Bone: Teleconferencing restoring medicine's house call roots

By MICHAEL BONE 
For the News-Register

For many of us, the images of doctors making house calls are relegated to nostalgic black and white movies in which the doctor arrives at the patient’s home carrying a black bag.

In early to middle twentieth century in America, the image of a doctor treating a patient at home was very familiar — so much so that during the period around World War II, 40% of all physician encounters occurred in patients’ homes.

As medical technology advanced during the latter part of the century, it increasingly became available only in hospital or clinic settings.

That led to a drastic decline in physician home visits, to the point where by 1980, less than 1% of all physician encounters were occurring in the patient’s home. Best practices and standards of care had simply grown beyond what could be carried into a patient’s home in the doctor’s bag.

The COVID-19 pandemic has accelerated the development of new technology, as well as the redeployment and adaptation of previously available technology for doctor-to-patient communication.

While telemedicine existed prior to the pandemic, it was not being widely utilized. But that has all changed.

The U.S. Department of Health and Human Services reports that less than 1% of Medicare beneficiaries received telemedical services in 2019, but by April 2020, some 43.5% were receiving them. This meteoric adoption was due, in part, to federal suspension of many of the regulations it had previously imposed.

The suspension of government telehealth restrictions is currently set to expire once the pandemic declaration is lifted. But the rise in use of telemedicine, and the benefits that have been realized as a result, lead many healthcare experts to agree this service will remain more widely available post-pandemic than it was pre-pandemic.

From my experience managing internal medicine practice through months of pandemic, I have witnessed many benefits first hand.

Telemedicine keeps medical providers, staff personnel, their patients and other patients safe from a pandemic's reach. It gives those of us on the provider end the ability to treat patients' concerning symptoms without the risk of infecting our space, our staff and other patients.

We have a predominance of seniors in our patient population, and telemedicine affords them more convenient access to monitoring for chronic conditions such as heart failure, COPD and diabetes. It also eases the burden of medical transport on seniors who don't drive.

Avoiding some of the need to see patients in a clinical setting helps conserve our supply of personal protective equipment. And it enables patients to obtain specialized care without travel.

How do you know if telemedicine is right for you?

It helps if you are comfortable using a smartphone, computer or tablet equipped with a camera and microphone. If you find that challenging, you can fall back on having someone with you who understands the technology and can help you with it.

If in doubt, speak with the staff at your provider’s office. Most staff members are extremely knowledgeable.

They generally know which visits are appropriate for telemedicine and which are not. If a question arises, they can ask your provider directly.

To make the most of your telemedical visit, be sure you understand the overall technology and the specific platform being utilized by your provider.

There are a number of different videoconferencing platforms in use. Your provider’s office can walk you through the steps of downloading and installing the correct platform to your device, if that proves necessary.

Since telemedical visits do not involve a physical exam, you can help your provider by reporting your vital signs during your appointment. That requires a scale, thermometer, digital blood pressure cuff and pulse oximeter.

All of these items can be readily obtained through your local pharmacy or online retailers. And they are typically inexpensive.

The ability of your provider to know your current vital signs is a key element in maximizing the potential benefits of a telemedical visit. So it's worth the effort.

According to Healthcare IT News, telemedicine is set for a “tsunami of growth.” For people receiving care in rural clinics and hospitals, this is particularly good news, as the technology allows patients to connect to specialty care not physically available in their current location.

In the radiology setting, patients may encounter telemedicine through services where an x-ray or scan is read by a radiologist at another location. Another specialty area set for growth is mental health, as telemedicine facilitates delivery of services in vastly underserved areas.

While trends come and go, it looks as though house calls delivered telemedically are here to stay. And patients are poised to reap the benefits.

Michael Bone serves as manager of physician services at Willamette Valley Medical Center, the 60-bed acute-care hospital serving the McMinnville area. He joined the hospital’s management team in April 2015. Earlier, he served by turn as an analyst with the National Institutes of Health in Bethesda, Maryland; practice manager at the Bassett Cancer Institute in Cooperstown, New York; and executive director of physician services at Holy Cross Hospital in Taos, New Mexico.