By Josef Molnar
A month into the quarantine that has dramatically slowed the economy of America’s fourth-largest city, Houstonians are finding themselves with limited access to services they once took for granted. Among these is access to medical care, which now presents the prospect of exposing patients and doctors dealing with illnesses unrelated to COVID-19 to its infection.
“All of the headlines say ‘coronavirus’, but what about other diseases?” said Steven Goldstein, a local neurologist. “They haven’t gone away since this came along. You still have people with heart disease, complications from diabetes, strokes and other problems.”
Fortunately, Goldstein and a growing group of doctors around the city and state are offering much-needed doctor visits to patients through telemedicine. This technology allows patients and doctors with camera-enabled computers to “meet” through the Internet.
“Right now you have doctors scaling back their operations, and patients canceling their wellness visits,” said Thomas Kim, a psychiatrist based in Austin who regularly uses telemedicine. “This creates greater health problems down the line. But, this technology allows the patient to engage with their caregiver.”
“The doctors I’ve spoken to say half of people should never have visited (a hospital), because once they step foot in the hospital, they expose themselves if they didn’t have it, and if they have it, they’re spreading to people who might not have it.” –Tisha Rowe, a doctor and owner of RoweDocs
In most cases, Goldstein said that a patient with a friend or family member assisting them can perform a physical exam the same way that he might. He can ask about the patient’s symptoms, and an on-camera neurological examination might involve directing the patient to walk, move their hands, arms and legs, and flex in ways that he can see through a decent camera. If the patient has a thermometer, blood pressure cuff and other measurement devices, that can add to the information that he can gain about the patient.
“This is not a perfect system,” Goldstein said, “but it’s a good tradeoff of not being there in person. It lets me get a lot of information about the patient that way, and also lets me order the appropriate tests the way I would from a physical exam.
“If it’s critical to do a physical exam, then I can do it,” he added.
Tisha Rowe, a doctor and owner of RoweDocs, a Houston-based telemedical company, said patients can visit her company’s website, set up an appointment and see a doctor within a couple of hours, even during the night and on weekends. The doctor can then prescribe medicine, which can be picked up or delivered from a local pharmacy.
With the ever-present threat of coronavirus infection accompanying every doctor visit, especially from people who are concerned that they may have COVID-19, telemedicine allows doctors to safely determine whether the patient needs to go to a clinic or hospital.
Rowe said that people who believe they may be infected would benefit more from a telemedical appointment than by going into a clinic or hospital.
“Anyone who thinks they have potential symptoms should do it,” she said. “The doctors I’ve spoken to say half of people should never have visited (a hospital), because once they step foot in the hospital, they expose themselves if they didn’t have it, and if they have it, they’re spreading to people who might not have it.”
“Telemedicine should be the first place for them to go,” she added.
Telemedical visits are usually less expensive than traditional doctors, and some doctors offer discounted rates for people without insurance. The efficiency of seeing a patient without waiting and the ease of scheduling has also led many insurance companies to start seeing this service as a primary benefit. However, some companies restrict telemedical visits to a set provider or offer limited reimbursement, so patients with insurance should check to be certain the service and the doctor are covered.
An issue that Kim believes has been alleviated by COVID-19 is the concern that patient privacy and medical information is being safeguarded by video conferencing services such as Zoom, Hangouts and WhatsApp. State and federal regulators have recently relaxed these restrictions to allow patients and doctors to meet in a virtual context, in the hope that the move will reduce transmissions of the virus. In doing so, the expectation is that both parties will use privacy filters, passwords and other available protections to safeguard the conversation between them.
Kim said these developments are a good first step, and hopes that telemedicine becomes a common option for patients seeking affordable healthcare when they need it.
“As we have this conversation and the telemedical field matures, my hope is that we’ll have consistent mementum and build access and efficiency into this service, rather than offer it as a satellite service,” he said.
The service has been used for many years throughout Texas to allow doctors such as Nasiya Ahmed, a doctor of internal medicine who works with seniors, to be able to reach their patients wherever they live, whether its in isolation or in rural areas far from a nearby hospital.
“This allows us another way to keep in touch with our patients,” she said. “There’s a huge shortage of geriatric physicians in the country. Medicare pays for telemedical services in rural areas, and this allows us to reach people in other parts of state who might not always be able to get to see a doctor when they need it.”
Kim and Rowe, who consult with doctors about setting up their own telemedical practices, both believe that doctors who set up telemedicine services will find plenty of patients who will take advantage of it. Brent Annear, director of media relations and public relations for the Texas Medical Association, said his organization is encouraging doctors to consider adding the service to their practices. The TMA offers training and technical resources to doctors through its telemedicine taskforce, which is composed of doctors and technology experts. This includes a recent telemedicine podcast, which covers the benefits of the service.
“This is one resource among a few others that we’ve put together to try to help doctors get into it,” Annear said. “As an organization, we support the physical ability to connect with patients, whether its through the adoption of telemedicine or any of the services we provide.
He said the coronavirus outbreak has challenged the TMA to enhance its training offerings to get more doctors to rapidly adopt the technology. This allows doctors to use the triage emergency system to sort patients into ones who can stay at home to recover, and those who need to go to the hospital.
“We’re been trying to make a year’s worth of progress happen in two weeks,” he said when the local lockdown occured. “Physicians are doing their best to triage patients through phone calls and telemedicine.
“That’s why using tools like these can be very beneficial to doctors and patients.”
Rowe said that telemedicine should be part of the toolbox of services that doctors offer to their patients, not only for the convenience, but also because it can be more efficient once the technology, education and training are in place to make it a good choice. She called the advent of telemedicine part of the coming “tide of technology” that is affecting many other industries that traditionally relied on physical and face-to-face interactions.
“Now doctors now have no choice but to be comfortable,” Rowe said. “Once the doctors see it working, it will be easier to get people to use it going forward.
“I think it will be good from both sides; the more doctors use it, the more patients will use it,” she added.
Goldstein said that despite the challenges of the coronavirus, telemedicine is helping doctors to serve their communities.
“People go into medicine because they want to help; this is not unusual, and it’s a common reason for physicians,” he said. “People go into (medicine) to be useful and be of service to others, and telemedicine is another way of serving our patients, and ultimately, our country.”