Telemedicine

David Cattell-Gordon, director of the University of Virginia Center for Telemedicine, uses a camera to have a conversation with Ashe Allende (on screen) at UVa Health System in 2019.

By Rob Solomon

Solomon is a board certified specialist in adult medicine training at Eisenhower Army Medical Center. He treated patients in the New River Valley since 1990 and currently sees patients at Lewis Gale Internal Medicine of Blacksburg. He is an Assistant Professor of Clinical Medicine with The University of Virginia School of Medicine.

Earlier this year, COVID-19 came to the New River Valley. Cases started in March and like the rest of the country, it appeared we might be overwhelmed with not enough ventilators, nurses and doctors, testing and proper protection.

In mid-March of this year my staff began canceling non-essential office patients, and began consulting by phone or even seeing them in their cars in our parking lot. I believed we should incorporate telehealth into our practice, and with this crisis, the time to start had arrived. We could not expose our patients or staff to this virus. After several days of treating almost no patients, Medicare approved telehealth by waiving the limitations allowing us to use Healow, Facetime, Google duo, and other platforms.

Within a few days we were seeing eighty percent of our patients by telehealth. Over the last two weeks we have seen about one hundred telehealth visits a week.

HCA Healthcare’s information technology staff were critical with training our team and ensuring equipment supported telehealth functions. It was not easy in the beginning, particularly with patients not familiar with or lacking immediate access to technology. Our office staff called patients and got them on board with this new way of seeing their doctor.

Already, we have found many telehealth benefits, the first being safety. Seeing patients while keeping them at home minimizes risk. That concern has always been present bringing the frail, elderly or otherwise immunocompromised into our waiting room filled with patients with infectious diseases including flu and other viruses.

Another benefit is efficiency. The average office visit in primary care requires two hours including waiting time and labs. Patients may live an hour or more from our office as far away as West Virginia or North Carolina, and telehealth eliminates travel time and costs. Reducing total time associated with a doctor’s visit can decrease the impact on a person’s work. I have seen patients avoid visits for type 1 diabetes or other serious conditions fearing loss of work, cost of the visit and loss of income. The telehealth appointment may not happen at the exact scheduled time but it is usually more convenient than travel and the wait associated with an office visit. Cutting transportation also decreases the carbon footprint of our medical care.

Telehealth also aids those with mobility struggles. Patients with severe arthritis, quadriplegia, multiple sclerosis, or any illness that impedes walking makes getting to an office an exhausting ordeal. Telehealth can make these visits feel more manageable and relaxed.

Another positive includes the treatment of psychiatric illnesses. Many people have increased stress during the pandemic, worsening psychiatric problems. We are successfully treating anxiety disorders, depression, attention deficit, and other psychiatric diagnoses. Also, there are many rural areas without adequate psychiatric care. Telehealth brings treatment to these patients.

Telehealth is like making a house call.

It brings the doctor into patients’ homes. Recently I “visited” with a patient and daughter in the patient’s final days. Witnessing her rapid decline, I ordered hospice care and medication easing suffering. She was comforted by our telehealth visits.

I sometimes begin the telehealth visit with a big hello, remarking “you didn’t know I was going to make a house call.” This was particularly warm and funny to my 90-year-old patient and her daughter. My patient remembered house calls and enjoyed showing me her home and the painting with red and purple flowers on the wall behind her. Patients are introducing me to spouses, partners, children, grandchildren, dogs, and even baby goats. They show me their working spaces during the pandemic, farms with fences they mend, the hay they grow, and the pride many have for their home lives.

Admittedly, telehealth brings disadvantages. Although providers can collect a surprising amount of the physical exam with telehealth, sometimes we need further examinations and tests. My 93 year old mother said “you can’t get hugs with Facetime.”

Although not for every patient, telehealth’s benefits are considerable. They should be offered to our patients after the pandemic and covered by insurance.

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