Telehealth anyone?

[Okie Poke]

How do you go about seeing if you qualify for telehealth?

[Mark Perry]

One advantage about telehealth is not picking up an illness in the waiting room.

[vatreefarmer]

As a pharmacist, I can tell you that tele has also brought it fair share of problems. It certainly has attracted a chunk of the dubious prescribers who used to run "pill mills" from town to town. Now they just advertise of facebook and do it all online. The pandemic changed the way medicine was being practiced and we all are trying to play catchup trying to sort the legitimate physicians from the bad. When scripts start coming in from across the country it's a lot to sort out. We also see a significant increase in drug-drug interractions so I often wonder if the format for tele providers allows for a true medical history.
If more of the tele providers were dedicated professionals like yourself, I think there would be a lot less issues. It certainly does have a significant role to play

[squib]

Have used it several times. Worked like a charm. Faster, easier, cheaper.

[86 inches]

As a pharmacist, I can tell you that tele has also brought it fair share of problems. It certainly has attracted a chunk of the dubious prescribers who used to run "pill mills" from town to town. Now they just advertise of facebook and do it all online. The pandemic changed the way medicine was being practiced and we all are trying to play catchup trying to sort the legitimate physicians from the bad. When scripts start coming in from across the country it's a lot to sort out. We also see a significant increase in drug-drug interractions so I often wonder if the format for tele providers allows for a true medical history.
If more of the tele providers were dedicated professionals like yourself, I think there would be a lot less issues. It certainly does have a significant role to play

Very interesting perspective. I'd love to hear more.

In our group we have an internal agreement not to rx controlled substances in most cases. We also do not rx lifestyle medications like sildenafil and others. Also, while we do cover several states we only cover those where we have a physical presence. For instance, I only practice in Arizona, where I'm licensed, of course, but also where we have physical locations in almost every city or town. I like that because it gives me a direct way to get a patient straight into one of our locations should they require or prefer an in person examination and or testing/imaging/etc.

Our EMR requires us to document a complete H&P and that includes a complete list of current medications and allergies. We can even pull up pharmacy records with our software. No doubt some providers are more thorough than others but the idea is to 'do it right', so to speak. I have always been a stickler with respect to DI's. I probably go overboard sometimes with interaction concerns but with the plethora of choices these days, I try to avoid them. Our EMR screens for these interactions and I often will use supplemental programs to check for some of the more obscure ones. But there is nothing inherently different when it comes to prescribing via tele vs how we do it in clinic except for our hold on controlled substances.

[86 inches]

9ne advantage about telehealth is not picking up an illness in the waiting room.

Totally! Patients definitely appreciate that aspect.

And I don't have to worry about them sharing with me. LOL

[86 inches]

How do you go about seeing if you qualify for telehealth?

You could look on your insurance website but I would think most telehealth groups have something in their system that verifies coverage when they sign you up. We have front desk staff that handles all of that. All through a phone app or via the website on a computer or tablet. Our staff communicates with the patient via texts or instant messages. If you're insurance requires you to go elsewhere, they help you with that.

[1781ccT]

I’ve used it a few times for follow up appointments. I really like it for the convenience

[DucksnBobs]

I personally cannot stand it. Hate it all. I have had 2-3 telehealth visits and for a PCP setting, I am ok with it. Especially due to the shortage of PCP's available and how hard it is to be seen by an MD these days. End of they day, a screen cannot tell you near what you need to know. Also, you are making sure the person on the other end is in tune with their body, well enough, to give you truly important info that cannot be seen in person. What happens when the pt has a cold, tells you absolutely nothing about their L foot turning blue. You assess his cold, write for some ABX and maybe some neb treatments. But guess what you missed, his foot turning blue because he is a diabetic and has poor circulation. Most common sense would say they should tell you about this, but common sense isnt so common anymore. Again, for PCP type situations, and maybe just to see the doc for a refill on meds, totally ok with a telehealth visit. Going over lab results, really like telehealth for this reason. So maybe follow up stuff, I do prefer, I suppose. Like when I got my vasectomy, and the urologist called to tell me I was sperm free, I was very ok with this telehealth visit. The information could of been easily relayed with a phone call though, I didnt really need to see the docs face again. ANY KIND OF ASSESSMENT... I am truly not ok with anything through a screen.

Where I am really really not ok with the new electronic doctor stuff, is the hospital I work in, there are no MD's at night. Or maybe one throughout the whole inpatient side (400+ beds). Instead night shift has these big monitors they roll into the room. A doc shows up on the screen, there is a camera looking at the pt, and the nurse does everything the doc asks. So if they want to listen to the heart or lungs, we have to hold the stethascope, connected to this monitor, to the pt so the doc can sit on their couch at home and do their assessment. During Covid, docs were afraid to go in rooms, so they would have us take an Ipad in the room to do their daily rounds on their patients. Tell me how a true honest to god assessment of their lungs was done with an Ipad???? In all honesty, you docs get paid a ton of money to sit behind a screen and not have to move these days. I personally cannot stand it. And since Covid, more and more of you docs are sitting behind screens instead of actually laying eyes on the patient and physically doing an assessment. I am happy its convenient for you in your latter end of your career, but if this is what medicine is turning into, then its no wonder why so many Americans are turning to self medication and refusing to get help in the healthcare world. What happens when the internet goes out, or the computer glitches and you misdiagnose someone through a screen? Does you medical insurance cover this? I have always wondered if MD's were truly comfortable putting their license on the line because of a computer malfunction when something goes wrong.

I had some serious concerns and needed a few referrals. I paid $200 for that visit, to be seen by an NP, and I got out about half of what I needed to say when she interrupted and she hit me with "Here is your referrals, do as you please with them". That will be my last telehealth visit and the total time on the phone was 3 minutes and 43 seconds. 200 dollars for 4 minutes of my time. MD's have gotten beyond lazy since Covid imo. So, nope dont like it at all, really pretty sad where the healthcare system is headed in the country.

[DucksnBobs]

Hi sir/mam, I know you’re having chest pain, here is the doc to see you now. This is what you will see in our hospital now at night.

IMG_0037.jpeg

[Bsktball55]

My wife and I have both used it. I like it. Used it for my last endocrinologist appointment which was nice. I usually have to drive 35 minutes up to the city find a place to park, wait for another 20-30 minutes, doctor comes in talks to me for 5 minutes says ok get your blood drawn and I'll renew your prescription. Did it on zoom last time, much nicer. My wife worked in a hospital lab so she would swab her throat run the test then call teledoc and get a prescription for strep throat. Much more convenient for the little things.

[Rangerdeepv]

I would use it any chance I could get rather than sitting in the waiting rooms. Also can go anywhere and get care.

[Jeff Hahn]

Hi sir/mam, I know you’re having chest pain, here is the doc to see you now. This is what you will see in our hospital now at night.

IMG_0037.jpeg

Hey, it worked for Dr. Sheldon Cooper!

[DucksnBobs]

Hey, it worked for Dr. Sheldon Cooper!

[86 inches]

I personally cannot stand it. Hate it all. I have had 2-3 telehealth visits and for a PCP setting, I am ok with it. Especially due to the shortage of PCP's available and how hard it is to be seen by an MD these days. End of they day, a screen cannot tell you near what you need to know. Also, you are making sure the person on the other end is in tune with their body, well enough, to give you truly important info that cannot be seen in person. What happens when the pt has a cold, tells you absolutely nothing about their L foot turning blue. You assess his cold, write for some ABX and maybe some neb treatments. But guess what you missed, his foot turning blue because he is a diabetic and has poor circulation. Most common sense would say they should tell you about this, but common sense isnt so common anymore. Again, for PCP type situations, and maybe just to see the doc for a refill on meds, totally ok with a telehealth visit. Going over lab results, really like telehealth for this reason. So maybe follow up stuff, I do prefer, I suppose. Like when I got my vasectomy, and the urologist called to tell me I was sperm free, I was very ok with this telehealth visit. The information could of been easily relayed with a phone call though, I didnt really need to see the docs face again. ANY KIND OF ASSESSMENT... I am truly not ok with anything through a screen.

Where I am really really not ok with the new electronic doctor stuff, is the hospital I work in, there are no MD's at night. Or maybe one throughout the whole inpatient side (400+ beds). Instead night shift has these big monitors they roll into the room. A doc shows up on the screen, there is a camera looking at the pt, and the nurse does everything the doc asks. So if they want to listen to the heart or lungs, we have to hold the stethascope, connected to this monitor, to the pt so the doc can sit on their couch at home and do their assessment. During Covid, docs were afraid to go in rooms, so they would have us take an Ipad in the room to do their daily rounds on their patients. Tell me how a true honest to god assessment of their lungs was done with an Ipad???? In all honesty, you docs get paid a ton of money to sit behind a screen and not have to move these days. I personally cannot stand it. And since Covid, more and more of you docs are sitting behind screens instead of actually laying eyes on the patient and physically doing an assessment. I am happy its convenient for you in your latter end of your career, but if this is what medicine is turning into, then its no wonder why so many Americans are turning to self medication and refusing to get help in the healthcare world. What happens when the internet goes out, or the computer glitches and you misdiagnose someone through a screen? Does you medical insurance cover this? I have always wondered if MD's were truly comfortable putting their license on the line because of a computer malfunction when something goes wrong.

I had some serious concerns and needed a few referrals. I paid $200 for that visit, to be seen by an NP, and I got out about half of what I needed to say when she interrupted and she hit me with "Here is your referrals, do as you please with them". That will be my last telehealth visit and the total time on the phone was 3 minutes and 43 seconds. 200 dollars for 4 minutes of my time. MD's have gotten beyond lazy since Covid imo. So, nope dont like it at all, really pretty sad where the healthcare system is headed in the country.

Wow. A lot to unpack here.

First, thanks for taking the time to contribute to the discussion. Your input is appreciated. New Mexico, like the rest of the country, is being hit hard by the doctor shortage so I can totally understand some of your angst.

Telemedicine isn't for everyone. I can't even get my mom to try it. But she's 94 and not too computer comfortable. She won't even use a mobile phone. LOL

Telemedicine isn't meant to address every medical problem. Nor is it meant to replace in-person visits. It's an adjunct to standard medical care and serves to increase convenient access to care.

I do take a little offense at your accusation that I am lazy. I've busted my hump for over 40 years providing direct hands on care. I've stood in blood-soaked shoes doing my job when HIV/AIDS was something we were just learning about. When covid hit, I put on homemade PPE and sucked it up. At one point, I brought in my welding visor because we didn't have any medical face shields. And now, because I sit at a desk 8 hours a day and see patients over a monitor, I still work hard to provide quality care to each and every one I see. I don't do 3 minute and 43 second exams. My average encounter is closer to 20 minutes and not infrequently as much as 35 minutes. If anything, I probably keep patients online longer than they would like but I do it to be sure we have a reasonable plan and they know what to watch out for so. I make sure I answer all of their questions and often won't let them go until they ask me at least something

I've known thousands of providers over the years and unfortunately the number of aholes is higher than I would like admit. But lazy? No sir. I probably could count on one hand the number of lazy docs I've known. We're a driven bunch. Even the worst of us can't do anything but work hard.

Your pic of the monitor is on point. Sometimes, we have to cover a clinic that is short a provider. I don't lke it but I guess it's better than the alternative. Would you prefer to look up and see a doc on that monitor or would you prefer to be greeted by a "Closed" sign hanging on the ER door?

[DucksnBobs]

Wow. A lot to unpack here.

First, thanks for taking the time to contribute to the discussion. Your input is appreciated. New Mexico, like the rest of the country, is being hit hard by the doctor shortage so I can totally understand some of your angst.

Telemedicine isn't for everyone. I can't even get my mom to try it. But she's 94 and not too computer comfortable. She won't even use a mobile phone. LOL

Telemedicine isn't meant to address every medical problem. Nor is it meant to replace in-person visits. It's an adjunct to standard medical care and serves to increase convenient access to care.

I do take a little offense at your accusation that I am lazy. I've busted my hump for over 40 years providing direct hands on care. I've stood in blood-soaked shoes doing my job when HIV/AIDS was something we were just learning about. When covid hit, I put on homemade PPE and sucked it up. At one point, I brought in my welding visor because we didn't have any medical face shields. And now, because I sit at a desk 8 hours a day and see patients over a monitor, I still work hard to provide quality care to each and every one I see. I don't do 3 minute and 43 second exams. My average encounter is closer to 20 minutes and not infrequently as much as 35 minutes. If anything, I probably keep patients online longer than they would like but I do it to be sure we have a reasonable plan and they know what to watch out for so. I make sure I answer all of their questions and often won't let them go until they ask me at least something

I've known thousands of providers over the years and unfortunately the number of aholes is higher than I would like admit. But lazy? No sir. I probably could count on one hand the number of lazy docs I've known. We're a driven bunch. Even the worst of us can't do anything but work hard.

Your pic of the monitor is on point. Sometimes, we have to cover a clinic that is short a provider. I don't lke it but I guess it's better than the alternative. Would you prefer to look up and see a doc on that monitor or would you prefer to be greeted by a "Closed" sign hanging on the ER door?

I am sorry to offend. And you are right, I definitely over stepped by lumping EVERY doctor into the lazy factor. Let me be the first to say this, I am beyond disappointed in most, with MD next to their name since Covid. Maybe not lazy, but the fact that your work is done through a screen and cameras and to have nurses hold this device and that device........ not ok with me. You have hands and feet and ears that work. You have a higher education than I do, yet you want my expertise and my ability to do an assessment because you would rather look at your patients through a screen. Pretty sure that's kind of a gray area because you are leaning on someone with less education. So in all reality, you are putting your license on the line with my education because I am the one at bedside. Let's say I give inaccurate info, because I dont have the years of training you do, and there is a misdiagnosis? Who is at fault then? I would assume you because the courts would probably view this as an RN/LPN situation. End of the day, an error falls on the RN's license, even if the LPN makes the error.

Again, I do appreciate the fact you spend well over 4 min to do your exams. Id appreciate this service, but most docs do not care or take that kind of time anymore. So I do appreciate you actually caring and spending time with your patients. Telehealth is a quicker way to see more patients to produce more income for the hospital. Most MD's and NP's are judged based on how many patients they see in a day. I know for a fact a few of my friends, who became NPs, get a bonus if they see more patients and have a higher quota. So a lot use Telehealth to achieve these higher quotas. I being one of them with a 4 minute visit.

I am not backing down from my stance. I thought it was bogus during covid when Ipads were used, I thought it was bogus when it went to PCP offices and I think its even more bogus we are using rolling monitors as bedside doctors. I feel like if my assessment is done through a screen or camera, then the billable hours should be reduced to an eighth of the cost. If you all want to provide your expertise in boxer shorts on a couch, then you can get boxer short type pay as far as I am concerned.

Sorry missed answering your last question. I would much rather have a closed sign on an ER, find somewhere else to go, than to deal with a 4 min visit over a screen and still pay for a visit as if I was seen by a doc in person. If you truly spent some time with me and heard me out, then I would consider it. After 3 visits of my own and seeing how docs treat this little telehealth thing, I'd happily put closed on the door myself and turn people away. As far as MD's being hard working, then I would love to see a group of you actually show up and be here for your patients and speak out against doing assessment through a screen. Instead, more and more are speaking out exactly how you are and praising the telehealth as the next best thing in being a doctor. Definitely not ok with this move.