As I sit here to write this article in a very Zen-like environment, gazing at the ocean being warmed by the sun, it makes me think about the peace and tranquility I yearn for in my daily life. Don’t get me wrong—my life is fairly normal. I’m a full-time working woman in America with a spouse, children, elderly parents, and a dog. There are the usual stressors that throw me off, like that emergency visit to the veterinarian during the work week. Or managing the day-to-day for aging parents who need significant physical, financial, and emotional assistance. There are even the positive stressors that can throw me off balance, such as planning a wedding for one of my children. Juggling all that life throws at me, like anyone else, can feel like quite the challenge.
Then I start thinking of my patients and am quickly brought back to reality. My personal stressors are nothing compared to our patients with rheumatic diseases and their families who would love to be able to deal with those “normal” stressors of everyday life. And so I ask myself, “What could we as rheumatology providers do to help our patients and their families achieve just a small piece of normalcy?”
Telemedicine may be a good place to start.
Just think about the things that bring patients to our office. are ongoing symptoms that require minor medication adjustments, straightforward management decisions that involve another specialty such as ophthalmology, follow-up for a stable patient who may only need to have lab tests ordered, and many more. Every one of our practices sees patients every day who need little more than minor adjustments and a “Thanks for coming in. See you in 3 months.”
I ask you to honestly think about these patients—do you really feel like you need to physically touch them for any other reason than to satisfy insurance billing requirements? How often do you simply run through a battery of routine questions during the office visit because you need to “check all the boxes?” Don’t you ask patients to send you photos of swelling, rashes, or skin issues prior to their office visit? Don’t you routinely order labs before the office visit or shortly thereafter? Don’t you adjust medications for patients with ophthalmic issues based on letters from their eye doctor?
And now the big question—how would telemedicine visits affect any of these? You shouldn’t have to think long and hard to conclude that they wouldn’t.
The majority of the general public has grown accustomed to the expanded use of FaceTime, Facebook Live and other real-time video-based technologies in various parts of their lives. How many of our older patients revel in telling us how they talked to their grandchildren through one of these platforms?
It was my own adult daughter who got me to seriously think about telemedicine years ago. She “FaceTimed” me after she took a dish out of the oven and spilled hot juice from the pan down her leg and into her shoe. Being the daughter of a nurse, she knew without needing to consult me that the first thing to do was to immediately remove her shoe and run the affected areas under cold water.
My No. 1 goal for all of my patients is to create as much normalcy as possible in their lives. Could telemedicine help? Absolutely.
Yet she became concerned when an area developed a large blister almost immediately, and so she sent me a FaceTime invitation. She was able to use her phone to show me images of all of the affected areas both up close and more distantly. It took some navigating to figure out the right angles so that the camera would focus appropriately, but once we figured that out, the vibrancy and color of the images were terrific. And so once our conversation concluded, I thought to myself, “If I could diagnose the severity of this burn, know what medication to prescribe and which wound care supplies were needed, and explain how to apply the dressing, what services could I provide to my patients using this or a similar platform?”
Now don’t get me wrong. There are many good reasons why it is preferential to see patients face-to-face in our offices. Nonetheless, there are patients whose quality of life would be improved without a significant impact on quality of disease management through the expansion of telemedicine in rheumatology.
We all see many, many patients who live an hour or more from our office. With travel time, reporting for lab tests, waiting in our office, and more, that’s 4 hours or more away from home. That’s 4 hours of time off work and/or time when they need to pay a babysitter to look after the kids, money for gas, parking fees, takeout meals, and more. There are a lot of “hidden” costs that we do not always think about when a patient comes to us.
Now take away everything but the time required for our actual consultation with the patient. That’s essentially the telemedicine visit. No more need for reliable transportation, no more money for gas or parking, no babysitter or significant time off from work. Far less lost productivity. Could this lead to more stable employment, a better chance at a job promotion and higher pay, and the Holy Grail for us all, reliable health insurance?
My practice is focused primarily on children, for whom the in-office visit has an added layer of complexity. We have to deal with issues such as parenting, discipline, school, social stigma, sibling relationships, sleep patterns, and many others. But my No. 1 goal for all of my patients is to create as much normalcy as possible in their lives. Could telemedicine help? Absolutely.
Hasn’t a parent seen you perform a joint count hundreds of times in the office? Couldn’t you teach them how to do it and then monitor them remotely during a telemedicine visit?
Most kids like to be on video. It’s still a “cool” thing for them. There are certainly challenges related to access—not all of our patients have the resources or technological know-how to be able to acquire and then set up a camera so that it provides enough light for us to be able to adequately see them as clearly as we need to—but that’s something you can almost guarantee will get better in the future. Practice and patience will persevere.
We give our patients so much as healthcare providers. Telemedicine gives us a chance to empower our patients and see how much of their lives they can take back to reach a step closer to normalcy, which is what we all want them to attain.
Cathy Patty-Resk, MSN, RN-BC, CPNP-BC is a certified pediatric nurse practitioner in the Division of Rheumatology at Children’s Hospital of Michigan in Detroit, MI, where she provides medical services to inpatient and outpatient pediatric rheumatology patients. Cathy is also the President-Elect of the Rheumatology Nurses Society.