Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

Email Dr. Alice

    follow me on Twitter
    This page is powered by Blogger. Isn't yours?
    Tuesday, July 07, 2020
    Virtual Medicine

    When I retired in early January of this year I planned to come in to the office one week a month to see patients.  Then COVID came along and I found myself jumping right back into medical practice to help out my medical group. I had never done a telemedicine video visit in my career until March; turns out it isn't all that difficult. Now I work from home several days a week. I'm not going into the office for now, as I have three elderly relatives who need my help and I'm trying to minimize any potential exposure so as not to put them at risk.

    My group uses a video program which is part of our electronic medical record system, as well as an alternative which is simpler to use called Doximity. (We can also use FaceTime or Zoom, but these systems are discouraged because they don't have the same privacy protections as the other two options.) Mostly they work well, but there are issues from time to time. 

    • There's the visit where I can't hear the patient, or they can't hear me, although we can visualize each other on video. Frantic gesticulating ensues. Sometimes I have to resort to telephoning the patient while having them hold their rash, or whatever it is, up to the camera. Shingles is particularly easy to diagnose on a video visit as it can't be mistaken for anything else.
    • There's the poor data quality visit where the video screen freezes or pixilates. Watching the patient dissolve into little cubes can be offputting to say the least. ("Mr. Smith, how long have you been falling apart like this?")
    • There are occasional complications with pets - the patient's dog gets jealous or nervous and starts barking, or the cat walks across the camera's field of view.
    • And then there's my favorite, the patient (usually elderly) who simply cannot figure out how to use either of the video options. Yesterday I had a particularly memorable example of this problem. I connected to the patient via the Doximity app but they didn't pick up, so I called the cell phone and got voice mailbox which was full. I finally tried the patient's home number, they picked up - the cell phone was shut off. ("Oh, so you can't do this on the laptop?" "No, you can't... did the medical assistant explain that?" followed by a tooth grindingly long delay as the patient turned on the phone and waited for the link to come through.)  As we are booked in with patients every twenty minutes, it's easy to run late if you get more than one of these in a session.
    We can always resort to telephone visits, but the group strongly emphasizes video visits when possible. The amount of data you can get on a video visit is obviously greater than on a phone call - you can check the patient's appearance as well as their surroundings (are they dressed neatly, disheveled, short of breath, pale?) And to be honest, reimbursement for video visits is better than for telephone visits. These days that is no minor issue. The clinic has reopened but patients continue to be reluctant to come in.

    Certainly not all patient issues can be addressed via video, but I would say that overall this system has worked well. My biggest problem with telemedicine is that I need a chair with better back support. After sitting at my desk for four hours straight it's almost impossible to move...

    Oh, and edited to add that it's really special when you realize after a four-hour shift that you've been interacting with patients all the while you have a big food stain on your shirt. On the up side, though, you can work barefoot and wearing shorts because no one can see you below the waist. So there's that. 

    Labels: , ,



    Post a Comment