Posts Tagged telemedicine

Telemedicine — the good, the bad and the ugly.

noseviewTHE GOOD:  If your brother is a doctor and you call him for medical advice that is probably good Telemedicine.   The doctor clearly has your interest at heart, you can call again, the doctor will likely look up information and will probably give you some Internet links to check out.  And, the doctor does not want to make you upset or interfere with the relationship you have with your actual doctor.  Good idea, except doctors will not usually prescribe for a relative, or should not.

THE BAD:  The same things wrong with actual provider interactions can still be wrong on video — not being given enough time to state the problem, not enough patient education, not enough of a partnership, and poor follow-up.  Also, prescribing antibiotics for viral infections (the common cold) can be even a greater temptation by video.

THE UGLY:  A low position of the video camera that seems to look up the doctor’s nose — yes, that’s ugly.

The most common reasons for visits to a health care provider are: cough, joint pains and skin conditions.

Evaluation of cough by telemedicine is difficult because it requires looking in the nose, ears and throat and listening to the lungs for wheezing or other sounds.  This is better in person.   Although, a telemedicine follow-up might be just fine.

Evaluation of joint pains is fairly easy with telemedicine.  For example, back pain is usually temporary and x-rays are not advised.  It’s easy to suggest ways to avoid straining the back and be encouraging.  Treatment usually involves over-the-counter medications.

Evaluation of a skin condition also is fairly easy with good quality video.  Diaper rash and acne are no-brainers.  But, trying to separate skin cancer from a benign seborrheic keratosis is a little harder — probably best left to an office visit.

Follow-up visits for lots of things can be done by telemedicine.  A follow-up visit for congestive heart failure can be done by video especially if the patient has a reliable scale at home.

Follow-up visits consume valuable office time that could and should be allotted to new or serious problems.  The phone will often work just as well.  Telemedicine visits can be done when office staff is not working — thus at a much lower overhead cost.

Provider-to-consultant video conferencing is a great idea.  This works particularly well if the two individuals work in the same organization.  If they are not in the same organization financial issues often get in the way.

A fine example of peer-to-peer video conferencing is in the UK where groups of NHS neurosurgeons at one hospital communicate with groups of NHS neurosurgeons at another hospital sharing x-ray images and and clinical details.  Very difficult decisions are often better with input from colleagues — and consistency of care is improved.

Telemedicine does not solve bad-care problems.  Switching bad-care in person to bad-care by video is not helpful.

Telemedicine can reduce the cost of care for simple issues that mainly need better health literacy and for follow-up of known health problems.  The capacity of health care is not adequate in many countries (including the US).   Telemedicine is a provider-extender and needs to be used a lot more.

 

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Why People See Doctors — it’s not that deep

Pimple

Question:  What is the number one reason people see doctors?

  • a)  because they have a life threatening health problem
  • b) because they are obese and want to lose weight
  • c) because they don’t get enough exercise and want an exercise program
  • d) because they have a skin problem

According to an article in the Mayo Clinic Proceedings this month the answer is “d”.   42.7% of visits are due to skin disorders.   You should have known the answer just by looking at the magazines at the grocery checkout counter or watching ads on TV.  We worry about skin blemishes but in the past people had to worry about smallpox or TB.  It is hard to be serious about health care cost and political change in the face of this statistic.  OK, acne scars are bad and skin cancer is real.  But, the real danger from skin problems is very low.  What can be done to alleviate skin problems without spending half of the U.S. GDP on trivial office visits?

The Mayo Clinic Proceedings article tangentially mentions dermatology telemedicine.  Great idea.  A picture is indeed worth a thousand words or perhaps a thousand patient visits.  What if there was an app for taking a picture of a skin lesion and sending it for a dermatology consult ($10).  Think of the cost savings for simple advice for acne or eczema or diaper rash!  The improvement in health literacy would be huge and visits to primary care would decline.  If a visit to primary care proved to be needed it would be for a substantial skin problem (or something else).  Any health system wanting to reduce cost should find this idea fantastic — any health systems out there actually doing this?

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