My Real-Life Brush with Telemedicine

Experts claim telemedicine is one of the 'next big things' in healthcare. If medical care can be delivered via video chat, just think of the implications this would have. Selfishly, as a provider, it could mean working from home. You know, the kind of job where you wear a collared shirt along with sweatpants and slippers since your patients can only see you from your shoulders-up as you sit in your home office (if you've ever Skyped with me, this was likely my wardrobe). On the part of patients, telemedicine increases access to medical care, for example in remote areas, where healthcare may not be available. 

Telemedicine certainly has its benefits and I'm interested to see where the phenomenon goes. One way the new trend has made it's way onto the healthcare scene is in working with psychiatric patients. This is how the emergency department where I work has implemented the new technology. 

The use of telemedicine for psych purposes has always slightly puzzled me. While I can see the benefit of having access to a psychiatrist at all hours of the day, rolling a screen into a paranoid schizophrenic's room and asking the patient to talk to the physician on the other end seems like it may not lead to a productive patient-provider interaction

The other night in the emergency department I witnessed a comical telemedicine snafu. Really, the story is sad given the patient's situation, but It was one of those times when I had to smile because I could have predicted this sort of thing happening. The patient was an elderly man with dementia. His wife brought him to the emergency department for increasing confusion and bizarre behavior. She simply couldn't handle him at home any longer. This sweet, all-over-grey couple reminded me of my grandparents-stereotypical old people

Once I had ruled out all medical causes of the man's change in behavior, I consulted with the physician on duty who agreed, yes, this sounded like dementia at work. This patient was bound for a short stay in a psychiatric facility to adjust his medications and make long-term plans for his future care. Based on emergency department protocol, a consultation with a psychiatrist was required prior to admission to the mental health facility. Via telemedicine

About two hours later, the psychiatrist had finally been reached (nighttime coverage is often spotty, not to mention one doc can cover multiple hospitals when working remotely), we encountered our first telemedicine challenge. The patient was not wearing his hearing aids. Even when he could hear what the psychiatrist was saying, he could not understand him. The doctor was foreign and spoke with a bit of an accent (there were also a few cultural prejudices at play on the part of the patient, I suspect).

So, a sweet new grad RN went in to help translate. Three hallways away, she could be heard screaming at the poor patient and his wife whatever words the psychiatrist had spoken, loudly and clearly enough for them to understand. Often forced to repeat herself, the encounter lasted what seemed like forever. As a positive, it was nearing the end of my overnight shift and the entertainment combated my fatigue more effectively than the Starbucks Refresher I was drinking (despite the natural sounding name these are loaded with caffeine). 

While telemedicine has its challenges, I'm certainly not against the service. It has its place. But, I predict it will only serve as an adjunct to practice of medicine in person. The way of the future seems like more of an "in with the old, in with the new" scenario.

 

Does your practice use telemedicine? How has your experience been with the technology?

 

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