Telehealth anyone?

[86 inches]

I recently retired from a lifetime in the Emergency Room. I transitioned to the urgent care setting and now to telehealth. I only work a few short shifts a week to stave off drawing from social security or from my retirement savings for another year or two. My company started down this path when covid hit but I was reluctant to give up the hands on work and I felt a responsibility to take care of patients despite the covid risks and all the day to day misery of wearing ppe and dealing with what seemed like an infinite number of almost daily protocol changes.

I was never the ER doc that lived for the blood and guts, so to speak. I never found the work particularly exciting and while my buddies always tried to pry stories from me, I never enjoyed recounting the tales. And while I was fortunate to work days the last half of my career, I hated those early years where I had to cover the night shift. My body wasn't designed for that.

But now I'm almost 6 months into this telehealth thing and I find myself really enjoying practicing medicine like never before. I get to work from home. Patients are pleasant and appreciative of the service. They are happy with the convenience and comfortable in their own surroundings. So far I've been allowed to spend as much time with them as I like... far more time than in the ED or clinic. I really love it. You can't imagine how strange that is for me to say about my work. Towards the end of my previous career, the work had become depressing and oppressive, really. The emphasis on patient flow, the understaffing, and so much more just made the work almost unbearable.

Who has tried telehealth? Did you like it? Some of you who haven't tried it, maybe consider the option the next time you have an urgent care type need.

[Doorman1]

My wife when she was in a rehab facility after her stroke all the specialists did telemedicine. It was ok but I felt it was a bit strange. Her current general practitioner doesn’t do it but I wish he did it is such a hard time getting her to the doctor.

[n2ratfishin]

I am using it every chance I get.

[castforcash]

We use it every chance we can if the issue isn't serious. Much easier than making appointments and sitting in the office waiting to get called back, always late. Then sit in room and wait another half hour to actually see the Dr. It may not be for everybody, but we like the convenience of it.

[ECobb91]

Im skeptical. Idk how a doctor can diagnose an issue and confidently determine the correct treatment through a camera. How do they know the difference between stept throat or something else without doing a swab test? Yet they give out prescriptions for it.

I can definitely see its benefit for mental health and minor stuff. But I don’t see it as a true replacement for an in person visit

[RNKingCx19]

Used it twice. Bad cough and sinus both times. 1st time was given a nasal spray and cough pills. (Didn’t work) 2nd time Doc gave me an antibiotic and cleared me up in a few days. If you’ll tell Doc mucus is green-yellow you’ll get an antibiotic. It’s a good thing.

[BigEasy]

I had my first telehealth visit a week or so ago. For that particular consultation I felt that it was fine. We discussed MRI results and next steps.

It saved me a three hour round trip drive and waiting in a doctors office.

What I didn’t like about it is pretty much the same with any doctor visit; they’re understaffed and over booked. The doc was 25 minutes late, pressed for time and in a hurry because he was behind schedule.

I don’t really see that as the practitioners fault as much as the practices fault/situation. It probably boils down to staffing. I’m guessing they just can’t find doctors. This is again brought out in the next step. My doc wants a procedure done by a specific guy in his office because of his technique in performing a procedure in a specific manner. All good, I want the best guy for the job doing the work. That guy only had three available appointments in the next six weeks. That again is a staffing problem.

My thoughts on the staffing thing is that boomers are aging and having health issues and the young folks are a smaller demographic from which to recruit doctors. Not enough supply to cover the demand.

[86 inches]

Im skeptical. Idk how a doctor can diagnose an issue and confidently determine the correct treatment through a camera. How do they know the difference between stept throat or something else without doing a swab test? Yet they give out prescriptions for it.

I can definitely see its benefit for mental health and minor stuff. But I don’t see it as a true replacement for an in person visit

When I talk to my patients i discuss the limitations of this type of encounter and give them options and let them choose what course fits them the best. As a first option, I always recommend an in-person visit and offer to schedule an appointment for them. But quite often, an in-person exam is not required. We are taught in school that 95% of your diagnosis should be achieved by the history (or what the patient tells you) and 5% exam and or tests. That's a tough task for someone just out of school but with experience one gets closer to that goal. With most of my tele patients I can narrow down the differential diagnosis to a few possibilities and then, within the framework of the limitations of this type of encounter, we can discuss possible courses of action. I keep their options within safe and reasonable boundaries and ask that if they are not improving in a reasonable amount of time that they follow up in person. I always discuss red flags and precautions and do my best to educate the patient so they are armed with the appropriate tools to monitor their symptoms.

In the specific example you mentioned, in the old days we didn't have rapid strep tests and we used a set of rules to determine who most likely had strep and needed an antibiotic vs those that were likely viral and did not. I apply that formula now just like I always have. The only difference is the limitations of the exam. Often times low resolution or poor lighting can limit the ability to see subtle findings. But we discuss this limitation and if there are any red flags or symptoms that are more concerning we talk about that and the importance of an in-person exam. Most often a patient will understand if I suggest that itmight be too risky to proceed with a course of action without a more complete evaluation.

Yeah... sometimes tele just won't work and we get them into clinic. My time is free in those situations. So, at least they get a consultation at no expense.

[n_gong]

I have had about five video chats with Drs. since 2001, each one was fine with the expected results. I had saved many hours of driving by using telehealth.

[dlewis10]

Not a fan of anything done via a computer screen. As a high school teacher, I believe Covid ruined my entire mentality about virtual or any face time interaction through a computer. I just don't like it, and it's not for me. Even now, on snow days, when our school calls for a virtual learning day, I call in sick. Just not a fan...

[Jeff Hahn]

I do a video conference with the PA to the surgeon who removed my prostate in 2019. We do an online visit every 6 months to run over my most recent PSA blood test results and she asks a series of questions. Since everything is good with my PSA, the video conference only lasts a few minutes. Not a problem for me and saves me a 3 hour round trip drive to the Cleveland Clinic, plus the hassle of parking, eating lunch there, and dealing with downtown Cleveland traffic.

[Jbass123]

I also have found that telehealth visits [I’ve had two] are more comfortable for both the patient and the doctor. As one poster noted, doctors might find it difficult to sign in at an exact time, but I’ve also *never* had a doctor appointment in person where the doctor showed up as soon as expected. I have monthly checkups, and typically I sit in an examination room for 10-25 minutes before the doctor comes in. By my estimate, probably 90% of doctor’s visits could be conducted as easily via Zoom or similar technology. If they need to listen to my heart or lungs through a stethoscope, we’re not there yet. But 90% of non-emergency, non-trauma medical visits are back and forth conversation. I also believe that most patients today are more comfortable conducting those conversations from their own homes, unless they are simply not comfortable using computers.

[Mark Perry]

I've enjoyed it the few times I've used it as a patient. Not a single complaint.

[OconeeMike]

We offer telehealth for our employees, it's a great option for a lot of simple things. I used it myself a couple of months ago when I had the flu and wanted Tamaflu. It took about 15 minutes to get the prescription I needed.

[nicapopolis]

I do telehealth with my epileptologist and it works out really well for me. He is a great doctor and does not practice close to my house.

I know this is not telehealth, but we followed our sons pediatrician into her concierge/direct primary care business. Amazing. Nothing like the doctor coming to your house.

[jigman51]

I did a video deal with VA after my knee replacement. Sure beat driving 2 hours to get there. I had a gunshot wound one time and tried to do that over video but they said I better come on down to the ER.

[castforcash]

One of my grievances with my Dr. is that he is a part of a large medical group, which is the norm now. Trying to get a phone call through is a complete disaster due to lack of staff. I miss having a primary family Dr. running his own office. That is a dying breed in this country all ruined by government interference, money and is in my opinion a great loss.

[RyanJ]

My employer offers telehealth to us. Its awesome. Quick easy and cheap! I think it is really made for the minor stuff we experience clearly not complex matters that need special testing etc.

[rednecktech]

I have used it once for a sinus infection, I like it. Hate going to a doctors office.

[ram1076]

Everything has its place, as does this im sure, but im not calling my mechanoc to tell me i neef a new engine but i will let him suggest i shoild get a new battery over the phone