Friday, 10 Apr 2020

You are here

A Rheumatologist’s Tips: Telemedicine in 6 Easy Steps

Ready for Telemedicine/Telerheumatology?

Once you and your patient agree on a virtual visit, the following suggestions may help facilitate the interaction.  If you have the ability and the capacity, record the visit. 

Step 1: Get your setup ready. 

Choose a quiet place that affords some privacy and have your computer in front of you with the patient’s chart opened.

Step 2: Connect with your patient. 

Introduce yourself and any staff present, then verify the patient’s name, date of birth.  Ask if they are by themselves and if they would like anyone to be present.

Step 3: Conduct the visit. As with any medical visit, inquire about their health/chief complaints. Ask if they have had any medication changes or new allergies. If they have a blood pressure cuff at home, have them check their own vitals and show you via the phone.  

There are free phone apps that can help to measure blood pressure, pulse, cardiac rhythms. Direct your assessments based on their chief complaint and remember the basics: LOOK (INSPECT) FOR ABNORMALITIES and EVALUATE THE FUNCTION. Unfortunately we cannot palpate or auscultate so identify other clues to help you. Examples: Patient: “Doctor, my hand hurts.” You: “Show me from your phone your hand. Now make a fist (at this time assess the MCPs for swelling and look at range of motion. Pick up a pencil and write a sentence (to assess function)." Document your findings while you assessi your patient.

Step 4: Order labs/imaging. Patients may have access to local labs and imaging centers.  If you choose to, you can have them come into your office for labs; however, these patients need to be scheduled so no one is in the waiting room and patients are spaced far in time to allow for adequate cleaning of the lab space and waiting room in between patients.  Send lab orders electronically or fax the order to the labs yourself. Some labs and imaging centers may take verbal orders, but I would discourage this due to high volume and risk for medical error.

Step 5:  Refill medications. If the patient is doing well, consider sending a 90-day supply of medication. Ask patients if the pharmacies they use deliver to their home or use the mail order option so that they can avoid having to leave home and risk exposure.  

Step 6: Ending the visit and scheduling followup. Reassure patients that they can reach you, and take time to answer their questions.  I find that this step is extremely important and will avoid multiple callbacks. Remember to follow up on any tests you have ordered and let patients know of the results. 

If you have additional hints to help with the virtual visit, please share by commenting below (Rheumatologists: please sign in to comment).

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Book Review: “Great Health Care Value: Chronic Diseases, Practice Teams and Population Management”

The US healthcare market has evolved into an incredibly expensive system that often does not deliver good medical outcomes. While most of us know these problems exist, we rarely have up-to-date data or can offer alternatives to the way we manage care, especially to the chronically ill who consume much of our health care dollars. In their book, authors Tim Harrington, MD and Andrew Johnson, MS, MBA offer insights, evidence and experience on how we may do our part to improve the management of chronic rheumatic/orthopedic issues.

Can the Happiest Subspecialists Experience Burnout?

The Medscape’s Physician Lifestyle & Happiness Report 2019 crowned rheumatologists as the happiest subspecialists. We topped the list with 65% of the respondents indicating that they were happy outside of work. I was not really surprised by reading that, and I would go as far as saying that our field is the best. 

Rise in Fatty Liver Disease Linked to Obesity and Diabetes

Gut has published population results from NHANES population study showing that the prevalence of fatty liver disease is rising in the US and is driven by obesity and diabetes.

Employed Physicians Outnumber Self-Employed

For the first time in the United States, employed physicians outnumber self-employed physicians, according to a newly updated study on physician practice arrangements by the American Medical Association (AMA). This milestone marks the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices.

 

Dr. Harold E. Paulus (1929-2019)

Dr. Harold “Hal” Paulus lives in the annals of Rheumatology as a major contributor, mentor, researcher and clinical trialist. He passed away last week, one day after his 89th birthday. I met Dr. Paulus as a fellow in 1985, when he easily included me in his discussions and research on rheumatoid arthritis. I admired his easy demeanor, wry humor and every man character. Most remark on his calm recessive and kind personality that was complemented by a body of work that was large, impactful and usually at the cutting edge. Many of Dr. Paulus’ colleagues and friends have contributed their testimonies and fond memories of this great man.