Coronavirus: We need to embrace telemedicine
Haider J. Warraich
As a physician, waiting for the worst of coronavirus to hit, I see a lot to fear. It seems increasingly likely that this will be one of the most significant pandemics in modern human history, and that it will change our approach to health care going forward. But not all of its legacy will be negative. Here’s one thing I hope will come out of the crisis: an increased reliance on telemedicine, something that should have happened long ago.
A few months ago, when I was between jobs, I took a part-time job in a rural hospital serving a county of more than 150,000 people. On the verge of bankruptcy, the hospital was unable to attract many specialists to join its ranks, and in desperation, had turned to telemedicine to cover many services.
So, for example, if a patient was rushed to the emergency room after a stroke, there was unlikely to be a neurologist in the room. Instead, a neurologist would assess the patient on a mobile screen from far away, with local nursing staff and doctors aiding him or her.
I had been sceptical of telemedicine going in. Physical exams are the bedrock of how doctors and nurses assess patients. We look patients and their loved ones in the eye, palpate sore spots with our fingers and offer comfort with a hand on a shoulder. Physical contact, I’d always thought, was at the heart of how doctors and patients communicate.
Screen on wheels
It was with this scepticism that I found myself next to a young man who been brought to the emergency room after attempting to take his own life. Again. This time, instead of seeing a psychiatrist in person, he saw one on a screen with wheels.
The psychiatrist was in some distant location, but she had been in touch with the local doctors and had access to his medical records. Despite her physical remoteness, she connected with him, and he opened up. She knew of all the local resources to refer him to, and at the end of her conversation, she had developed a real rapport with him.
After the visit ended and the nurse wheeled the monitor out of the room, I asked the young man what he thought, and to my surprise, he told me he was more comfortable with this than an in-person visit. He wasn’t the only one many patients say they prefer a virtual doc to one sitting across from them.
Over the past few decades, medical care has been transformed by technology. Whenever a new drug becomes available, or a medical procedure is approved by the FDA, the medical community is quick to deploy it. Yet, when it comes to how we see patients, our current practices haven’t changed much since the time of Hippocrates.
If a patient is sick they either have to come see us in clinic, urgent care, the emergency room or the hospital. Despite the internet transforming every aspect of our lives, from how we find love to how we order groceries, the way we deliver medical care has stagnated.
In the United States, not only are doctors often inaccessible for those living in rural areas, hospitals everywhere have huge economic challenges. One health care executive jokingly told me his hospital made more money from its parking lots than its clinics.
The response to COVID-19 might help change that. One of the main reasons China has been able to slow coronavirus transmission has been because of a dramatic increase in virtual visits.
In fact, China has moved half of all medical care online, allowing patients to consult with their doctors and get prescriptions from the comfort of their homes. Hospitals have been notorious petri dishes for deadly bugs since long before COVID-19, and this pandemic has brought that risk into crystal-clear focus.
In-person visits
Medicare has announced that it will greatly expand coverage for telemedicine visits, previously sharply restricted. And at a White House briefing, the government announced it was urging states to similarly expand Medicaid coverage to include telemedicine visits by Skype, FaceTime or other platforms. Some insurers have also said they will cover tele-health visits at parity with in-person visits.
These measures are commendable, but policies need to be put in place to ensure that the expansion of telemedicine is not temporary. Of course, in-person visits will still be necessary in many cases. But supporting telemedicine on a par with such visits has the potential to protect patients and health care personnel and allow for much more efficiency in the system.
That said, physicians and nurses will need high-quality training to provide compassionate and thorough care to a patient from across a computer screen.
This week my team converted most of our clinic visits from face to face to virtual visits. Some were over the phone, others were over video, often with a family member present as well. While there were some patients that still needed to be seen in person, we were able to minimise the risk of viral transmission not only for patients, but also for valuable members of our clinical team.
Even before this crisis, as part of my job at the Veterans Affairs Health System in Boston, I often consulted with patients I had never seen as part of an “E Consult” system. While I was initially nervous when I first started doing this, it allowed me to expand my footprint far beyond what I could manage if I were seeing every patient in person.
At some point, I fervently hope the coronavirus will be a thing of the past. But I hope it leaves behind a legacy. I hope it changes how well we wash our hands, how well we fund public health and how well we protect the health care workers caring for our sickest patients. And, most of all, I hope it pushes us to embrace telemedicine.