Category: Telemedicine

Can Physicians Change Vaccine Hesitant Patients’ Minds??? Nah!!!

Check this out. What you will see is some mildly interesting stuff concerning telehealth. Skip over that and go to the section on VACCINE HESITANCY. 

There you will find some interesting numbers. More specifically, you will see that 52% of physicians believe that they need 2-3 conversations with patients to change their minds about vaccinations, BUT 67% of physicians believe that most patients’ minds can’t be changed. 

Put together, these numbers would support what I have been telling our On Doctors’ MindsSM subscribers based on my recent conversations with physicians, and that I also noted in a recent post.  That is, almost a year into vaccine availability, many doctors are largely giving up on evangelizing the COVID-19 vaccines with the unvaccinated. Why? In summary, they see time spent on these efforts as wasted, and they simply don’t have the time to waste. Put another way, doctors believe that anybody who hasn’t gotten vaccinated after a year is not likely to do so in the near future, no matter what their HCP says.

Bottom Line. The plot thickens. It should be noted that with the approval of new booster protocols and pediatric vaccinations, this whole dance is going to start up all over again. 

My bet? People that are already “fully vaccinated” should be ready to get their third shot. No problem.

On the other hand, how people will feel about getting their munchkins vaccinated will be interesting to watch. New objections? Same old? We shall see! 

Telehealth Use Up, Patient Satisfaction Down!!!

Check this out. What you will see is common sense as it applies to telehealth. Quite simply, the pandemic hastened the proliferation of telehealth platforms and of physicians ready, willing and able to use them. The fact that third-party payers, in many cases for the first time, compensated doctors for telehealth visits was a significant driving factor here. Just so, patients seeking safety and convenience stood ready to try telehealth visits during the pandemic.

BUT. Challenges in actually using the telehealth technology reduced patient satisfaction, as did confusion about treatment costs and lack of a “provider details.” Also, rather common sensical is the fact that telehealth is seen as being more satisfactory by the relatively well than by those in poorer health, who are looking for more support from their physician interactions. 

Bottom Line. All of these J.D. Power findings line up rather nicely with the results of my On Doctors’ MindsSM conversations, wherein doctors are telling me month after month that it is the less complicated, follow up patients, and those demanding special handling in terms of safety and convenience, who are now the only ones getting serviced through telehealth platforms. Especially for specialists, the loss of direct physical examination and patient relationship management inherent in telehealth visits causes most doctors to far prefer in-office patient visits. 

Integrative Psychiatry

Check this out. What you will see is a brand of psychiatry very different from the usual focus on mental disorders. Here, the focus is clearly on enhancing mental health. More specifically, “Integrative Psychiatry includes traditional psychiatric practice as well as elements of Integrative Medicine including nutrition, sleep management, lifestyle modification, and mind-body modalities such as tai chi, yoga, and mindfulness.”

Roam around the site. You will see a free mini-course designed to get you immersed in integrative psychiatry. You will see several upbeat videos featuring Dr. MacKenna. And as usual with these kinds of offerings that we have touched on before, you will see that the good doctor will be happy to meet you on a telemedicine platform.

Bottom Line. I must admit, I am finding it fascinating to see the plethora of different practice models that are emerging. Which will thrive, which will remain niche plays? Stay tuned!

Direct Care Rheumatology

A few days ago, I posted on tele-urology. I highlighted a urologist who was advertising her telemedicine services directly to patients, offering to treat a large variety of urological problems from the comfort of home. At the time, I wondered out loud what other specialties could go the “direct care” route. Here’s today’s answer to that question. Dr. Girnita, pictured above, now offers her expertise as a rheumatologist directly to patients through her website, Rheumatologist OnCall

And the concept of “direct specialty care” in rheumatology is not a solution in search of a problem. The good doctor has it right. At least on Hilton Head Island, SC, an appointment with a rheumatologist is often six months and a two-hour drive away. If a patient is acutely suffering, e.g., from an autoimmune disease, that can be forever.

An important note here. This is “direct care.” The “direct” part means that the patient pays, directly, for their care. There’s even a society now that is attempting to organize physicians who are establishing specialty practices based on this model.

Bottom Line. This is clearly an important trend for us to keep an eye on. If it picks up a head of steam, we are going to have an entirely new segment of physicians to promote to. Doctors that don’t go to offices to see their patients. So, we can’t go to their offices to see them. 

Think about it!

Tele-Urology

Check this out. What you will see is that Dr. Diana Londono, the urologist pictured above, offers a sort of fascinating array of services on her website. These include:

Treatment of Acute Symptoms

I offer same day, virtual, tele-video or

telephone appointments for urgent

urological conditions.

Funny. I usually think of such one-off telemedicine encounters as being the purview of Primary Care Physicians. Where I have seen telemedicine employed by specialists, it has usually been as a “follow-up.” All of which got me to thinking. What other specialties could profitably offer such appointments for “acute symptoms,” and what conditions would they cover?

Bottom Line. Clearly, the “right way” to employ telemedicine in the long run is still undetermined. It will be fascinating to see how all of this shakes out in years to come. The COVID-19 pandemic threw most physicians willy-nilly into telemedicine, and many found virtual visits to be less than satisfying. But telemedicine clearly has a place in the practice of medicine in 2021 and beyond.

What is that place? Stay tuned!

The Ethics of Telemedicine

In my On Doctors’ MindsSM research that tracks the adaptations that office-based physicians have made to the COVID-19 pandemic, I have been fascinated to learn about how quickly clinicians were able to adapt to telemedicine, and some of the hurdles they encountered going up the learning curve involved in using this new technology.

But check this out. What you will see is a discussion of whether it is ethical for a physician to limit the treatment of unvaccinated patients to telemedicine visits. Survey results revealed that 69% of doctors thought this was ethical given the risk such patients pose to medical staff. A medical ethicist weighing in on the same topic agreed, but put in the caveat that if a patient’s condition requires personal contact for good treatment, e.g., in the management of a movement disorder, it was incumbent upon the practitioner to either allow personal visits or refer the patient to an HCP that would provide such service.

Bottom Line. Think about it. The COVID-19 pandemic brought with it, among many other things, a slew of new and important ethical questions with which healthcare providers must wrestle daily. As with so many aspects of the pandemic, I am thinking that the results of these wrestling matches will substantially modify thinking in the field of medical ethics for years to come.

If not forever!

One Confused Physician

Check this out. What you will see is the rather amusing story of the day that Dr. Anthony Fleg, pictured above, unknowingly held a 20 minute “telehealth” visit with a patient who was sitting in an examination room in his clinic.  In a day comprised mostly of virtual visits, he had missed the intake note that said “Room 11.” A sign that things were starting to “open back up” in primary care. Also, a sign of just how confused the pandemic has gotten all of us, with those in the front lines of healthcare being particularly vulnerable.

Bottom Line. Sitting here as July transitions into August 2021, I wonder. I wonder what kind of confusion will be caused by the CDC once again flip-flopping on mask recommendations for the vaccinated. By Pfizer and the FDA trying to make sense of the need (?) for a booster shot. By doctors once again, without much guidance from anybody, trying to decide whether to close their offices and revert to telehealth. 

Every single doctor with whom I have held a conversation during the monthly iterations of my On Doctors’ MindsSM  project has told me that it has been confusion that has been the worst part of the pandemic. Lack of guidelines. Inconsistent guidelines. Unclear future. Unclear timing. You name it. 

As I listen to the news today, I think that we are unfortunately not done with this confusion!  

Cannabis M.D.

Check this out. What you will be led to is the web presence of Jill Becker, M.D.  Trained in Ob/Gyn, Master’s Degree in counseling psychology, ordained Minister, etc.  BUT. Her main claim to fame is that she has extensively studied the use of cannabis used to deal with a large variety of medical problems. She will “work with your care team” to figure out the right cannabis program to cure what ails you. AND. Talk about a practice that is perfect for using telemedicine! She can work with patients nationwide using telemedicine platforms and can also help patients avoid any stigma that might accrue to being seen sitting in her waiting room. 

Bottom Line. Got me to wondering. How many other doctors have figured out this schtick??? Do the Google search and roam around like I did and you will know what I know. LOTS!!! All doing it via telemedicine.

Smart. I can see this specialization filling a real and important need that many (most?) doctors wouldn’t touch with a ten-foot pole!

New Causes Of Malpractice Concerns For Physicians

I just got off the phone with a Family Physician discussant who was participating in one of my On Doctors’ MindsSM conversations. He had a lot of interesting things to say, but one really stood out in my mind. More specifically, he told me in no uncertain terms that he had NO interest in participating in medical care delivered via telemedicine. None! He feels that he cannot deliver proper care without “putting a stethoscope on the patient,” and that the malpractice concerns attendant to telemedicine are consequential. 

Then I read this. An actual case study involving a “wearable,” i.e., a medical device that permits remote monitoring of patients. In this case, a device that was supposed to keep track of a patient’s heart function. Only thing is, the patient didn’t put the darn thing on for several weeks after receiving it, and never got it to function. Punchline? The patient’s doctor got a report from the wearable’s manufacturer, that he shared with the patient, that the gadget had determined that the heart function was “normal” during this time frame. Whoops!!!

Bottom Line. New technologies are opening up new “roads to risk” for physicians relying on them. Medicus Emptor (Let the doctor beware)!!!

Telemedicine Doesn’t Eliminate Healthcare Inequality!!!

Check this out. No you don’t have to read the whole thing. Just the abstract will be fine. Especially because its message is pure common sense. That is, a large-scale study of patients lined up for telemedicine visits found that certain demographics reduce access to telemedicine during the COVID-19 pandemic. Old age, low income, minority ethnicity, etc. reduce the probability that a patient will use telemedicine.  

The reasons for this? DUH! Old people are far less comfortable with technology, and value the social interaction obtained through a personal visit to the doctor’s office. Poor people can’t afford the computer equipment and Internet access required to participate as a patient in a telemedicine encounter. Latinx patients are less comfortable with English, and are thus prone to feel uncomfortable conversing online with an HCP. Etc.

Bottom Line. SO. Even though we might have hoped/expected telemedicine to decrease disparity in healthcare, there are a lot of reasons that this doesn’t happen automatically. Rather, we will need to develop special programs to incorporate each of these demographic subgroups if telemedicine is supposed to help us in the important task of reducing health disparity!