telemedicine

[Rmweiss]

Wondering if anyone has experience working in telemedicine.  I have a full time EM job, but have lots of blocks of time off and would enjoy working from home some vs picking up more shifts in the ER for a change of pace.  

Anyone have experience, tips, thoughts on telemedicine?

Thanks

[thinkertdm]

My thoughts about telemedicine: its not real medicine.  You are pandering to two groups- the first is to a group of overly anxious people who are too "busy" to put some skin in the game to actually go to a medical provider about a concern and think that "calling" or "videochatting" or whatever will address their concern.  Which it won't in most cases- in my mind, the actual magic happens in the exam room.  You can see, hear, smell, and feel things that lead you to a diagnosis, and you can't get those things from a phone.  

Here's one: a UTI.  How many times has a patient come in and said they have a UTI but wasn't?  Can you have a UTI and STD concurrently?  Can you have bladder cancer show as a UTI?  Especially if they see a different telemedicine provider every time.  how many times have they been seen for a UTI before someone picks up that maybe it's not a UTI?  

Here's a better example: back pain.  you can't see how they are sitting.  Can't test reflexes.  Can't check CVA tenderness.  Can't watch them walk around the exam room.  

My point is that if it can be handled via telemedicine, it probably will go away on it's own in a few days.

Of course, one could argue that this information can be obtained simply from a good history- but the telemedicine visit isn't geared toward time, it's geared towards throughput and money.  Which brings me to the second group it benefits- the stockholders.  Because it is purely a financial money maker and not geared towards health.

PS I do not feel adding "patient advised to go to ED if symptoms worsen" is good medicine either.  which is what you would do after every telemedicine visit.

PPS: one could argue that telemedicine brings health care to distant sites.  As I explained above, it's not medicine; also, PA's bring health care.  hire them.

PPPS: I do use it now for going over blood sugars and blood pressure readings.  Labs ok. 

I just hate telemedicine.  It is the wave of the retail medicine future.

[Reality Check 2]

The VA is making us all certify in the ability to do telemedicine visits. 

I don't plan on using it. My panel is full in my brick and mortar building and I don't have many open slots. I will certify per requirement but hope it just floats away into my toolbox of stuff I CAN do but don't. 

I don't favor telemedicine. Thinkertdm above cited most of my reasons. It can border on malpractice and is not useful in strep vs mono, CHF vs pneumonia, UTI, STD, Back pain vs flank pain vs rupturing AAA. 

It has worked some on psych patients needing a check in or to discuss behavioral aspects of diabetes, etc.

My past experience was employees being coerced by their employers to use telemedicine while at work rather than take time off, be sick, get better and not infect their coworkers. Nothing like talking about vaginal itching while hiding in a broom closet at your work while your supervisor counts how many minutes you are using.

It works in remote situations when there is a licensed provider on EACH END OF THE TELE. Such as remote Alaska with a PA skyping with a cardiologist in Anchorage or Seattle using technology to watch, listen to a heart and make joint decisions. 

Otherwise, I hope it goes the way of Beta Max and dies off. A few law suits and a few more providers losing their licenses because of working across state lines - and it will be done.

I will stick with eyes on, hands on, spidey sense and a real physical exam. 

[thinkertdm]

1 hour ago, Reality Check 2 said:

The VA is making us all certify in the ability to do telemedicine visits. 

I don't plan on using it. My panel is full in my brick and mortar building and I don't have many open slots. I will certify per requirement but hope it just floats away into my toolbox of stuff I CAN do but don't. 

I don't favor telemedicine. Thinkertdm above cited most of my reasons. It can border on malpractice and is not useful in strep vs mono, CHF vs pneumonia, UTI, STD, Back pain vs flank pain vs rupturing AAA. 

It has worked some on psych patients needing a check in or to discuss behavioral aspects of diabetes, etc.

My past experience was employees being coerced by their employers to use telemedicine while at work rather than take time off, be sick, get better and not infect their coworkers. Nothing like talking about vaginal itching while hiding in a broom closet at your work while your supervisor counts how many minutes you are using.

It works in remote situations when there is a licensed provider on EACH END OF THE TELE. Such as remote Alaska with a PA skyping with a cardiologist in Anchorage or Seattle using technology to watch, listen to a heart and make joint decisions. 

Otherwise, I hope it goes the way of Beta Max and dies off. A few law suits and a few more providers losing their licenses because of working across state lines - and it will be done.

I will stick with eyes on, hands on, spidey sense and a real physical exam. 

We have to do like two a month.  My biggest problem is that 90% of my panel is 75 or older, the fastest adopter of new technologies.

In a worst case scenario have the patient in another room and do your vvc from there, if they want you to do x number.

I have found it's handy to touch base for blood sugars.  Someone said to talk to patients about labs, which I find ridiculous.

"Hi Mr Smith, would you like to set up a ridiculously complex video chat to talk about your labs later?"

"How about now?"

"..."

 

[Reality Check 2]

If you factor in the number of hearing aids my panel wears multiplied by the number of smart phones they can't operate - telemedicine is laughable. 

I have to remind at least 2 people a day that their phone is ringing in their pocket but they can't hear it and then can't figure out how to shut it up.

Some of my older folks are tech savvy - and Dr Google just will NOT go away. 

I just keep telling folks that I LOVE seeing them in person - body odor and all - if it means we make a connection and we do something positive.

Then CPRS crashes and I write things down on paper anyway........