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Interesting take (both in the article and by @Angiologist about telemed. I have a slightly different view. I work in a system (@MdAtlPermanente @KPMidAtlantic) that uses a lot of virtual care. Not just consults, Also telephone, video, secure messaging, remote monitoring etc. 1/n
In fact more than 50% of our patient interactions are non face to face. And here is what we have learned. All of these technologies are just technologies. It is not what they are but how they are used that matters 2/n
For ex, we use virtual chart reviews for all of our preop CV assessments. We worked with our preop team on questions to ask (functional status, etc) and now, we can review the hx/ekg and give an opinion on the same EHR while saving the patient a trip to see a cardiologist. 3/n
Our Urgent Care team uses video house calls to help manage patient's urgent care needs without leaving their house. And if turns out they need to be seen in person, that UC doc can help get the care plan set up while the patient is on the way to a CDU/ED 4/n
But what about relationships with patients? Well, I think modern social interaction is a mix of virtual and in person care. I see my parents once every few weeks, but I text/email them much more frequently then that. The same can be true for my patients 5/n
For my hypertensive patients - we come up with a plan and I have patients email me their BP logs after 2 wks. We can have a long conversation over several months (or even years) in bits that easily fit into their lives - when its convenient for them 6/n
For my stable CAD patients, I say we check in once a year - it can be in the way they want to (phone/email/video/in person). The patient gets to decide the way and the frequency they interact with me (just like my parents 😉) 7/n
What about the physical exam? Yes its true there are things that require a physical exam for dx or tx, and some patients prefer F2F and some conversations require it. So F2F is not going away. But I also think virtual care offers some advantages as well 8/n
Our remote monitoring platform for CHF management, for example, has given us lots of really interesting info about activity, weight and sleep patterns that helped with clinical care & that periodic F2F visits would not have offered 9/n
And I can't tell you how many patients email when the media over-exuberantly describes a new study. Lowering the barrier to ask a question means that our patients reach out to us for context more often, which helps them and helps our relationship with our patients too. 10/n
But the Bloomberg article is about single transactions of care via telemed, right? True. And that is why I think the way the technology is used matters way more that the technology itself. 11/n,
Building relationships with pts, making thoughtful and thorough diagnoses, collaborating with colleagues and bringing satisfaction to physicians - all is possible with virtual care. IMHO, its the system that is built around it that will drive those attributes, not the tech 12/n
If you want so see an example of how virtual interactions can build all of the above, you need to look no further than #cardiotwitter. 13/n
@willsuh76 @DrMarthaGulati @HeartOTXHeartMD @mmamas1973 @mirvatalasnag are just a few examples of the many folks on this media that I've never met, but are all people who have made me a better doctor and a happier person. 14/n
I understand the concerns re virtual care. The best part of all our jobs is the patients we get to take care of. If u want to make these new methods of care work for u, start by asking how the tech can make those interactions better. I promise u wont be disappointed! 15/15
