basis for all the trials that are taking place currently. So once a vaccine is available, we will encourage our patients to receive the vaccine. Those that choose not to will place themselves at risk, especially if theyre elderly and have chronic medical problems.

Q. What is the phenomenon behind the anti-vaccine movement?

A. Theres no scientific basis for it. Most of their ideas have been refuted and so its unclear. I think there are certain groups of individuals who feel that they want to have "complete control of their lives" and so they dont want any interference from the medical community in terms of what they put in their bodies. Its that simple and its really concerning.

Q. What would you say to someone who said, "I dont believe in vaccines" or "I think theyre harmful"?

A. I would ask them to take a close look at whats going on with this particular COVID-19 issue in terms of the demographics, in terms of this disease that has affected the entire world, and avail themselves of information regarding vaccine development and how these vaccines are used by the medical community. The better informed most people are, I believe, the greater likelihood that they will have a change of mind and a change of heart.

Q. You, sir, are an optimist.

A. Thank you. Education is very important. I would like to see people in our county begin to take more responsibility and educate themselves better and do what is right and helpful to protect our youth, our elderly and our very sick individuals. The thing that concerns me the most is what to expect later on in the year when flu season returns. Theres a big concern in the medical community about the possibility of co-infection with influenza and how were going to approach that. So the best we can do now is try to flatten the curve and to encourage our patients to take the flu shot when the time comes.

This is a situation that can be salvaged and its something we must get a better handle on. If you look at the Europeans, theyve done an excellent job as a whole with this and I really have difficulty understanding why were not doing it. What were asking people to do is very simple washing hands, keeping distance, wearing masks.

Thomas Oldt can be reached at tom@troldt.com.