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Telehealth and RA: Am I My Own Doctor Now?, Part 1

With great interest, I have read several accounts of persons living with chronic illnesses report on their telehealth appointments. Many of these appointments have been for routine follow-ups related to chronic conditions. I have yet to read an account of a virtual visit conducted for an acute flare-up of rheumatoid arthritis or multiple sclerosis.

What encompasses an in-person visit

During a normal year, I will see my rheumatologist at least four times and my neurology team at least twice. These appointments are much the same each time. Vital signs are checked; medication lists are confirmed; questions regarding symptoms are asked, and some degree of hands-on examination is conducted.

The outcome of these appointments is usually the same — new prescriptions electronically sent to the pharmacy, if needed, and orders for laboratory or imaging tests issued. A confirmation to “continue what you are doing” is typically added as well.

Patients are the greatest source of information

For these appointments, I can’t conduct my own blood tests or write my own prescriptions. But I am in charge of reporting on issues or concerns that I need my physician to focus on. As an engaged patient, I become the greatest source of information during each of these encounters.

How telehealth and in-person visits compare

With telehealth, not much is different except that I can take my own vital signs with equipment at home. What’s missing from the virtual appointment is the hands-on portion of the examination.

The need for a more thorough exam

To be honest, my current rheumatologist doesn’t conduct a very thorough physical examination. Nothing like my retired rheumatologist who was quite thorough. She had a knack for touching a spot I didn’t even know was tender until it made me jump.

We might be talking about how things were going and I would have to suddenly pause and say, “Wait, wherever that was that you just pushed on my ankle, it really hurt.” She was great at teasing out the swelling and tenderness I had not yet noticed or had come to ignore.

A virtual appointment with my rheumatologist

Just a few weeks ago, I had a virtual appointment with my current rheumatologist. The experience was somewhat laughable. An appointment time was offered by a staff member (8:30 am) and I expressed concern about how long the appointment would take. I had another appointment at 9:00 am with my therapist.

I was assured that my appointment with the rheumatologist was her first of the morning and that we would be concluded well before 9:00 am. Great!

I was instructed to log in at 8:15 am to be available to go over preliminary information. So of course, I logged in at 8:10 am to be early and was ready and waiting in the virtual “waiting room” the morning of my appointment.

I waited. I waited and checked my email. I waited and checked Facebook. I waited some more.

Will I be seen for my appointment?

Fifteen minutes after my appointment was supposed to have begun, I called the office. Nobody answered, but I could leave a message which I did. I waited some more. Another ten minutes later, I called the office a second time and left another message.

“Hi. This is Lisa Emrich again waiting for an appointment with Dr. G. I have been logged into the system since 8:10 am for my 8:30 am appointment. As I previously mentioned, I have another appointment at 9:00 am. I will need to sign-out of your system at that time. I’m sorry that this didn’t work. I’ll try calling the office again later to reschedule. Thanks,” I say.

Darn. I really just needed my doctor to send new orders for Rituxan infusions. I don’t have any real problems right now to report, nor do I need any new prescriptions.

A little too late

Not 10 minutes into my therapy appointment, my phone rings. It is the nurse who is calling to tell me to log in for my appointment and that the doctor is ready.

“I’m sorry. Like I mentioned when we made the appointment and in the two messages I left on the office phone this morning, I am not available right now. I can call you back at 10:05 am to find another appointment time if that works.”

I felt a little ridiculous outright saying, “No, I’m sorry. I can’t talk to the doctor right now.“

The quality of care with telehealth appointments

My goodness, these words I heard coming out of my mouth reminded me of a book titled The Patient Will See You Now: The Future of Medicine Is in Your Hands by Eric Topol. According to the New York Times Book Review, Topol made some bold assertions such as, “By the end of 2014, nearly 1 in 6 doctor visits in the United States will be virtual.”1 It only took a pandemic for Topol’s predictions to come to fruition.

The NYT review continues: “Such visits will improve access to physicians and possibly reduce costs. Nevertheless, I think it is fair to say that we don’t yet know whether the quality will be acceptable to patients or doctors.”1

Quality of care — that’s exactly the topic I wish to address in Part 2 of this series of "Telehealth and RA: Am I My Own Doctor Now?"

Be well,
Lisa

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