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Telemedicine Bloopers and Successes

Mar 31, 2020 2:42 pm

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)

Charge: 99442 

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. “   

Charge: 99443

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

Please comment below on your stories and experiences of working from home.

 

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

Kathryn Dao, MD, FACP, FACR, is the Associate Professor of Internal Medicine, Division of Rheumatology at UT Southwestern Medical Center, Dallas, TX. She is actively involved in patient care and medical education. Her interests include rheumatoid arthritis, systemic lupus erythematosus, drug safety, and pregnancy in rheumatic diseases. Thoughts are her own and do not necessarily reflect the views of UT Southwestern. Follow her on twitter @KDAO2011.

 

Rheumatologists’ Comments

Joseph Flood

| Mar 31, 2020 4:14 pm

Tender points???? What are those?

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