Blog | Friday, June 12, 2020

Telemedicine surges during the coronavirus pandemic

Not long ago, telemedicine was something that I read about. Now, it's something I do. Over the past weeks I have been evaluating patients over the phone from home. It has been an adjustment, but it has been smoother than expected. First, I have always thought that the physical examination is overrated. Yes, I recognize that such a declaration constitutes medical blasphemy, but I stand by it. Don't extrapolate beyond my actual meaning. I am not suggesting that the physical exam is superfluous. Indeed, there are many circumstances when the exam is absolutely critical. However, for a good bulk of the routine gastroenterology patients I see, particularly for those who are returning to my office for a follow up visit, the exam contributes little value.

Here is a sampling of patient visits where the history alone is largely sufficient.
• A patient with years of chronic constipation returns to see me for a six-month follow up visit.
• A new patient sees me to evaluate frequent heartburn.
• A college student returning from a spring break camping trip in Central America sees me for diarrhea.
• A 35-year-old new patient is referred to me for abdominal cramps that occur after eating dairy products.
• A 65-year-old asymptomatic patient is sent to me with occult blood in the stool.

For cases similar to those I listed above, it is highly likely that I could obtain sufficient information simply from the patient interview, a hands free encounter. This is why telemedicine can be a highly functional modality for treating patients. And, while it is beyond the scope of this post, technology exists and will be further developed that will allow for many aspects of the physical examination to be performed remotely. Even without futuristic technology, we can evaluate a patient's appearance skin, pharynx, speech, joint mobility, respiratory effort, and ambulation through the miracle of video transmission. And, a patient can palpate their own abdomen and report if it is tender.

My telemedicine encounters have been nearly all conducted by phone, and they have gone well. At times, patients have needed to have their expectations revised. For example, if I have a phone visit with a patient whom I have never seen, who has years of unexplained abdominal distress and has seen digestive specialists and had emergency room visits, it would seem unlikely that a new physician will crack the case on the phone.

As I have written throughout this blog, I lament how technology has exacted a cost on the doctor-patient relationship, much as it has eroded humanity and intimacy writ large. To reclaim what has been lost would require canoeing up a steep waterfall. It can't be done.

After the pandemic has passed, I hope that I can return to my conventional office practice, which for me is the ideal setting to practice medicine. But who knows what the new normal will be?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.