SideGigs: Telemedicine and Why I Do It

Spoiler Alert: It’s actually not for the money

In the advent of the COVID-19 pandemic, much of medical care moved towards telemedicine visits. These visits, that are often done with some sort of phonic connection +/- video input to help triage care for those that can not be examined in person, have both pros and cons. However, the truth is that this form of healthcare delivery has been around for over 50 years as a way to bridge the gap for access with rural communities and expand the availability of coverage for those that need it. In certain situations for which a patient can accurately describe or show a complaint, or has a minor concern that simply needs education or guidance, it has become a perfect form of delivering care. Yet, in so many cases and at the root of medicine, the physical exam, is lacking 100% of the time. Even in video visits or with pictures uploaded, the quality of the consultation is privy to technology and its shortcomings (eg: bad connections, pixelated conversations, lag time). We get better every single day and large companies have arisen to monopolize this part of the market, but we aren’t quite perfect… Not yet. But let’s focus on the good things!

Now, eventually I’d love to write my thoughts on simulation, extensions of AI and virtual technology robotic exams that are going to be earth shattering, but this is not that post.

Particularly as a Pediatrician that is never in one spot, many colleagues have questioned my practice of telemedicine as children, arguably different than adults, require physical exams more than not due to lack of ability to accurately verbalize health issues. Sometimes, I do get calls that very obviously need to be seen in person. Sometimes, I do get calls for which a family expects certain treatments or antibiotics, but this isn’t that different from in person outpatient clinic. Sometimes, I worry about the liability and caveat my phone calls with precautions that a telephonic visit will NEVER be superior to an in person one; but, over time I have realized some amazing benefits for this innovative form of healthcare delivery and spend time, especially when I work at night, trying to truly help those that ask for it. There’s obviously the personal pros of working when i want and wherever I want, but let’s be less self-centered here:

Access – I had a long conversation with a mother recanting an odd history of intermittent vomiting and some mysterious rash in her daughter for several days. She started the conversation with: “I have tried to see my Pediatrician. But they can’t fit me in. Also, they’re 1 hour away.” I spent 30 minutes on the phone with that one; and, I get compensated per consult NOT per time. We took a lengthy history over the phone, i looked at pictures sent electronically and we ran through some possible thoughts and what to do. Overall she actually seemed well, but likely would need a subspecialist.

Urgency… Or not – To tag on to the above, another thing I love about doing telemedicine is when I realize parents are genuinely calling out of shear concern and freaking out over night to ask, “My kid has a fever! Does this mean I need to go to the emergency room?! Can this wait until the morning?!” As I would normally have triaged an after hours line or discuss with my own patients when i worked outpatient, i discuss the signs that become truly concerning and when an ER visit vs. an Urgent Care visit is necessary. I have prevented multiple visits to the ER/UC by doing telemedicine and it has been super gratifying to think i’m saving the anxiety, costs and wasted visits in an ever-expensive healthcare system.

Education without Time Constraints – Since I do these consults on my free time (or secretly during night shift when i’m bored), I get to talk for as long as I want or need. I don’t have the time constraints of a traditional office visit and can dive into preventative education and bigger picture conversations with parents. I have discussed allergies and asthma at length hoping to lead some larger picture preventative care for the next time. I have made recommendations that may have been missed out by shorter history taking in time-constrained clinic settings. My favorite part of telemedicine has hands down being able to discuss these things; my favorite part of being a doctor is being an educator after all.

I have felt overly appreciated by most of the families I have talked to via telemedicine consults. It’s obviously not for everyone or every case, and certain things (eg: respiratory distress) are no-brainers for in person evaluations. Sometimes, as all of medicine runs these days, it becomes a consumer driven situation; but a majority of people have been respectful and not pushy when I explain why I won’t automatically prescribe antibiotics. While I don’t miss outpatient clinic most of the time, taking the time for telemedicine helps to bring me back to why I do medicine: to help those that need it.

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