ICYMI: Telemedicine Bloopers and Successes Save
Editor's note: This blog was originally published March 31, 2020 and is being shared again in case you missed it.
At my COVID home command center, I feel pretty prepared for everything. From here, I can run my practice, manage and home-school 3 children and keep the family afloat.
I have 2 computers: one for telemedicine/business meetings and one for e-learning lessons/school updates that teachers and school administrators email me throughout the day for my children. As a no-nonsense, organized mom and doctor, I felt ready to handle any issues that would arise.
I have a backup charger cord, noise canceling headphones, a pot of coffee and duct tape and bungi nearby. Every screen that I could possibly need was pulled up and ready to go (e.g., EPIC, Microsoft outlook, Zoom, Chrome, CNN, NPR, Schoology, Seesaw, Discovery Education, and RenWeb).
I did not anticipate this, but what I actually needed was a psychotherapist. By the end of this tale, you will understand why.
I have had great successes with telemedicine - being able to diagnose cervical instability, inflammatory arthritis, and fibromyalgia with video and sometimes only by phone - but I also endured embarrassing transgressions. Here, I will share with you my wins and losses.
Case Report 1: Head, Shoulders, Knees and Toes
Patient: “I have a lot of pain everywhere; I am exhausted, and this has been going on for a while.”
Me: “Get on your computer and search fibromyalgia tender points—pull up images then push on those spots according to the diagram.”
Patient: “Doc, I am pushing on those points; they really hurt; I cannot endure it, please stop—you’re hurting me!”
Me: “Miss, you can pull your fingers away from your body anytime,” while I typed in her diagnosis ICD10 code: M79.7 (Fibromyalgia)
Case Report 2: Gumby Wins
Patient: “I have a lot of pain; I am pretty flexible, my mom and sister are very flexible, my skin bruises easily—what bothers me most is my neck, severe headaches, and arm numbness. The neurologist I went to could not find anything; I had an EMG/NCS and MRI of my brain and neck. ”
Me: “Please look up to the ceiling while cradling the phone to your shoulder with your neck without using your hand, tell me what happens.”
Patient: “There is severe shooting pain down my arm.”
Me: “You have a cervical radiculopathy as indicated by a positive modified Spurling’s test now call the ‘Dao-phone neck test.’” I verified she fulfilled Beighton criteria and diagnosed her with ICD10 code: M54.12 (cervical radiculopathy) and M35.47 (joint hypermobility). “When the pandemic is over,” I told her, “tell your neurologist to get a dynamic or positional MRI of your C spine to investigate this further. “
Case Report 3: Blinded
Patient: “I have joint pain and swelling in my R knee, and this scaly rash on my bottom.”
Me: “Let me see the rash.”
Patient: pulling down her pants… (… unfortunately, at this very moment, my 9 year old son walked right up to me to ask me for help on his school assignment. )
Son: “AAAAaaaa!!! What kind of job are you working at???!!!”
Me (after muting video and audio): “Son, you know I am a doctor. I was going to look at a rash. Please leave.”
Me: ICD10 code: L40.59 (psoriatic arthritis), L40.0 (psoriasis), and X1.00XXX (traumatized boy)
Charge: million$$ in family counseling
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