Hi everyone,
I am probably identifying myself as an old curmudgeon, which may well be the case. But I really have concerns about telemedicine in the family practice setting.
First, I certainly have older patients without smart phones, or who have them and are very limited in their ability to use them.
Secondly, more importantly, I cannot imagine a visit with an older person with multiple problems without a physical exam. What is your blood pressure? Heart regular or irregular? Lungs have rales? Mild ankle edema? Is that back pain just musculoskeletal?
And it would be pretty hard to give a joint injection remotely.
I guess the way to look at it is that telemedicine is better than nothing, which I believe is true. But the idea that televisits will take the place of in office visits long-term seems nonsensical.
Any thoughts?
Thanks.
Gene
Gene,
That wouldn't even be our decision. The insurance companies would never pay once physicians can safely see patients in their offices. As to treating patients that you can't see, this would be the way you would look at it:
a) if your level of care would decrease from a 9/10 to a 7/10, then it is worth it given the pandemic. Everything has to change to some degree.
b) if they are S.O.B. and have edema and your are worried about CHF, then you have to refer them to the ED. But, telemedicine will decrease the EDs being overwhelmed and may even give better care.
c) if we are able to make income during this extremely difficult time, then we can help with patient care, a vital part of the overall strategy
Sure, you will make decisions to do telemedicine where an actual office visit would have been better, but the ICUs will have to triage persons with pHs of 7.1 and O2 sats of 89 to decide who goes on a ventilator.
Do not beat yourself up over whether your care won't be a 9/10 or 10/10 with you.
And, let me say, I don't feel a bit of guilt because in 23 + years, I have likely done over 50,000 messages of which I didn't get paid. Ten thousand pages where I didn't get paid.
