LETTER from RICHARD STERNBERG
On a recent morning, I had a first visit/consultation with a physician from Columbia-Presbyterian in New York City. In going to the city and back to Cooperstown, Columbia presents a special challenge to me.
It is a difficult facility to maneuver through under fully normal conditions and these times aren’t normal. It would have required driving about four hours each way and maybe even an overnight stay. Both the physician and I chose to do a telemedicine visit.
Most of you already know about telemedicine.
It was starting to be used by patients who had to travel long distances to see a doctor, especially if there was a satellite clinic where the transmission could be accommodated. Now, with the advent of multiple video options, the patient can be anywhere, from home to half the world away.
At the beginning of the COVID-19 lockdowns, many large practices, including hospital-based ones, decided video and telephone appointments were better than nothing. What they found out was that many times they were equal, if not better, than an in-person visit.
Probably the one thing holding back telemedicine use was the refusal of insurers, especially Medicare and Medicaid, to pay for such visits. These visits take the same, if not occasionally more, of the physician’s or mid-level provider’s time. Reimbursement, when given, was less than the equivalent amount of time for an office visit.
With the onset of COVID, insurers were forced to accept the value of telemedicine, given the lack of options if as many people were to be seen as before the pandemic. As an emergency measure, tele-visits were being approved. They still are, even when an in-person option exists.
Most U.S. healthcare administrators and consultants believe it will be impossible to turn back the clock.
According to the Wall Street Journal, “20-25 percent of all care in the future could be remotely delivered.” But already, even as practices have resumed in-person appointments some large groups
are still seeing up to 40 percent of all visits virtually. Personally, I was beyond satisfied with my new-patient consultation.
First, I didn’t have to drive 450 miles roundtrip and probably stay overnight. In my case, nothing was really lost by lack of direct contact. A thorough history of my illness and past history was obtained pre-visit, and the physician had obviously reviewed them before even seeing me.
He asked some questions, then reviewed what he had seen, and finally discussed with me recommendations and potential risks and complications of both having procedures and failing to have them.
Locally, tele-visits are especially useful in follow-up visits, where mostly there is discussion of the patient’s course since previous visits, lab work and other studies.
In our area, winter travel, even of moderate distance, can prove trying. But the biggest advantage I and others have found is that the practitioner has to focus on you and watch you during the interchange. Frequently I have found myself at in-person appointments with practitioners who have their back to me while working on their computer and frequently there is little or no physical exam anyway.
Some studies have shown the need to recognize when a tele-appointment isn’t working and the need to develop a “web-side” manner, a bit different than the classic in-person one.
Some specialties have found these visits to work very well. Dermatology, for instance, where a history is important and the physical exam portion of the visit requires looking but not touching.
Also, the physician can “see” a large number of patients and determine quickly who needs to be seen in person soon.
In my specialty of orthopedic surgery, it probably doesn’t work as well when a physical exam, at least initially, is necessary to fully diagnose a problem. And, one certainly can’t change a post-operative dressing or a cast by video.
Bottom line, telemedicine like telecommuting has expanded dramatically in the last year and there is no need to put the genie back in the bottle. It is not just acceptable but mostly equal and occasionally has advantages over an in-person visit.