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Has anyone here ever worked a position that was purely telemedicine (ie. completely remote/practicing from anywhere). I was wondering if any of these U.S. positions are feasible to do from overseas in locations where PAs have not been adopted into the healthcare system locally. Some of the job descriptions sound like they could potentially be done completely remotely. Curious if anyone has had experience with this and what it was like.

 

 

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Telemedicine represents a threat to the income of the PA (and Physician) working in the United States. That may sound alarmist but consider what happens to demand for face visit when telemedicine is implemented. Patients don't need to drive to appointment, don't need to hunt for parking in medical facilities, don't need to wait in lobbies, don't need to wait in exam room for physician, don't need to wait for orders to be written and scrips to be handed to patient, don't need to deal with rude front office staff, don't need to listen to rude medical assistants. The overhead for patients for a ten minute office visit can be substantial waste of time. For people who work for a living (I'm omitting the millions of people who are on Medicare, Medicaid, SSDI, Disabled Veterans, etc), using time effectively is important because these are still contributing to society.  Primary care, psychiatry, urgent care are just the beginning. The only thing that keeps jobs protected are State and Federal laws that serve no purpose other than imposition of trade barriers. If State and Federal governments remove all restrictions to free trade in healthcare, foreign manufactures will bypass pharmacies and deliver direct to patients. Patients will bypass doctors for prescriptions and order their medicines direct from overseas pharmacies. Doctors and other health professionals in Eastern Europe, India and China will sit at computer terminals and see patients for sixteen hours a day in exchange for two bowls of rice and a cot. The AMA and Physicians think they will keep this from happening but they weight of overwhelming costs of health insurance and hospital care will break the bank of third party payers. Governments will have to relent to save the system from collapse. To date, every major health systems is using telemedicine in the areas I noted above (urgent care, primary care and psychiatry). Kaiser, Providence, VA, etc all do it. 

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That post not only makes several excellent arguments in favor of the appropriate use of telemedicine, it also turns into a classic example of the Slippery Slope argument - or more accurately, the Slippery Slope fallacy.

 

https://en.m.wikipedia.org/wiki/Slippery_slope

 

Basically, 1) yes, there are a lot of benefits to patients (and also to providers!) in the use of telemedicine... sometimes. And 2) there are plenty of other good reasons for traditional, face-to-face office visits.

 

So no, telemedicine is not going to be the death knell for everything we do.

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I think anyone who works in telemedicine should not be exclusive to that genre. You cannot give up hands on evaluation and the knowledge of human anatomy and physical exam skills. Combining the two would provide for the best scenario - if there is one.

 

My personal take on telemedicine is that it is not a good idea and something I do not plan to participate in.

 

I can see its use in remote areas for specialists that are hard to come by. I have seen cardiologists do remote evaluations with audible stethoscopes, live EKG and good camera - BUT, there was a licensed practitioner on the other end - with the patient. It was two folks working collaboratively on someone who could not be transported due to condition, weather, location, etc. 

 

Skyping with someone in a broom closet of their factory that doesn't want them to leave to get checked out for illness - eeewww. Just sounds sketchy all the way around and subpar for ethical medical practice.

 

A psychiatrist (are there any?) working with a patient could be feasible. Can still see body language, can still hear speech patterns. It has potential. I would just hope for someone licensed on the patient end to intervene when the patient claims suicidality or desire to harm others or is completely unstable and needing of emergent care. 

 

The whole diabetic thing kind of leaves me wanting. A stable patient without neuropathy who needs a hands on foot exam once a year might fly. Most of my diabetics are multi system issue - HTN, hyperlipid, hypothyroid, hx of MI, CHF, etc etc etc. Those folks really need a face to face with an accurate weight on a same scale for comparison.

 

So, for the OP. I don't think a provider SHOULD work exclusively in telemedicine - complete loss of skills. 

 

As far as telemedicine as a whole - meh, not a fan. It has its roll but it certainly is not a replacement for family practice, UC/EM.

 

My old 2 cents.......

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Hi everybody~ I’m Nichole Tian from Blue Fountain Media, an agency headquartered in NYC.

We are working on a project to explore ways to improve the telemedicine consultation experience. We would like to invite you to participate a short survey to help us learn about your basic workflow.

The survey only takes 3 minutes to complete. Your responses are completely anonymous and no information will be shared with third parties.

If you are interested, please fill out the survey: https://goo.gl/forms/WbA4enIdq4sYgqKh2

Your input is extremely valuable and we appreciate your participation. Let’s work together to give telemedicine a better future!

Best,

Nichole Tian from Blue Fountain Media

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The Texas Medical Board tried to keep telemedicine out of Texas and got slammed in court. Like previous posters I see some limited utility in the service. What I see in reality is you call or have a visual connection and you get what you...typically for me antibiotics and steroids for conditions where it isn't needed or appropriate.

It will evolve I have no doubt and we will start to see some of the evolutions soon based on some conversations I have had with some folks a lot smarter than me.

Until then I'm with Reality... meh.

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Nicole I checked out your survey. Interesting that PA wasn't a default choice of identity but rather I had to choose "other" and write it in.

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There was an awesome neurosurgery telemedicine program at Walter Reed where a PA would see the patients at the remote site, work them up, present surgical candidates to the surgeon via a weekly teleconference; after surgery the pa can follow up with wound care and follow up via teleconference.  The patient is there too.  This is versus a bullshit pay 15$ to get "looks tired" and a zpack "telemedicine".  One is expanding coverage to distant sites and underserved areas, while other is a cash cow that increases press ganey scores.

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The telemedicine companies like teladoc are a joke.  They claim to follow "evidence based guidelines" including not distributing abx without a good reason, but that's a load of shit.

I've seen MULTIPLE docs on teladoc hand out antibiotics for ear infections, sinus infections, etc with no physical exam.  I've reported those clowns to the medical board because IMO that's medical malpractice.  I've also reported those docs to Teladoc for breaking their company guidelines, but of course nothign happened to them because Teladoc (and the rest of them) just pay lip service to guidelines and have no intention of following thru

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2 hours ago, nicholetian93 said:

 

 

Hi everybody~ I’m Nichole Tian from Blue Fountain Media, an agency headquartered in NYC.

We are working on a project to explore ways to improve the telemedicine consultation experience. We would like to invite you to participate a short survey to help us learn about your basic workflow.

The survey only takes 3 minutes to complete. Your responses are completely anonymous and no information will be shared with third parties.

If you are interested, please fill out the survey: https://goo.gl/forms/WbA4enIdq4sYgqKh2

Your input is extremely valuable and we appreciate your participation. Let’s work together to give telemedicine a better future!

Best,

Nichole Tian from Blue Fountain Media

 

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1 hour ago, nicholetian93 said:

Hi sas5814, thank you for your participation and reminding! We add PA into default choice now. Thanks again!!

Nicole, 

Thanks for adding PA, however, frustrating you list MD, nurse practioner, DO then remaining in alphabetical order. If you do not list alphabetically, should at least by education, MD, DO, Dermotologist, since they are physicians, then PA as education requirements are more than NP, then NP an others. Sorry if I missed another physician specialty on the list. 

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Last telemedicine patient that I saw 3 days later in person had been diagnosed by the telemedicine doc with the flu - doc didn’t bother to acknowledge her dysuria and lack of respiratory symptoms, but was very interested in her body aches, back pain and fever.  Oddly enough, no Rx for tamiflu, but was told to take 2000 mg of vitamin C daily (wtf?).

I admitted her to the ICU with sepsis from pyelonephritis.  That whole CVA tenderness thing, you know, hard to examine over the internet.

 

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On 3/20/2018 at 7:51 PM, eighthnote24 said:

Last telemedicine patient that I saw 3 days later in person had been diagnosed by the telemedicine doc with the flu - doc didn’t bother to acknowledge her dysuria and lack of respiratory symptoms, but was very interested in her body aches, back pain and fever.  Oddly enough, no Rx for tamiflu, but was told to take 2000 mg of vitamin C daily (wtf?).

I admitted her to the ICU with sepsis from pyelonephritis.  That whole CVA tenderness thing, you know, hard to examine over the internet.

 

"Please punch yourself over your kidneys and tell me how that feels."

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I may be seeing routine sleep apnea therapy follow-ups as Telemedicine soon.  I don't mind--I get a sufficient PE on new patient exam, and we're seeing some patients from 50+ miles away.  Telemedicine seems like a good way to split the difference between skipping a visit and having them drive all the way just to hear things are going OK.

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