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Life in Emergistan

Life in Emergistan

Extend Your Career with Telemedicine

Leap, Edwin MD

doi: 10.1097/01.EEM.0000688856.65936.49
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    It seems as if telemedicine is everywhere. Many of our colleagues have done it already, or are trying to get into the game now in the professional chaos that has followed the coronavirus pandemic. I practiced telemedicine part-time about six or seven years ago. I found it a pleasant experience and financially rewarding for the time invested, so much so that I'm doing it again.

    The COVID-19 pandemic has changed the face of medicine. I don't think it's an exaggeration to say telehealth consults have been beneficial. Most of us are not pleased that volumes are down and jobs are imperiled, but a lot of people were able to avoid viral exposure because physicians took telemedicine calls and were able to answer simple questions and provide simple solutions.

    Given the degree of asymptomatic carriers, this likely helped staff avoid exposure to the virus as well. We won't know how much this mattered for a while, but national companies and local systems, as well as primary care physicians, have all tried to set up or ramp up telehealth experiences for patients in need.

    The medical education process made physicians a little leery of telemedicine at first. I mean, we learned through medical school and residency that being a clinician means talking to patients, reading their body language, looking at their wounds, rashes, or behaviors. It means touching them, feeling the warmth of swollen joints, assessing the tenderness of their abdomens, listening to their heart and breath sounds.

    There have always been hints that some of what we do is, well, theater. I remember my venerable mentors who would look at a patient from the doorway, ask a couple of questions, and tell me the diagnosis. They were spot on almost every time.

    Lowering Costs

    A few years into practice, we all learn roughly the same thing. A head cold is largely a head cold, a bruise is a bruise. Most back pain is a big yawn. A young, healthy person with gastroenteritis with active vomiting and diarrhea benefits little from our touch even though we're supposed to do it. Rectal exams, despite the insistence of admitting physicians, ultimately yield little information. Even the COVID-19 experience validates my point: Physicians are diagnosing respiratory distress without having their stethoscopes on the chest of patients (who are likely filling the air with viral particles).

    We also know that many of the patients we see are being charged a lot of money for things that don't need to be evaluated in an emergency department. I'm not saying they don't have problems. I'm saying they don't have options. “I tried to take the baby to our doctor, but she doesn't have an appointment for a week.” “My kids have to have a school excuse.” “I'm out of my blood pressure medicine, and haven't been able to find a doctor since I moved to town.”

    We see these people day after day for simple problems, and they are charged exorbitant fees. There was a time when we could write those off, but that's no longer an option in these days of corporatization. The work excuse and the refill end up costing $1500-$2000. It's silly, and it's woefully unfair.

    Telemedicine is a great alternative. Whether it occurs by phone, video, or text, simple issues can be dealt with in a cost-effective and pleasant way for the clinician and patient. Companies with insured patients save money. Corporations that need a job-related injury evaluated also save money, and patients often go back to work immediately without having to leave work, cross town, wait in a waiting room, and travel back to work.

    Reassurance and Guidance

    What about the really sick people? We know the red flags. We can tell who looks sick by phone or video. We can request a photo if it's a text interaction. It's our fundamental algorithm, right? Sick or not sick. And you always have the option when doing telemedicine to advise them to be seen in person, call 911, or go to their nearest emergency department. I have had this conversation, and it was not only quick but also helped convince the patient that his problem was real when he might have minimized it and stayed home.

    These patients, in my experience, are those who don't really want to go to the doctor and who want to save costs. They are often tech-savvy and motivated. I have had very frank conversations about antibiotics, and they were extremely receptive to not receiving them. Many times, as in person, they just want to be reassured or receive guidance.

    Only time will tell if telemedicine reaches its potential. But I hope it does because I can see this extending my career longevity and enjoyment for a long time. And as many of us grow older and our bodies become less resilient, our minds remain repositories of many experiences and huge amounts of information, all of which we can apply remotely.

    More than once I've heard telemedicine physicians say that it's friends and family medicine, the sort of thing we all do when loved ones call us for advice. This is a nice way to look at it.

    I encourage you to try this unique pathway. It's simple, it's helpful, it requires no mask, and you can eat or drink whenever you want. Whether you wear pants is up to you.

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    Dr. Leappractices emergency medicine in rural South Carolina, and is an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available at www.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, http://edwinleap.com/. Follow him on Twitter@edwinleap, and read his past columns athttp://bit.ly/EMN-Emergistan.

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