These are but a few of the dozens of questions circulating the medical community these days. The world has once again turned upright and now that patients are permitted face-to-face visits with their doctors, telemedicine’s role in healthcare is one of ambiguity. We consulted Dr. Francis Counselman, M.D., C.P.E., F.A.C.E.P. of Emergency Physicians of Tidewater and Dr. Robert Fink, M.D., F.A.A.P., Pediatric Specialist at CHKD, to better understand telehealth in two of medicine’s most demanding arenas.
Telehealth existed long before the pandemic. In 1925, radio and publishing pioneer Hugo Gernsback predicted telehealth with his vision for “teledactyl,” a device that would allow doctors to simultaneously see, touch and treat patients through a viewscreen. Although parts of Gernsback’s teledactyl are too advanced for even today’s engineers, the radio, and later the television, played vital roles in the creation of the app-based telehealth we use now.
Access to telehealth expanded in the mid- to late- 1900s, but access was not synonymous with demand. Fink explains that prior to the emergence of the COVID-19 pandemic, U.S. doctors rarely needed to perform telehealth visits with their patients. Only after the fear of contagion spread did physicians perceive telemedicine as a necessity rather than a novelty. “It became imperative for us to determine how to best minimize exposure of our patients to COVID in the office and this is what truly paved the way for telemedicine to become an appropriate alternative to in-person care,” says Fink.
Following Fink’s logic, Counselman adds, “The COVID-19 pandemic accelerated and expanded the use of telemedicine. It forced [us] to consider telehealth as a means to expand access to care for a broader patient population.”
Access is critical, especially in emergency care. “The days of every hospital having every speciality 24/7 are long gone. Telehealth allows a specialist, such as a [neurologist for a stroke, for example], to be available for consultation at multiple hospitals at the same time,” says Counselman. The accessibility telehealth privdes specialists also allows patients access to better care. Many patients no longer require hospital transfers or outpatient referral as they can consult with specialists virtually.
“Some specialties lend themselves more to telehealth than others. For example, dermatology, with a heavy reliance on the history and visual appearance of a lesion, lends itself well to telehealth,” explains Counselman. “In our area, [emergency physicians] use telehealth almost exclusively in dealing with consultants. We typically do not interact with patients primarily using telehealth.”
Fink, however, speaks directly to the experience of a specialty provider. “Families were grateful to have the opportunity to have their children evaluated virtually through telehealth. This was especially true for families with children who had rashes, ADHD, anxiety, depression and other mental health issues or school-related problems,” he says. “It also gave us the opportunity to inform and educate parents of newborn babies, especially those who were breastfeeding, before they needed to be seen in the office.”
This journey to easy access, however, was anything but. Fink offers an intimate peek into the role of a physician during the implementation of COVID-era telehealth. Words like cumbersome, laborious and time-consuming come to mind when Fink recounts the onset of virtual visits. “There were initially platforms, or internet programs, that were mandated we use, and for many months, the process was quite laborious. The platforms had to have appropriate firewalls to be HIPPA compliant so that an outsider could not gain access to the physician-patient interaction,” he explains.
Fink notes that physicians, as well as patients, also struggled with the limitations of a poor internet connection, low-quality images and the extensive documentation permitting a virtual visit. “I found that the telehealth visits actually required more of the physician’s time than an actual office visit,” says Fink. “With time, the process became somewhat easier and quicker as we were allowed to access more polished platforms, and subsequently, the entire interaction became less time consuming.”
Not all ailments lend themselves to virtual treatment though. “Telehealth is not advisable if you are having serious complaints—crushing chest pain, severe shortness of breath or headache, numbness or weakness on one side of your body. These are all life-threatening complaints requiring immediate evaluation in person,” says Counselman. “I think telehealth is here to stay, but seeing patients in person, taking a history and performing a physical exam will always be the gold standard.”
Fink echoes Counselman’s thoughts. “Telemedicine is not appropriate to evaluate a child with a fever, ear pain, sore throat, coughing, vomiting or diarrhea, and these comprise a major proportion of illnesses in children, so it is essential that children with such problems be evaluated and examined in person,” says Fink. “I personally find it invaluable to see patients preferentially in the office where we can get an accurate weight, determine blood pressure, take a temperature and perform an appropriate physical exam.”
Despite the hardships Fink, Counselman and their fellow physicians faced, neither can deny the tremendous value telehealth brought and continues to bring to patients and their families. Throughout the constant peaks and valley that is post-pandemic reality, we all have peace of mind knowing that healthcare will never be inaccessible, rather at our fingertips.
