”Laughter is the shortest distance between two people.” — Victor Borge
Having spent the last week on the phone providing tele-health services to our patients unable to come into clinics because of social distancing and quarantine guidelines has been an eye-opener for me. Clearly, those on the other end of the phone or on FaceTime are relieved and grateful to have someone reaching out to them. Their needs are as varied as primary care is. Some have chronic conditions such as diabetes or cardiovascular disease that need to be monitored and for which they need refills for medications. Others have the usual array of acute problems, bladder infections, headaches, colds, flu, skin rashes, stomach problems, musculoskeletal aches, pains, and injuries. Some need a release from work or return to work note. Many are worried about COVID-19, of course.
Managing their medical care over the phone isn’t too hard, especially with established patients. But managing urgent care patients, not previously seen by me or even anyone else at The University of Texas Medical Branch, requires a new skillset, like working in a drive-thru emergency room. Without the face-to-face interaction, gathering essential information, and avoiding “don’t miss diagnoses” by phone can be daunting.
One lady I spoke to complained of a flare up of her chronic obstructive lung disease, which seemed like a straightforward issue until she also mentioned her pounding headache for which she wanted something. Turns out, she had measured her blood pressure and found it to be over 200 with a pulse rate over 120. I advised she immediately go to the emergency room, preferably by ambulance. She declined, just wanting medicine for her breathing problem since she was the sole caretaker of a man on hospice care. I reasoned with her that she could suffer a stroke or heart attack, but to no avail. I asked our nurses to check in with her later.
Many folks I contacted were clearly affected by the pandemic and limitations it was putting on their lives, families and work. Sniffles, allergies, sore throats, coughs that they would otherwise shrug off were eliciting fears of coronavirus infection. Most of these cases turned out to be straightforward, but people needed to be talked through their situation and reassured and treated at home. E-prescribing and drive-thru pharmacies help.
At the end of a long day on the phone on Saturday, I reflected that tele-health, email and web video types of visits may well be the future of medicine. While technology has advanced, the delivery of medical care hasn’t kept pace. This has been primarily because reimbursement guidelines have not routinely allowed health care providers to bill for services not provided face to face.
Medicare and other health insurers have waived those rules now in the face of needing to keep people out of close contact in our clinics and hospitals. This could be a breakthrough in how we can reach out and care for people in the future from a distance, efficiently, effectively and safely.
Crises are also opportunities. Contact your doctor if you need something.