Be wary about telemedicine (sinus, thyroid, ankle, infected)
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I know a surprising number of people who prefer doctor-by-internet, and of course doctors prefer it, because it because it makes them money in the long run.
But don't forget that once covid is over, medical writer Elisabeth Rosenthal reminds everyone that traditional in-person visits have advantages.
Telemedicine Is a Tool. Not a Replacement for Your Doctor’s Touch.
Covid-19 let virtual medicine out of the bottle. Now it’s time to tame it. If we don’t, there is a danger that it will stealthily become a mainstay of our medical care. Deploying it too widely or too quickly risks poorer care, inequities and even more outrageous charges in a system already infamous for big bills. The pandemic has demonstrated that virtual medicine is great for many simple visits. But many of the new types of telemedicine being promoted by start-ups more clearly benefit providers’ and investors’ pockets, rather than yielding more convenient, high-quality and cost-effective medicine for patients.
“Right now there’s a lot of focus on shiny objects — ideas that sound cool — rather than solving problems,” said Dr. Peter Pronovost, a national expert in medical innovation at University Hospitals Cleveland Medical Center, who has written about finding the value of virtual medicine. “We know preciously little about its impact on quality.” https://balthazarkorab.com/2021/04/2...doctors-touch/
I know a surprising number of people who prefer doctor-by-internet, and of course doctors prefer it, because it because it makes them money in the long run.
Not necessarily. It depends on the doctor and their specialty. I think telemedicine can work very well for some specialties and be a win-win for physician and patient. In other specialties and situations, it can be a big hassle. I know the doctor who lives in this house hates telemedicine and quickly discontinued using it as soon as he could. By the summer, he was only using it in very limited situations, usually only if an existing patient requested it (and then only if they needed follow up care). Or if a patient needed F/U and was Covid+ or quarantining.
The big issues he had were:
1. He really has to be able to do a physicial exam on every patient.
2. It was much less efficient and slowed him down.
3. There were occasionally technical issues- sometimes legit IT, sometimes user error on the part of the patient.
4. The camera's ability to capture images of wounds, incision sites etc was poor compared to seeing it in person.
Telemedicine definitely has its uses and can really be beneficial for patients in rural areas, for instance.
Last edited by Texas Ag 93; 05-06-2021 at 05:08 PM..
Telemedicine Is a Tool. Not a Replacement for Your Doctor’s Touch.
Covid-19 let virtual medicine out of the bottle. Now it’s time to tame it.
Yeh my doctor has annoyed me. She moved out of the area and seems to think it is perfectly ok for me to see her via telemedicine and if I need to see someone in person dispatch her PA. Nope.
The only problem is that there is a doctor shortage due to covid... and it is impossible to get a new primary care.
Telemedicine would have worked wonderfully when I was under 40 years old.. now I need someone to observe me and touch things...
Medicine is evidence based and studies are needed to show outcome whether doing it one way or another makes a difference. Anecdotal stories don't push the balance one way or another.
People are generally unaware of changes based on outcome studies that showed for example that a yearly physical isn't necessary in a healthy young person. Studies also show that doing lab work blindly every year as a part of the physical likewise was basically a waste of money. Even checking BP at every visit has shown that there is no outcome differences in people whether you check their BP or not.
Some cancer screening show that with some cancers it doesn't change the outcome. In some cancers like thyroid and prostate there's even a fall back on insisting that every one get a PSA. There's even talk of changing the name of some rare cancers that are so very slow growing that it isn't worth the treatment because if you call it malignant or cancer then the patient expects it to be treated. Like I got cancer and so get rid of it.
Nations with socialized national healthcare are notorious in performing outcome studies. How long can one wait before having knee surgery? They study it. How long can someone wait for heart surgery? They study it and monitor it.
Rendering an opinion without studying something to see if it makes a difference is the way to go rather than jumping on things and assuming that because we have been doing things in the past that that is the only option.
There were waivers to allow telemedicine to explode because people were not going in to see the doctor because they were afraid of going in and getting infected. There were delays in some serious diseases including death. The middle ground was telemedicine where one could screen and if needed then a face to face could be done.
People are generally unaware of changes based on outcome studies that showed for example that a yearly physical isn't necessary in a healthy young person. Studies also show that doing lab work blindly every year as a part of the physical likewise was basically a waste of money. Even checking BP at every visit has shown that there is no outcome differences in people whether you check their BP or not.
HAH were these studies done by the insurance companies? Yes, I need my BP taken - at every visit. By a qualified person not a machine. You need to see a pattern.
I only hope your thoughts are not the way medicine is heading.
Under the "care of someone" who is nothing more than a talking head? millions of miles away -- that will be $500 for that.
My doctor offers telemedicine appointments, and sometimes it's convenient. He also offers in-person appointments. If you request a telemed appointment and it's not something that can reasonably be handled over the telephone or webcam, then he asks you to come into the office. For example, my young adult son once booked a telemed appointment for an ankle injury.... of course the doctor had to see it in person, so he told him to go into the office. But when I was having headaches, I was able to handle it through telemed. I take my blood pressure at home, and I wasn't having sinus congestion or ear pain, so there was really no reason for the doctor to see me in person for the first visit regarding the problem.
HAH were these studies done by the insurance companies? Yes, I need my BP taken - at every visit. By a qualified person not a machine. You need to see a pattern.
I only hope your thoughts are not the way medicine is heading.
Under the "care of someone" who is nothing more than a talking head? millions of miles away -- that will be $500 for that.
Medicine is headed towards evidence based outcomes in proving if it makes a difference or not. My comments referred to those who consider themselves healthy. There's exceptions on when to see a doctor which obviously includes symptoms.
Taking or measuring one's blood pressure does not prevent hypertension. It doesn't change the outcome. Interventions happen when one develops hypertension. Sure they can lose weight then and it can go back down or put on medication. It's sort of like prediabetes where it's called prediabetes because people don't do anything and it develops into diabetes. If you tell somebody that their BP is slightly getting higher but still not hypertensive does not change your behavior.
You need to open your eyes about health screening and this article is a good one and again changes were made that you didn't notice. All I am commenting on is that future changes will be evidence based and right now if you go in to see a doctor insurance companies expect a certain level of vital sign checks to conform with the billing practices and so they want to see vital signs. Telemedicine has been cleared of those requirements because of COVID at this time. There's also concern for future exposures of variant mutants that might make some changes permanent and to determine that one would use studies. As mentioned most studies are government sponsored to answer such questions as quite a few are universal health issues. We have medicare in this country and the government determines how the practice of medicine should be carried out and what or if they will pay for it. Private insurance policies and practices usually follow medicare.
With regards to the changes already in existence long before COVID hit,
Society of General Internal Medicine.
"Health Checkups
When you need them—and when you don’t
Like many people, you may schedule a yearly checkup or “annual physical” with your doctor. It usually includes a health history, physical exam and tests.
It is important to have a regular doctor who helps make sure you receive the medical care that is best for your individual needs. But healthy people often don’t need annual physicals, and they can even do more harm than good. Here’s why:
Annual physicals usually don’t make you healthier."
I love telemedicine. I get my prescriptions renewed this way rather than wasting effort, time, and aggravation going to a doctor in person just to get prescription renewals.
The telemedicine has nothing to do with my previous physician or previous clinic - it's a stand-alone web-based telemedicine.
HAH were these studies done by the insurance companies? Yes, I need my BP taken - at every visit. By a qualified person not a machine. You need to see a pattern.
I only hope your thoughts are not the way medicine is heading.
Under the "care of someone" who is nothing more than a talking head? millions of miles away -- that will be $500 for that.
Nothing is more simple than taking one's own blood pressure at home!
A blood pressure device costs only $35 and are very accurate and easy.
And one can monitor one's own blood pressure at home a couple or several times per week, if desired - which is helpful and beneficial for health.
It is recommended and can actually be more accurate than a doctor office visit.
A blood pressure device costs only $35 and are very accurate and easy..
They are not accurate. They are routinely high every time I have it done at home or at the doctors office with a machine. If i put up enough of a stink they will do it the old fashioned way -- much lower.
You people are probably going to get me killed with your hook line and sinker ideas about how you can monitor your own health and pay $500 for the pleasure.
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