Telemedicine

[LuvOrlando]

So there is an article out about telemedicine and I wonder how many other people like it & use it? Wondering what other people think

I like it very much and prefer it often, my Dr can direct me to come in if it's necessary but I can do a lot of the standard stuff by taking a photo of my temp and Blood pressure machine & they can tell me what to do from where they are. During 2020 & 2021 it was a super helpful innovation because if it wasn't for this I wouldn't have seen anyone. I think it was easier on the Dr's too, who looked a lot more rested and could probably fit way more people into their days especially since they were spending so many hours at the hospital they could just drop into a quiet space to give me 15 min and get back to saving someone instead of pulling themselves away for office hours. Truthfully, this isn't even new for me, I ALWAYS avoided medical facilities for the Flu season Halloween-Easter unless there was some immediate concern, with telemedicine I didn't fall off the map for half a year.

Reading this article I'm feeling a bit bummed about access being restricted, why is this a benefit to patients or it it just resistance to change? I just had surgery in the spring for BRCA status and started a Dr lead Zoom telehealth group session for high risk people but being in another State last night meant I couldn't participate. There really is no reason I should be denied the benefit of the group session, whose purpose is to bring behavior modification techniques like meditation and such to people who find themselves in a weird space like me right now. As I thought about it, why would it be that people who travel with family or on business are cut off from their Dr's while away? There must be people in recovery or dealing with grief whose jobs take them away from home, shouldn't they be able to grab an appointment with their Dr? Urgent care is fine but it's way more expensive and doesn't always fit, the majority of time ER is just overkill and Urgent Care is often even too much. I can think of countless times I sat in the WDW hotel with a kid screaming about an ear infection where my family would lose a whole day of fun and park time because it was going to be a full day in Urgent Care with the rental car and family stuck with pizza in the room instead of a short chat with the Pediatrician who knew my kids and the school district who could say, "Yep, had 10 kids from your kid's school in today with the same thing, lets do XYZ." I also think of family with dementia, it would be amazing if her caregiver could get her on Zoom with the Dr and all three of her adult kids could listen in of Dr appointments from 3 different states instead of the burdon falling on the child who lives closest.

https://apnews.com/article/science-health-business-covid-cancer-56deaf3a9ff108775dc36e3bd767175e

 

[amcnj]

I don’t go to doctors too often. Mostly just the annual or semi-annual check-ups.

I did use telemedicine once, during the height of Covid, when that was the only option. I am not sure of its status within my medical plan now. I remember getting lots of emails about it a couple of years back, but can’t say I have seen anything recently.

But it seems like it would be useful for some cases. As you said they could then tell you to come in if it was something they couldn’t properly address remotely.

 

[Schneewittchen37]

We did a few teledoc appointments during the worst of the pandemic.

DD and I both managed to get UTIs during that time, so a teledocs really helped with that. For me, as soon as I realize I have one, it's like an emergency-emergency situation.

And then there were various outbreaks at the kids school about a year ago, DD was exposed, then DS was exposed. Both times we needed to do a teledoc appointment first to get approval to go get them appointments to get tested. What a pain.

 

[Laugh O. Grams]

I've never personally tried telemedicine, though the option's offered by my current healthcare provider & I have considered it. I do know that Walmart recently acquired telehealth provider MeMD, so I have zero doubt these "kinks" in the system, like access across state lines, shouldn't eventually be ironed out

 

[kdonnel]

I listened to a podcast not long ago that talked about telemedicine and how it was changed by Covid.

https://freakonomics.com/podcast/will-you-ever-go-back-to-your-doctors-office/

The show covers how the use of telemedicine affected quality of life of the physicians and how it affected quality of care for the patients.

The effects are not what I would have expected.

For example the increase in telemedicine actually seems to have increased the amount of time doctors have to work outside of work. The non clinical workload increases under telemedicine.

The preliminary findings are that telemedicine is somehow inherently less efficient than in person visits from a physician quality of life perspective. Telemedicine is a factor in physician burnout that was intensified by the pandemic in general.

 

[LuvOrlando]

I've been doing it a lot and Dr's seem way more comfortable with telemedicine than in person, they appear fresh and more comfortable and the few times I asked they said it was great. Often if a Dr is busy they will request it be changed to telemedicine, happened with an apt today where the Dr wanted off so I'm bumped to telemedicine tomorrow. I'll ask again next time but when I go in person they are always running room to room washing hands and reviewing the chart, stuff is missing and they need to wait for staff. Thinking on it staff needs to clean up in between patients and stock supplies, plus all the things that go into the landfills because on in person visits and sanitary practices. All these considerations must eat up a lot of effort and billable minutes by the end of the day, as opposed to staying in the same spot and pulling my info up which they can read while talking with me reserving limited available trained staff effort for other time consuming things like inpatient care and such.

Only group I can see objecting is Insurers because they probably enjoy profits based on the throttling back access that occurs due to bottlenecks, a thing that normal humans see as bad (suffering not good) but profit motive seekers would see as fantastic (who cares about suffering, we pocket way more premiums because person X didn't get an appointment so cha-ching.)

MEHROTRA: We’re starting to get some preliminary evidence that telemedicine is increasing the number of visits that patients receive, and thereby increasing spending. If it’s increasing spending, in certain clinical situations, it’s great. We’re going to be happy that more patients are getting care and that leads to better health outcomes. But in other clinical areas, it may drive up spending and patients’ health doesn’t improve. It would be low-value care, and we need to develop mechanisms to curb those excess visits.

Some people with chronic issues won't improve so if a relief of suffering is the motive then increased access to care is good but if making them go way and exit the system by any means necessary is the goal, well then, increased access is bad. There are ways to reduce suffering inexpensively but that particular avenue has been severely restricted in favor of channeling people into very pricey drug regimens and this should maybe be reexamined.

 

[kdonnel]

I've been doing it a lot and Dr's seem way more comfortable with telemedicine than in person, they appear fresh and more comfortable and the few times I asked they said it was great. Often if a Dr is busy they will request it be changed to telemedicine, happened with an apt today where the Dr wanted off so I'm bumped to telemedicine tomorrow. I'll ask again next time but when I go in person they are always running room to room washing hands and reviewing the chart, stuff is missing and they need to wait for staff. Thinking on it staff needs to clean up in between patients and stock supplies, plus all the things that go into the landfills because on in person visits and sanitary practices. All these considerations must eat up a lot of effort and billable minutes by the end of the day, as opposed to staying in the same spot and pulling my info up which they can read while talking with me reserving limited available trained staff effort for other time consuming things like inpatient care and such.

Only group I can see objecting is Insurers because they probably enjoy profits based on the throttling back access that occurs due to bottlenecks, a thing that normal humans see as bad (suffering not good) but profit motive seekers would see as fantastic (who cares about suffering, we pocket way more premiums because person X didn't get an appointment so cha-ching.)

MEHROTRA: We’re starting to get some preliminary evidence that telemedicine is increasing the number of visits that patients receive, and thereby increasing spending. If it’s increasing spending, in certain clinical situations, it’s great. We’re going to be happy that more patients are getting care and that leads to better health outcomes. But in other clinical areas, it may drive up spending and patients’ health doesn’t improve. It would be low-value care, and we need to develop mechanisms to curb those excess visits.

Some people with chronic issues won't improve so if a relief of suffering is the motive then increased access to care is good but if making them go way and exit the system by any means necessary is the goal, well then, increased access is bad. There are ways to reduce suffering inexpensively but that particular avenue has been severely restricted in favor of channeling people into very pricey drug regimens and this should maybe be reexamined.

As you saw the podcast talked some about how cost was affected. There need to be additional studies to ensure that there is not an increase in low value care as that is not good for anyone.

Low value care is a waste of physician time, low value care is a waste of patient time, low value care is a waste of money.

An increase in low value care will cost us all a great deal of money in increased insurance premiums.

It seems obvious that some types of care will end up being better performed as telemedicine, while other types of care are low value. Yet sometimes there are unintended consequences and it just doesn't work out how we expect.

Something else to consider is care related to telemedicine. Other podcasts in the series have covered using technology for continuous care which may be the holy grail for some diseases.

Rather than a scheduled telemedicine appointment that takes up time for the physician and patient and money for the patient, the patient has smart sensors that are sending data back to the physician to analyze during a portion of their day set aside for analysis. This adds nothing to the physician off work work load and has been shown to ultimately lower long term care needed by the patient.

The physician can then see trends and adjust the treatment plan, all without having to have even have a telemedicine appointment.

 

[DLgal]

I think it should be standard for some things that are easy to self diagnose. Things like UTIs, yeast infections, pinkeye, etc. These are things that usually need antibiotics, but also tend to recur so someone who had had it before knows what it is. I used telemedicine for a stubborn yeast infection that didn't respond to OTC treatment. Once I got the pill, it was gone. Didn't even have to see the telehealth doctor. Filled out a questionnaire and had an electronic Rx sent to my pharmacy within 10 minutes.

I understand why it can't replace in person visits, but I feel like a LOT of in person visits could be switched to telehealth for established patients who have recurring issues as long as that patient goes in once a year for a physical.

I think it would also help if we could get more OTC tests. Now that we have gone through covid, everyone knows how to swab themselves. Let's approve rapid strep and flu swabs for OTC use. It's all the same procedure. It would save a lot of aggravation to be able to tell your doctor that you have a positive strep or flu test and be prescribed antibiotics or antivirals without having to leave home and possibly spread to others.

 

[tvguy]

Only done one telemedicine visit. I had an in office appointment set with a tumor specialist and his office called and asked if I minded doing it on the computer instead. I took it as good news and it was. My tumor is no big deal and there was no need for him to see me our counsel me in person.
Now my primary Doctor that wouldn't work because the primary reason for my visits with him are to confirm my blood pressure readings that I get at home.