Search This Blog

Follow by Email

Wednesday, October 19, 2011

Telemedicine: where could it lead?

I have only 6 more days in my present job as a primary care internist in my home town. The process of wrapping things up has been new and time consuming, but ultimately very rewarding. I get to see patients I've known for over a decade, in some instances, and review what has happened with their lives and their health and we work on future plans for maintaining what they have gained and getting a handle on problems still bothering them. We say goodbyes and good lucks and talk about the important, big stuff, like hopes and dreams and medication refills. Interspersed among these appointments and phone calls are multiple communications about my next job, whatever that will turn out to be.

I am signed up with 2 locums companies, and in contact with 4 recruiters who are my agents, as well as the recruiters that are associated with my possible new jobs. The phone calls are mostly really interesting, since I get to hear about new places and how they are doing what they do in health care. Many of the jobs that sound perfect have been non-starters because they need me at times when I can't be there, or for lengths of time that would take me away from my family for too long. Primary care positions would like me to be around Monday through Friday, with the occasional call weekend in some cases, for 3 months. This could work if they are within a reasonable traveling distance of my home and family, which does cut down on my options. Hospitalist positions, where I would take care of just patients in hospital, usually for 12 hours each day, are considered full time if I work 1 week on and one week off. If they are willing to fly me in and out, and the location is within a reasonable distance of an airport, that could work anywhere in the country. I would not have to be away for so long that my dog forgets who I am.  Of all the jobs I could get, I would prefer "traditional internal medicine" which involves both outpatient and inpatient work because I think it will teach me more about a whole community and how it is coordinated to do health care. It is good  locum tenens etiquette to apply for only one position at a time, which can lead to serial disappointments and presently I remain on the edge of my seat as I wait for confirmation of my first assignment. I'm sure it will be just fine and dandy, whatever it is, but it would be so reassuring to know where I will be in 2 months.

My resources for this adventure (my 2 years off from my regular primary practice) include quite a few friends and colleagues who have done or are still doing locum tenens (latin for "place holder") work. They tell me what places they have liked, where the ethics or the support might be thin, which companies take care of their clients. Sometimes they even know of specific needs, where I might work without using a recruiter at all. One such opportunity is doing telemedicine.  Telemedicine is the practice of taking care of patients remotely, using telephone or computer. It is often practiced in places where the right doctor cannot be present physically, such as when a rare specialist is needed in a tiny hospital. It is used to share expertise over great distances, and is used internationally by some medical aid organizations. At the recommendation of a friend, I contacted an organization called MDLivecare, which provides telehealth services domestically, with private clients (people who arrange e-visits on their own) and corporate subscribers. A large company may wish to provide their employees with a way to contact a physician quickly, easily and inexpensively as a way to reduce time lost from work and in order to provide services more inexpensively. The telehealth visits include many of the trimmings of a real doctor visit, including documentation of what was discussed, communication with the primary care physician if there is one, and even prescription of medications (though controlled substances are strictly out.)

At some point in the future I will probably know more about telemedicine because I will probably try  doing it. I have always enjoyed the challenge of treating patients over the phone, and having a video chat interface will be even easier than that. Much can be communicated verbally, and though loss of the touch aspect of medicine is a considerable hindrance to some diagnoses, I think it will be really interesting to see how much can be done in this type of an encounter.

Yesterday I visited with a patient who had a very odd neurological problem, a "funny walk" that was new and didn't really fit into patterns I had seen before. More than anything, I wanted her to be able to see a world class neurologist, who could probably ask a couple of questions, watch her walk down the hall and know what she had. But we were in a small town in a small state, and getting to a world class neurologist is probably nearly beyond her. It would be so simple, if telemedicine were more widely accepted, to call my favorite world class neurologist, web cam her funny walk, tell him my concerns and ask any questions he might have and get our answer. What presently hinders this are the fact that even practicing telemedicine requires a state license, and that there are no easy ways to bill for this service. Clearly that needs to change. We have technology at our fingertips that would reduce human suffering and we are hamstrung in our ability to use it. I look forward to the inevitable adjustments in payment schemes and regulations that will allow us to use what we have to its best advantage.

No comments: