Hello, this is Dr. Levy and I’ll be your online doctor for this visit. Can you please confirm your name and birthdate? Are you located here in Colorado today?
This introduction is a typical way I start my telemedicine visits when I am seeing patients as a physician on the MDLive network. I want to confirm that the person I am talking to is the actual patient and make sure they are located in the state where I have my medical license. Telemedicine cannot be practiced across state lines since each state has their own licensing.
What exactly is Telemedicine? A formal definition is the remote diagnosis and treatment of patients by means of telecommunications technology. Actually I find that the majority of my visits are over the phone rather than using video. I prefer the video chat since I can see the patient and get a better sense of how ill they appear, but the video still has more technical glitches with trying to get video and audio to work all the time for both the patient and I.
So can you actually diagnose and treat patients over the phone or a video chat? I admit I was sceptical at first, but after a year of seeing patients virtually, I am more comfortable with what I can and cannot treat. Common ailments such as colds, flu symptoms, sinusitis, urinary tract infections, blepharitis (inflammation of the eyelids), and stomach ailments can usually be assessed and treatment recommendations given. In this day and age, I was concerned that most patients would expect antibiotics for every simple cold, but I find only a small percentage of patients are angry when I do not recommend the antibiotics. It does take some time to explain that most cases of colds and even sinusitis are often caused by viruses and thus not susceptible to antibiotic treatment.
This year though the influenza outbreak has been particularly bad and so based on CDC recommendations I do prescribe Tamiflu for presumed influenza (without asking the patient to go into the Urgent Care to get a test) more liberally than last year due to the potential severity of the illness.
Sometime I tell the patient that a visit to the Urgent Care or ER is actually necessary. For example if you complain of cardiac or neurological symptoms, have a possible cellulitis (bad skin infection), or have problems breathing then you need a physical exam and some tests. For example one patient complained of severe pain in the arms after doing 100 pull-ups. I instructed the patient to go to the ER right away as it could be rhabdomyolysis (breakdown of muscle). I followed up with the patient over secure email and indeed he was diagnosed with this potentially severe condition and required several days of hospital stay. I think his $40 virtual visit was worth the advice.
Most patients seem satisfied with their virtual visit and the quick ability to receive medical advice without driving to the clinic and being exposed to all the other sick patients. Of course, I also don’t have to be physically exposed to all those influenza patients as well!
By the way, its not too late to get your flu shot! Even if you think you had the flu.
Stay tuned for my next blog: What does TeleHealth have to do with Informatics?