Telehealth Q & A with Healthcare Providers
Coleman Associates conducted four interviews with physicians in Colorado during the COVID-19 pandemic about their experiences with telehealth. Below is the full podcast episode and a partial transcript of some of the highlights from those interviews.
Full Episode
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Partial Transcript
Question: Do you feel like this takes you out of your comfort zone in terms of “what you normally signed up for in your day job?”
MD Answer: So the immediate transition that we made in our office was to start doing primarily phone and video visits instead of in-person. We had done some phone visits in the past, but we did limited things like following up on depression, simple things. So we went from a state of seeing some telehealth patients to a state of, you know, 20, 30, however many phone visits a day.
Question: What’s different now?
MD Answer: {Telehealth} really requires you to think outside the box a little bit. How can I help the patient? How can I rule out the serious things and what are the resources that I have available? I like touching patients, uh, because it connects us. And, just being on the phone or just being in videos separates us. However, we’re still helping. People still really appreciate it. This is something we need to do. In the long run, when we get through all of this, it will help us. There will be some positives that will come from it. We just need to get a little bit more comfortable with not having all the tools we’ve had and weighing the risk and benefit and knowing that you can follow up the next day. There’s not the cost or the availability issue at this point with more frequent follow ups. So that’s, that’s useful too.
Question: What is your overall opinion about providing telehealth services?
MD Answer: I was so skeptical that this was gonna work at all and I have been shocked. I’m really surprised how much you can glean from a face-to-face visit via a screen. What I have found is that it has been much more, um, difficult to offer care via telephone than through the video. Video gives patients much more reassurance. And I’ve had this wonderful aspect of being able to try to triage someone’s abdominal pain. I had them put their heads down on their beds and had them palpate, looking for rebound tenderness.
Question: So do you feel like you’re making this up sometimes as you’re going along?
MD Answer: 100%. The video sometimes is, it’s complicated. I’m seeing rashes, so sometimes I’ll have them take pictures and then text them to me. Then I can see, that’s the circular rash that goes with shingles or this looks more like a contact dermatitis. Okay. Parents take pictures of their children’s tonsils to see what those look like, make sure the uvula is midline, make sure there’s no abscess issues. Um, again, imperfect, but it’s certainly better than bringing them in at this point.
Question: Are there any tips or tricks you’d offer on how to efficiently get an HPI?
MD Answer: I have found that sometimes you do have to just interrupt a person. They don’t have those social cues. Even on video, people are staring at themselves on the phone. They can babble on. And I think they realize that sometimes too. So just that gentle interruption and with an empathic voice telling them that, you know, I really care about making sure I understand what’s going on. They don’t mind if I interrupt and ask a few questions.
Question: What is your one-liner way to do that?
MD Answer: “Can I please stop you for a moment? Not that I’m not interested in everything. I just really would love to ask you some questions. Is that okay?”
Question: So you’re focusing on the history, can you do the visit without a physical exam? So whether you’re on the telephone or on a video, there is a component of a physical exam being important to your differential diagnosis?
MD Answer: Sometimes I’ll have them do some vitals on the other end, teach them how to do a pulse respiratory rate. If it’s a parent calling about a child, I’ll have them put the phone up to the child so I can hear the breathing. Or ask the parent to look at their child’s chest and at their abdomen and walk them through that. It’s really helpful. Some patients actually have a pulse oximeter at home. But with COVID-19, I think a lot of providers are worried about missing someone who could be hypoxic and needs a face-to-face visit. It’s hard to make that decision and then be concerned about exposing them to the emergency room or urgent care. So some people actually do have pulse oximeters and they can get them pretty fast. Pharmacies carry him for like 15 – maybe $25 at the most, so I would have them go for that.
MD Answer 2: There’s so much that we do where we don’t need a physical exam. You realize that when you’re doing this, you know, diabetes and high blood pressure. If the patient has a cough and, um, even ear infections and older kids, you trust that it hurts. They’ve got the classic symptoms, you treat it, that’s not the end of the world. But there’s things that are more challenging, like people who are having palpitations and you can’t get the EKG immediately and so then you have to really just problem-solve.
The reality too is that the vast majority of people do not want to come in. They don’t want to get their labs done. They don’t want to get their chest X-Ray unless they have to. And if they’re sick enough to need that, then they’ll do it. So I’m finding that a patient’s judgment in general is pretty good and they’re working with us really well.
Question: Are you having more frequent contact with patients through telemedicine platforms now than you would in an office setting?
MD Answer: Yeah, I mean, absolutely. I am following up with people who have respiratory complaints. Our system has it built in where we can send patients to our nurses to check on them. And, some of the physicians are just doing it themselves, like for patients who have orthopedic issues, for example, I had a patient who fell directly on his knees in his eighties and I wanted to bring him in. And so each day we set up a visit and he just didn’t get better. It was over three days. And so we got an x-ray and he had a patellar fracture and he was actually evaluated within 30 minutes of the x-ray. So, it didn’t delay any healing for him. It’s just some people do end up having to be seen.
MD Answer 2: Not yet for me. It’s only been three weeks for us. People have been very thoughtful about making the phone calls when they do. They know that one day there were 600 phone calls and so they’ve really been thoughtful about when they’re calling. They consider whether they really need to see the doctor or not? So I haven’t noticed a frequency issue. My throat by the end of the day is raw. I can’t believe how much more work it is to do telehealth than it is to just see patients. I was shocked by that. That’s the biggest change for me. But uh, no. Besides that, not the frequency is often an issue.
Question: What’s a positive side of delivering telehealth?
MD Answer: I mean, we used to order a lot of labs. We do order a lot of diagnostic tests and I’m now realizing that sometimes that’s not needed. The other part that we have access to, and I don’t know how relevant it is for other folks, is that our specialists are doing the same thing. So we don’t need to order them again.