Sunday, July 24, 2022

Why This Doctor Gave Up Telemedicine

During the pandemic, I engaged in telemedicine with my patients out of necessity.  This platform was already destined to become part of the medical landscape even prior to the pandemic.  COVID-19 accelerated the process.  The appeal is obvious.  Patients can have medical visits from their own homes without driving to the office, parking, checking in, finding their way to the office, biding time in the waiting room and then driving out afterwards.  And patients could consult physicians from far distances, even across state lines.  Most of the time invested in traditional office visits occurs before and after the actual visits.  So much time wasted! Indeed, telemedicine has answered the prayers of time management enthusiasts.

At first, I was also intoxicated treating patients via cyberspace, or telemedically, if I may invent a term.  I could comfortably sink into my own couch in sweatpants as I guided patients through the heartbreak of hemorrhoids and the distress of diarrhea.  Clearly, there was not much of a physical exam that could be performed virtually, but as I have opined elsewhere on this blog, in most cases the physical exam is not essential.  I felt that the quality of my virtual care approached the level that I performed in my traditional office visits.  There were instances, however, when a virtual visit was inappropriate and I advised a face-to-face meeting with me.

But the novelty of the experience wore off after a few months.  Many of my patients are chronologically advanced but technically limited.  A recurrent frustration for many participants was when they couldn’t connect to the platform or activate the audio.  Those lucky enough to have a 12-year-old grandchild nearby could be easily rescued.  For the rest, my staff would be calling the patients to try to guide them toward cyber success, an exercise that burned up staff time and burned out my patients.  This demographic rapidly became disenchanted with this experience. And so did I.


Remember this?


From my standpoint, telemedicine was simply less fun.  I realize that the work of doctoring is serious business, but the personal rapport and interactions I have with patients contributes greatly to the reward of what I do.  I found that this could not be replicated with two of us staring into our computer screens.  Virtual visits are transactional experiences.  Similarly, much of America soon tired of zoom meetings recognizing that efficiency has costs.  Ever heard of the term ‘zoom fatigue’?

But telemedicine won’t be deterred as the forces favoring it are overpowering.

Wonder what the patient experience will be when conventional medical care is replaced by artificial intelligence?  How important will the human physician be then?

There is already too much technology separating patients from medical professionals.  How much time do patients watch us pecking on our keyboards during their visits?  Do you think that telemedicine and the next technological frontiers will bring patients and physicians closer together?  As technology advances, our health may be much better and we will reminisce about doctors of yore as we do today about typewriters, pay phones and the Kodak Instamatic camera.

11 comments:

  1. Thank you. I have to agree. While I will continue to do an occasional televisit due to inability to actually see the patient, the personal contact, ability to assess nuance, and physical exam make me value the in person visit, as my patients seem to.

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    1. @anonymous, glad you have added your voice to the chorus. So much in medicine and beyond has been sacrificed in favor of efficiency.

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  2. I have to agree-- I went into medicine not to cure disease but to help people and be part of their lives. And I think that now that I am mostly retired, when I run into old patients they consistently say how much they miss the human interaction I provided, and that doctors now are too busy to listen. And touching the patient, whether listening to the heart and lungs or putting my hand on the arm or shoulder of someone talking about their spouse's death or illness, really meant something. One problem with the internet is that it gives you what you are looking for, but makes it hard to find the unexpected (I love book stores for that reason) and telemedicine will never let you find an unexpected murmur or a mole on someone's back.

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  3. @anonymous, I fear that we are anachronisms. The sacrifice of humanity to technology is ubiquitous and i fear we are outmatched. Yes, the advantages of a cyberworld are mind boggling, but there is a cost to this that is simply not valued or understood by those who came of age in the digital era. Thx for your thoughts.

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  4. Perhaps in pediatrics where our patients and parents are younger the tech gap is not as much of a burden if you are lucky and privileged enough to own the tech. I personally experienced the opposite as far as personal connection, especially with my teen patients. By being able to see each others faces on the screen vs being under N95s and goggles in person it felt more like the in person encounters we had in the past.

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  5. Good points. The pandemic disrupted and distorted medical practice as it did throughout society. In my workplace, masks remain required for all employees and patients and I'm uncertain if this will be relaxed.

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  6. I don’t know if you experienced this as well, but insurance reimbursement for telemedicine visits dropped substantially over the past two years. We were getting less than a 99213 visit for nearly all of them…I can barely pay my staff with this low rate!

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  7. I retired in 2016, prior to the era of TM, so I have no direct experience with it. I have read the comments with interest. I can understand all of them. However I am surprised that none of them shared that seeing the patient in an exam room WILL always be the most accurate form of medical endeavor. The chances for medical error-and with that increased litigation & patient harm-likely has already raised its evil head! I’m surprised that none of you practicing folks were courageous or smart enough to bring it up.

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  8. Telemedicine is very similar to Zoom. It does not replace the richness of a face-to-face encounter. However, it allows for many very worthwhile interactions in an inexpensive and incredibly convenient manner.
    Full disclosure on my own bias, I am a pediatrician who has been practicing and advocating telemedicine for well over a decade My practice has been comprised of busy parents from most of the economic spectrum. The never met a parent that didn’t appreciate these visits.
    Like any technology it has its place. For triage of children who may or may not be “sick” It is wonderful. For many rechecks it is quite adequate, and for behavioral issues you get to see the patient in their natural environment. Telemedicine certainly can’t replace everything, but it is a very worthwhile technology when used appropriately. I do understand in other fields that may be challenging. However as our population ages and our tech savvy 20, 30, 40, and let’s face it 50 and 60 somethings age, this will be not only more easily accomplished, but expected. I think of myself in 20-30 years and unless my cognition decreases more than my mobility, I will certainly be appreciative of the convenience of telemedicine for needs that require only that.

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  9. Telemedicine is most useful when the patient is fully known (have all medical records) and the diagnosis is known. Short of that, EDs are seeing many significant errors and misses from Telemedicine, e.g. diabetic foot treated with keflex only, nearly lost leg. There are 100s of example of poor care.

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  10. Steven Silverman, MDAugust 15, 2022 at 10:13 PM

    Medicine is based on the History and Physical. We do a physical to corroborate the History. Many times in my practice what patients say and what I've found are two different things, even when a medical complaint seems simple. The same goes for medicine over the telephone. Telemedicine is in it's infancy and we have yet to hear about all that can go wrong or has gone wrong. But since much of medicine is controlled by large corporations that have to meet the bottom line, they choose to ignore the dangers in a rush to scoop up all the profits they can wrangle before it's too late. I'll admit during most of the pandemic that there was no other way, but everything has it's risk/benefit ratio, and for Telemedicine, the future will tell.

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