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I work at the VA and really don't like telemedicine. Never have, never will. I have the capability but don't use it and 95% of my patients don't request it or want it. 

We have a telehealth division with RNs who work to monitor chronic conditions with patients - they do a lot by phone and some by video. They are very helpful and good at what they do. 

Half my patients can't operate a smart phone much less a video appt and they can't hear sitting 4 feet from me with hearing aids so any type of video/audio thing is a nightmare. 

Telemedicine has its place - it does. Just not with me and what I do.

Yes, if coronavirus becomes the new Spanish Flu - we will need all the NOT hands on we can handle. 

I still see telemedicine as a corruption of the ART of medicine and hands on patient care.

Just my crusty old 2 cents.

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I hate telemedicine. They are pushing that where I work. They fixed cameras on all the monitors in the exam rooms.... and the docs keep pulling them off and tossing them aside lol. They do have little covers on them. 
 

I think telemedicine just cheapens and disrespects the medical profession. This is the CVS/Walgreens sweatshop crap that the pharmacists fell into. It depersonalizes the patient-provider relationship even more. 
 

I refuse to encourage it or promote it. I’ll do it only if I have no choice. Gross. 

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3 hours ago, Reality Check 2 said:

I work at the VA and really don't like telemedicine. Never have, never will. I have the capability but don't use it and 95% of my patients don't request it or want it. 

We have a telehealth division with RNs who work to monitor chronic conditions with patients - they do a lot by phone and some by video. They are very helpful and good at what they do. 

Half my patients can't operate a smart phone much less a video appt and they can't hear sitting 4 feet from me with hearing aids so any type of video/audio thing is a nightmare. 

Telemedicine has its place - it does. Just not with me and what I do.

Yes, if coronavirus becomes the new Spanish Flu - we will need all the NOT hands on we can handle. 

I still see telemedicine as a corruption of the ART of medicine and hands on patient care.

Just my crusty old 2 cents.

 

2 hours ago, GMM2019 said:

I hate telemedicine. They are pushing that where I work. They fixed cameras on all the monitors in the exam rooms.... and the docs keep pulling them off and tossing them aside lol. They do have little covers on them. 
 

I think telemedicine just cheapens and disrespects the medical profession. This is the CVS/Walgreens sweatshop crap that the pharmacists fell into. It depersonalizes the patient-provider relationship even more. 
 

I refuse to encourage it or promote it. I’ll do it only if I have no choice. Gross. 

Amen. 
 

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Telemedicine makes costs go up, way up.

Reason?  In the "bad old days" before telemedicine if people got a cough or runny nose it's a hassle to go to the doc so they just wait it out and get better after a few days.  Cost to health system = $0

Nowadays in telemedicine world, you get a runny nose for 30 mins and it's an emergency that's gotta be dealt with ASAP so they call Teladoc and get a script for azithromycin.  Cost to health system = ridiculous for a trivial complaint that would have gotten better on its own anyways.

 

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5 hours ago, TexasPA28 said:

Telemedicine makes costs go up, way up.

Reason?  In the "bad old days" before telemedicine if people got a cough or runny nose it's a hassle to go to the doc so they just wait it out and get better after a few days.  Cost to health system = $0

Nowadays in telemedicine world, you get a runny nose for 30 mins and it's an emergency that's gotta be dealt with ASAP so they call Teladoc and get a script for azithromycin.  Cost to health system = ridiculous for a trivial complaint that would have gotten better on its own anyways.

 

I understand the argument that it makes it easier to seek care for trivial self limiting things. My experience is people who don't pay for their health care are just as prone to do this in person anyway. When there is a cost...any cost...this behaviour is lessened.

People are people. Having a bit of financial skin in the game seems to change behaviour more than ease of access.

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11 hours ago, sas5814 said:

My experience is people who don't pay for their health care are just as prone to do this in person anyway. When there is a cost...any cost...this behaviour is lessened.

The city where I went to PA school, there was a program for free primary care for the severely poor (beyond medicaid poor).  It was terribly abused by patients who showed up almost every day, and some multiple times per day.  The problem was solved almost immediately and completely when they instituted a $1 copay policy.  Most of the providers didn't even collect the $1, but just the notion of it basically solved the problem.

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I object to telemedicine when forced upon the provider or the patient.

Several large businesses in my area were pushing it on employees so they wouldn't leave the workplace.

Literally, go find a quiet closet or room and Skype with some random provider about the symptoms that would send a normal, rational person home to convalesce. Sore throats, fevers, UTIs with flank pain, rashes.

Now that we have coronavirus and folks are actually being TOLD to stay home - maybe telemedicine has a brief purpose - make sure someone doesn't need respiratory support and TELL THEM TO GO HOME or STAY HOME. 

Our society has lost sight of the need to heal and the detriment of working while sick - making bad decisions, infecting coworkers and general stupidity. Now, don't stay home for 3 sneezes but use some freaking common sense. 

As in the ART of medicine - we need to change some priorities away from satisfaction scores and technology and take a step back to common sense and human interaction.

Yep, I am crusty today......

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1 hour ago, Reality Check 2 said:

Our society has lost sight of the need to heal and the detriment of working while sick - making bad decisions, infecting coworkers and general stupidity. Now, don't stay home for 3 sneezes but use some freaking common sense. 

As in the ART of medicine - we need to change some priorities away from satisfaction scores and technology and take a step back to common sense and human interaction.

Yep, I am crusty today......

 

Agreed, but most people can not stay home.  They are not offered sick time or even PTO for that matter and they can not miss the paycheck.  We have no safety nes in this country and the mentality is "you show up for work regardless, or we will find someone to replace you...."

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I hate telemedicine. They are pushing that where I work. They fixed cameras on all the monitors in the exam rooms.... and the docs keep pulling them off and tossing them aside lol. They do have little covers on them. 
 
I think telemedicine just cheapens and disrespects the medical profession. This is the CVS/Walgreens sweatshop crap that the pharmacists fell into. It depersonalizes the patient-provider relationship even more. 
 
I refuse to encourage it or promote it. I’ll do it only if I have no choice. Gross. 
Just wait for AI. Its coming after radioligists 1st.

Sent from my SM-N975U using Tapatalk

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  • 1 month later...

I get that Telemed is a crappy option...but as everyone points out, it's here, big time.  That being said, an exhaustive search on this forum did not find a definitive discussion thread for the following questions, wondering what y'all think.

(1) Being that telemed is a reality, especially now during this mess,  what are the legal pitfalls? Are providers, at some point, going to sued en masse due to lack of physical exams?  Like, do we (or the AAPA) have an official stance as to whether PAs should truly be engaging  in telemed?  All I could find on this forum are a wide range of opinions, but no hard guidance or personal employment experiences...

(2) I notice a lot of "cold" telemed jobs online that are willing to take PAs...these seem to be mostly "prescribing" jobs (evaluate patient for men's health supplements, OCPs, ED meds , etc etc)...are these all too risky to work at? 

(3) Does anyone here actually work telmed primarily, and what are the medico-legal guidelines your employer gives you? Are you pressured to do things like rx ABX without physical exam, or are you given the latitude to say "I'm not comfortable prescribing this over the phone without listening to your lungs" etc?

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Telemedicine

 

The horse is out of the barn.....  can't get it back in...

 

now I think there is some realm for it - chronic care patients that you would like to check in on more frequently

 

Having had a house call practice it would have been very helpful to have the ability to alternate in person and house call visits - and helped productivity.....  

 

But as an acute care, occ health or urgent care clinic, nope now way...

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I am stuck with phone visits and the awful video thing right now - no choices. My patients live in 4 different states. The only saving grace is that I am federal. 

Will I use it in perpetuity for practicing medicine - NO. Just NO.

No one has really ironed out all the legalities - no one stops the machine long enough to see how it works. No one ever does. If it sounds like a good idea - let's do it......

Right now during COVID - no one really cares either.

I have been told to continue to make "clinical judgements" as appropriate for prescribing. 

Not a solid guideline. When someone is so short of breath they can't speak and need respiratory support and you tell them to go to hospital or call 911 - that is clinical judgement. The patients don't necessarily like it but I tell them it is what I would do for a family member. When someone says their knee has hurt for 5 yrs and they want hydrocodone. I say No, let's try some other things. That is clinical judgement and the patients certainly DO NOT like it.

I imagine there are lawyers on both sides currently looking at this mess and coming up with a branch of telemedicine legal - and you will see the TV commercials just like "did you or someone you love take THIS medicine and die?". I can hear the voice now "Have you or someone you love been forced to use video for medical treatment and suffered injury or illness? We are here to help. Call 1-800 SHARKS." 

I hope there are no PAs being forced into 100% video medicine or choosing it for that matter. It isn't real medicine but is helping during a pandemic. That's the best I can say.

Would love to hear from attorneys on this one - I said that. Damn these are tough times.

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On 3/2/2020 at 12:02 PM, TexasPA28 said:

Telemedicine makes costs go up, way up.

Reason?  In the "bad old days" before telemedicine if people got a cough or runny nose it's a hassle to go to the doc so they just wait it out and get better after a few days.  Cost to health system = $0

Nowadays in telemedicine world, you get a runny nose for 30 mins and it's an emergency that's gotta be dealt with ASAP so they call Teladoc and get a script for azithromycin.  Cost to health system = ridiculous for a trivial complaint that would have gotten better on its own anyways.

 

Those people would end up in the ER normally.

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  • 2 months later...
On 2/26/2020 at 9:55 AM, GMM2019 said:

I hate telemedicine. They are pushing that where I work. They fixed cameras on all the monitors in the exam rooms.... and the docs keep pulling them off and tossing them aside lol. They do have little covers on them. 
 

I think telemedicine just cheapens and disrespects the medical profession. This is the CVS/Walgreens sweatshop crap that the pharmacists fell into. It depersonalizes the patient-provider relationship even more. 
 

I refuse to encourage it or promote it. I’ll do it only if I have no choice. Gross. 

I would Fkn Murder for a telemed job. 

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I had a family member call me yesterday about her daughter (early elementary age) who had fever and a stomachache.  I called and immediately said "What do you think that I'm going to tell you?"  Too many possibilities and without an assessment it's just a guessing game.  Apparently went and saw someone (not sure if PCP) and their suspicion is that she has salmonella due to kissing a pet snake at her dad's house with a wife whom I've never met but by other's statements I probably don't need to (family member and dad no longer married).  🙄

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On 3/3/2020 at 2:10 PM, Cideous said:

We have no safety nes in this country

No safety nets in this country?  Really?  Well, here's a few:

https://www.medicaid.gov/
https://www.ssa.gov/benefits/disability/

https://yourtexasbenefits.hhsc.texas.gov/programs/tanf/families  - Texas specific

https://www.twc.state.tx.us/ - Unemployment for Texas.  Oh, and remember that additional $600/month unemployment benefits that is funded by the feds.

In case you have patients who need housing assistance in the Dallas area:  https://dhantx.com/.  Every other area has somewhat similar safety net for housing.

Kids need to eat for free in the summer, right?  There's a program for that too:  https://www.fns.usda.gov/nslp

So, we have a safety net for health care, for the disabled, for the unemployed, for those without a home, and for those who need to feed their kids.  Oh, and TANF to cover anything else.

What we don't have is a culture that encourages people to have a few months of savings instead of buying the new $1,000 iphone every year.

Edited by Boatswain2PA
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Too bad we cant actually have good discussions like this MediMike.  You had a good rant there.

I didnt say we had a perfect safety net.  We dont, and we never will because it doesnt exist.  The more robust safet net we have, the more some people will take advantage of it, and the more perverse incentive some people will have to use it instead of work.  Meanwhile the more uncomfortable we make our safety net, the more people will fall through the holes.

 

I replied to Cid's erroneous statement that "we dont have a safety net", and showed that we do indeed have one.

 

Regarding the Covid post - There are densely populated areas that were hammered, thinly populated areas that have been barely affected (The county I am in right now has seen ZERO cases), and everywhere in between.

Perhaps someday the mods here will ket us have political discussions without bashing on each other, or shutting down the conversations as almost everything we do in healthcare has political consequences.

 

Back to the OP

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