Not long ago, Telemedicine was something that I read about. Now, it’s something I do. Over the past weeks I have been evaluating
patients over the phone from home. It
has been an adjustment, but it has been smoother than expected. First, I have always thought that the
physical examination is overrated. Yes,
I recognize that such a declaration constitutes medical blasphemy, but I stand
by it. Don’t extrapolate beyond my
actual meaning. I am not suggesting that
the physical exam is superfluous.
Indeed, there are many circumstances when the exam is absolutely
critical. However, for a good bulk of
the routine gastroenterology patients I see, particularly for those who are
returning to my office for a follow up visit, the exam contributes little value.
Here is a sampling of patient visits where the history alone
is largely sufficient.
- A patient with years of chronic constipation returns to see me for a 6 month follow up visit.
- A new patient sees me to evaluate frequent heartburn.
- A college student returning from a spring break camping trip in Central America sees me for diarrhea.
- A 35-year-old new patient is referred to me for abdominal cramps that occur after eating dairy products.
- A 65-year-old asymptomatic patient is sent to me with occult blood in the stool.
For cases similar to those I listed above, it is highly
likely that I could obtain sufficient information simply from the patient
interview – a hands free encounter. This
is why telemedicine can be a highly functional modality for treating patients. And, while it is beyond the scope of
this post, technology exists and will be further developed that will allow for
many aspects of the physical examination to be performed remotely. Even without futuristic technology, we can
evaluate a patient’s appearance skin, pharynx, speech, joint mobility,
respiratory effort and ambulation through the miracle of video
transmission. And, a patient can palpate
their own abdomen and report if it is tender.
Do you think you could canoe up a waterfall?
My telemedicine encounters have been nearly all conducted by
phone, and they have gone well. At
times, patients have needed to have
their expectations revised. For example,
if I have a phone visit with a patient whom I have never seen, who has years of
unexplained abdominal distress and has seen digestive specialists and had
emergency room visits, it would seem unlikely that a new physician will crack
the case on the phone.
As I have written throughout this blog, I lament how
technology has exacted a cost on the doctor-patient relationship, much as it
has eroded humanity and intimacy writ large.
To reclaim what has been lost would require canoeing up a steep
waterfall. It can’t be done.
After the pandemic has passed, I hope that I can return to
my conventional office practice, which for me is the ideal setting to practice
medicine. But who knows what the new
normal will be.
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