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Last week, I had my first " #telehealth" (actually, telephone) visit.
It was a long-scheduled annual wellness visit with my primary care doc.
Thread, from my dual vantage point as a doc & a patient:
It was a long-scheduled annual wellness visit with my primary care doc.
Thread, from my dual vantage point as a doc & a patient:
1. There are so many signifiers of "medicine" that go missing in #telehealth.
No weight check, no BP check, no pulling of the curtain.
No weight check, no BP check, no pulling of the curtain.
2. I know (as a doctor) that much of the physical exam is "for show" - but I've come to expect it.
It's tough to accept that a visit is "thorough" without these physical markers of care.
https://www.webmd.com/a-to-z-guides/annual-physical-examinations )
It's tough to accept that a visit is "thorough" without these physical markers of care.
https://www.webmd.com/a-to-z-guides/annual-physical-examinations )
4. To get academic: the semiotics felt .... off-kilter.
5. BUT: I was also surprised by how reassuring it was to hear my long-time doc's voice. To hear her usual questions. And to have the chance to dive in deep on sticky issues (like: given my mixed heritage and distant family history of cancer, do I *really* need genetic testing?)
6. And to find that maybe it didn't matter so much that this was on the phone, instead of in person.
I still felt cared for and healthier as a result.
I still felt cared for and healthier as a result.
7. A little bit of me wonders about cost: is it FAIR that docs should be paid the same for these visits?
(Quick answer: yes. The cognitive load is the same.)
(Quick answer: yes. The cognitive load is the same.)
8. A little bit of me wonders about efficacy: Will Americans' health suffer because of the widespread transition to #telehealth? I talked about cancer, but what about in-person screenings?
(Quick answer: it will probably suffer.) https://www.statnews.com/2020/05/04/cancer-screenings-drop-coronavirus-pandemic-epic/
(Quick answer: it will probably suffer.) https://www.statnews.com/2020/05/04/cancer-screenings-drop-coronavirus-pandemic-epic/
9. A lot of me wonders about cost-*effectiveness*, which of course depends on both of those.
(Quick answer: Still up in the air.)
https://khn.org/news/are-virtual-doctor-visits-really-cost-effective-not-so-much-study-says/ (old article, but interesting)
(Quick answer: Still up in the air.)
https://khn.org/news/are-virtual-doctor-visits-really-cost-effective-not-so-much-study-says/ (old article, but interesting)
10. But the "value" of the annual visit - even via telephone - may be incalculable. https://www.statnews.com/2017/06/23/medicare-annual-wellness-exam-doctors/
11. And with newer telehealth modalities that are developing during #COVID19, we may see a new, enhanced experience that keeps patients healthier & happier 
12. Most of all: we may not have a choice.
/fin
/fin
