Is Telemedicine For You?


telemedicine

By now, as the age of Zoom seems here to stay, many of us have experienced at least one or two telemedicine visits with a doctor. The obvious advantages of talking with your doc on a screen at home are mostly related to convenience. It takes less time, less energy and even less cost when you figure in transportation, not to mention time away from work. This is especially true for those of us who have mobility challenges and already work from home. But there are potential downsides.

For me, in the last five years or so, I have had more doctor appointments than at any other time of life, no doubt due to my advancing age and more frequent complications. Zoom appointments have worked well for me, but not always. Of course, people of all ages can be busy and beset with complicated medical situations. United Spinal Association’s Tech Access Group, which meets bimonthly to discuss access to technology for wheelchair users, is made up of mostly 30- to 50-year-olds. “A main topic we’ve been discussing lately is when telemedicine works best or not so well, for whom, and what the future looks like when remote medical appointments seem to be gaining popularity and widespread usage,” says TAG Director Brook McCall.

The consensus of the group is that telemedicine definitely holds a lot of potential benefit for SCI survivors, but they don’t want to see it become the default, go-to-choice for regular medical care. And the danger of anything new to mainstream culture is it rapidly becomes the preferred overall health care protocol — to the detriment of those of us with little-known or poorly-understood health situations. Sadly, many doctors and nurses are lacking in detailed specific knowledge of our everyday circumstances, which calls for more educating in the process of making new public healthcare policy. “And we need to be part of that process,” says McCall.

Searching for Doctor Right

My own experience with remote doctor appointments began with telephone appointments, which offer some, but not all, of the benefits of onscreen visits. For me, any kind of remote communication works best with someone you already know or have ample in-person experience with. My primary care physician, Dr. Mel, has been my doc for more than 20 years. When we talk, our shared history is extensive, so getting to the point in an efficient way is the norm, as is picking up on subtle clues on mood and tone of the conversation. I also trust him unconditionally. He is a truly dedicated doctor. In 2005, as I was struggling in the hospital with the pain of angina the night before my scheduled quintuple coronary artery bypass graft operation, I woke at 3 a.m. to find him sitting in the darkness next to my bed. “Is that you, Mel?” I asked. “What are you doing here?”

“I came in a little early to check on you and say a prayer,” he said.

When you find a doc who is this caring, they can be trusted in any situation — in-person, on the phone, on a screen or with email. Docs like this are worth their weight in extra years of good health and friendship. Trust them. Employ them. Use them however you will. They are the best of all health care providers.

Over the last four years, in my ongoing battle with recurring infections with UTIs and epididymitis (see NM, January 2021), my need for frequent doctor appointments has been more urgent than before. When my regular urologist suggested I needed surgery to fix a urethral fistula, I began a search for the right doc, one who had the right credentials and experience but also would be available for appointments whenever I needed one. My then-current urologist, also a busy surgeon, only kept office hours one or two days per week. I changed to another urologist who was always available, but he didn’t impress me with his SCI knowledge. So I changed again, to someone who met my needs.

Dr. N was friendly, detail-oriented and understanding of my history and my problem. At times it felt like, under different circumstances, we could have been personal friends. Then came the pandemic, and I no longer had access to him. After a few months of being in limbo, we had our first Zoom visit. It felt good to reconnect. We seemed to enjoy our virtual visits. We shared the same opinion of what needed to be done. On the third virtual visit, he explained to me his plan for operating. In the meeting, he tried, unsuccessfully, to tell me the exact location of a tricky incision that would be needed, but words alone sometimes aren’t sufficient. In an awkward improvised moment, he took his laptop off his desk and aimed it a specific area in his crotch. He was fully clothed, of course, but there I was looking at an extreme close-up of my doctor’s crotch on my laptop when my wife happened to walk by behind me. Talk about a weird, comical moment. The look on her face was priceless.

Of course, that’s one of many examples of what’s missing with virtual appointments. A detailed physical exam in the doctor’s office would have put the matter to rest. As it turned out, after all of our discussions, we both decided I needed a surgeon who specialized in fistula repair. So off I went in search of my next urologist/surgeon.

Is Seeing a New Doc Virtually Advisable or Not?

Unless it is absolutely necessary, I would not recommend it. That is why I opted to meet my new specialty surgeon in her office. It was the right choice. She was prepared, thorough and wanted to examine me. Too much can be missed in a virtual appointment, even when you are face-to-face on a screen. Better to have an initial consultation and physical exam, either complete or partial, before going to virtual visits. But sometimes that can’t happen.

Today, for instance. This morning I had a virtual appointment with an infectious disease doctor for the first time. The visit began with a technical glitch that blocked my video — a virtual meeting killer — so we switched to our phones. Then I began having problems understanding her every word because she spoke in an accent that I wasn’t used to. Thankfully, the glitch was fixed, and we returned to Zoom. “Well, look at you!” she said on first glance. Instantly we connected, personalities and all. The accent problem gradually disappeared as I watched her speak. The only problem with this visit was I got the impression that she, too, lacked extensive experience with spinal cord injury. But I could see on her face, and hear in her words, that she was aware of this and willing to learn. It went as well as any in-person visit could have — except for the initial glitch. I decided to trust her.

As a rule, especially when dealing with specialty care rather than your primary care physician, there is simply no substitute for face-to-face, hands-on, in-person visits, especially when you have a skin problem or some other complication that must be seen to be appreciated. For instance, McCall had difficulty convincing a doctor of the severity of a swelling problem in her leg in a remote visit until she was able to re-connect with her physiatrist in person, who examined the leg in her office and instantly saw the need for immediate action. No photo sent remotely could have adequately captured the full extent of the problem.

Potential Benefits of Telemedicine

Hugh Brady, 63, a T1 para living in New Hampshire, has also had experience with video appointments during the pandemic. “That was the only way you could speak directly with your physician for the first six months of the pandemic,” he says. He had two virtual visits with his dietitian and one with his regular doctor. His takeaway from his limited experience was similar to everyone I have talked with.

“It was similar to a visit in person, but if you had any type of problem that required it to be examined, you were told to go through the emergency department if it couldn’t wait. I think they will continue to use it for minor problems in the future regardless of the pandemic.”

Also like others, he says his biggest benefit was cost savings on travel. “I have to take a 100-mile round trip, and if you have multiple doctor appointments in a month, it saves quite a bit.” He finds that, in general, “new technology is always tough to get used to. But it’s a sign of the times — you either adapt or get left behind.”

Mike Collins, a stalwart NEW MOBILITY contributor and former columnist, has logged several decades as a C5 quad and has a lot of medical needs these days. He has had four telemedicine calls, mostly just in the last month. Before that, he used telephone as well as in-person visits. He had no camera available on his computer, so he bought a portable camera to open up that option. “It seems like the preferred option for a lot of providers,” he says. “They’re all offering it. It’s worked well for me, but for some reason the docs I’ve been talking to seem like they’re in a dark cavern with one light that is too bright.”

It seems a lot of us could use a mini-course in camera lighting and “set decoration” to maximize this new technology.

Collins, a Washington state resident who lives in a suburb of Seattle, had virtual visits with a physiatrist, a urologist and a stand-in for his PCP. He changed insurance plans recently and now gets his healthcare from UW Medicine, with its three hospitals, several clinics and much better SCI care. “But everything is 20 miles away, and I can’t drive anymore, so just getting there takes a ton of effort and help.”

He had one in-person appointment with a physiatrist who had become familiar with some spasm problems he was having. “When she wanted to meet again in person, I declined due to the spike in coronavirus cases.” Enter telemedicine, just at the right time. “In our virtual meeting we discussed the possibility of spinal stenosis surgery. It was mainly just talking and discussing, and it worked well for making plans for the future. I’d had an MRI done previously so she was able to pull those up when we talked. I did the same thing with a urologist later who was looking at an earlier ultrasound.” No physical exam was needed in either case.

His PCP was a brand-new provider he had never met personally before. “I was new to their system. We’ve had phone conversations before, but nothing face to face. On the virtual visit we talked about options for changing prescriptions and other types of health problems and also about future opportunities for in-person appointments, which I’d rather not do if not necessary. So for me, Zoom works best, especially given my circumstances now that I no longer drive.”

All of his docs are now a 20-mile round trip both directions. Gas and parking are both problems. He likes the convenience and not risking his health and sums up his experience neatly: “Why not take advantage of the new tech as well as the traditional model when you need it, virtual or whatever? Better to see a face on screen than hearing them on a phone. They become real. It’s more personal talking with a face than a disembodied voice.”

*****

Action Alert: Protecting Access to Post-COVID-19 Telehealth

United Spinal Association understands that telemedicine is not a replacement for in-person medical visits but during challenging times, it is a critical supplement to necessary care.

United Spinal supports expanded access to telehealth, and the COVID-19 pandemic has demonstrated just how valuable this service is not just to our community but to all Americans. United Spinal supports the Protecting Access to Post-COVID-19 Telehealth Act, H.R 366, bipartisan legislation introduced by Reps. Mike Thompson (D-Calif.), Peter Welch (D-Vt.), David Schweikert (R-Ariz.), Bill Johnson (R-Ohio), and Doris Matsui (D-Calif.). This bill would do the following:

· Eliminate most Medicare restrictions on where a person can use telehealth services, while establishing that patients can use telehealth in their own homes and allow their health care provider to be reimbursed by Medicare.

· Prevent a sudden loss of telehealth availability at the end of the COVID-19 public health emergency by authorizing the Centers for Medicare and Medicaid Services to continue to reimburse health care providers for telehealth services for 90 days beyond the end of the public health emergency.

· Make permanent the current disaster waiver authority, allowing the Department of Health and Human Services to expand telehealth during all future emergencies and disasters.

· Require a study on the use of telehealth during the COVID-19 pandemic, including its costs, uptake rates, measurable health outcomes, and racial and geographic disparities. Please visit our Action Center, unitedspinal.org/action-center/ and contact your members of Congress and tell them to pass H.R. 366 today.


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