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Wednesday, April 29, 2020

Telemedicine vist

Telemedicine visit

Your doctor does not want to see you in his/her office. At least your doctor should not want to see you in his/her office. Not now.

We are in the middle of a pandemic – goes without saying. Covid-19 stands for coronavirus disease 2019. Its novel because it is new and something the human immune system has not previously encountered.  We have experience with other deadly coronavirus infections. SARS had a mortality rate of around 15% and MERS was scary deadly with a mortality rate in the smallpox range, 30+ percent. Covid-19 is less deadly but much more contagious. The true numbers of those infected and the mortality rate are to date unknown.

Covid-19 is the dreaded pandemic, more than an epidemic.

An epidemic occurs with rapid dissemination of an infectious illness through a susceptible population. It may be worldwide as occurs yearly with influenza.

A pandemic is worldwide dissemination of a new deadly infectious disease. This is the stuff of sci-fi movies.

A friend’s parents live in a Maryland Assisted Living facility and tested positive for Covid.  Both presented with diarrhea and without fever or cough. Unusual presentations may not be unusual.

A typical physician’s medical examination room is an 8X10 or somewhat larger rectangle with relatively poor circulation. It is a perfect incubation chamber for coronavirus. Infectious particles may persist in air – droplets and aerosols and on incompletely sterilized surfaces. I am more concerned about transmission to patients from asymptomatic medical staff.

Covid is present in at least two thirds of our state’s nursing homes. Family members are barred. The virus is invariably introduced by unwitting staff members.

When possible, and it mostly is, stay at home and stay safe.

Telemedicine in Maryland is defined as a medical encounter with the use of an audiovisual aid such as a computer using a HIPPA approved platform. Telephone calls are excluded from the definition of telemedicine.

State licensure rules regulate the use of this technology for out of state patients. Most states have loosened the rules. But changes in regulations vary tremendously from state to state.

Telemedicine is more personal than phone medicine and feels more like a normal doctor-patient visit. I can get a sense of the patient’s general overall health based on his/her appearance. Objective data is missing but patients can help fill in some of the blanks.  Patients have easy access to home BP devices, oximeters, scales and thermometers. I can look at a throat, rash or swelling. I can see where pain is without having to guess. I can get a general sense of breathing based on observation. And many patients can get an EKG with a wristwatch or other portable device and show me the tracing on the screen. Prescriptions are electronic.

If a patient needs more advanced care, at an ER for example, the platform is extremely helpful vs a phone call. 

Please use the or another similar platform. It’s easy to use and does not require an app. And I can hear much better as well.