Around the Island

Telemedicine and its tele-woes

Banking with a tele-teller recently I felt like something was missing. 

In person, I would have likely smiled wider, and maybe ended with a “See you soon,” but none of that occurred. What happened was a cordial, but a merely transactional conversation.

So it’s no surprise that I find it difficult to embrace the growing popularity of telemedicine. Separating the patient presence from the medical evaluation is foreign to my psyche and so I grapple with my need to auscultate — listening to sounds from the heart using a stethoscope.

But enough about me. I’m reminded that it’s all about you, my patient. 

Like most challenges, all that’s needed is a catalyst to propel progress, and COVID-19 provided just that. “Face-to-face and heart-to-heart,” a mantra long-practiced by bedside physicians, now faces its alter-ego, the “screen-to-screen.”

Once a laughable thought, virtual doctors now line the internet touting great care with Medicare, the federal insurer, covering its costs. Better yet: patients are calling in.

So let’s break this down and see the pros and woes.

“Tele” is a term referring to distance and added to “medicine,” a term referring to the practice of providing a diagnosis, prognosis, treatment and prevention of disease.

A mouthful you say? Just wait, there’s more. The first step of the diagnosis is the “history and physical,” endearingly called the H&P. Medical students are painstakingly drilled into crafting this art of a document.

Resident doctors are belabored by its length and attending physicians have resorted to note templates softwares. This history (aka, what you tell us) amounts to the well-quoted 85% of what it takes to formulate a diagnosis, thus leaving the remaining 15% to be gleaned from the physical exam.

Your provided history includes: your complaint with details; a review of your overall body systems; your past medical history; your family history; your social history including all vices; and your allergies and medication list. All this prodding into your personal life medically sums you up to us.

“The doctor will be right in,” in telemedicine means we now query from afar and have you take your own pressure.

Of course, there are pros to this method of care. Thanks to COVID, our need to double mask at double-arm’s length of each other led to skipping the physical exam, altogether, for safety concerns. Plus, the convenience of clicking right into a physician-ready room can’t be beat. And if you already know your doctor from pre-pandemic periods, well, that’s all icing.

So, what’s my hang-up with telemedicine then? What are the tele-woes?

For starters, I don’t get to see you, and 15% of an examination is plenty because without the physical exam, my diagnosis stands the chance of being only 85% correct.

Additionally, placing so much on the patient to supply all their tele-needs is going a bit far. To see your doctor, you must now have: internet service; an internet-capable video equipment with application; your own medical devices; and have the knowledge to operate it all. 

Where is all this funding coming from when co-payment could barely be made? Where did all my overly-in-need-of-assistance patients suddenly go?

The answer is concerning, since these patients get lost — lost in the system, lost to closed practice doors. And lost in isolation, as studies show that up to 85% of physician visits by the elderly are for socialization.

Anthonette Desire, M.D., who saw patients at the Shelter Island Medical Center for several years, is an internal medicine-trained physician currently serving on the medical board of St. Charles Hospital. She uses her experiences as a doctor and mother of a boy with autism to educate and support patients and parents via her writings, website (desiremd.com) and upcoming book.