Last week marked something of a medical milestone, with more than 10 million telehealth services delivered since the expansion of services on March 13.
So it was a surprise when I heard a South Australian GP saying, “I’m not doing any telehealth”. He went on to detail a series of patient presentations that could not have been done without physically seeing the patient. Oh, a series of four.
The contrast with my own experience, and that of my colleagues, was so great that I decided to get all scientific. So I audited my practice. Which meant going back and counting (and not stopping at four).
Since I was released from quarantine and allowed back to the practice, I have “seen” 334 patients. Of the physical health consultations, 65% have been by telehealth, 35% face to face. The proportion of telehealth for predominately mental health consultations was a bit higher, at 80%.
The bad bits? The toughest part is not the medicine, but the voice quality. It is amazing that in 2020, with all our advances in technology, it is still so hard to get a decent quality phone connection.
It’s near impossible to assess someone’s pain when every third word drops out, or their voice is so muffled it sounds as if they’re talking through a pair of Scandinavian hiking socks.
It seems even harder to get people to actually use their devices properly. I swear some people stick their phone on speaker and try to conduct the consult while doing the washing or walking the dog. Please don’t expect me to diagnose the cause of your halitosis when all I can hear is the rustling of a poop bag.
Video calls are a rarity. Experience shows that most of the allotted time is spent with the patient baffled by various settings, and the subsequent picture is of little use unless they have a sinus problem, the one time a close-up of their nostrils might be helpful.
Time keeping is interesting. The patient who sits for 30 minutes in the waiting room without complaint will call reception seven minutes past their allotted telehealth time to ask why the doctor hasn’t rung yet.
Something about all these Zoom parties has created the expectation that guests will “arrive” within a minute or two of the invited time, and now the same is expected of their doctors’ telehealth appointments.
And here’s a gross generalisation, pointed out to me by one of our female doctors. She reckons that women are more used to settling back for a long chat on the phone, while men see it as a rather distasteful device, for making arrangements and to be abandoned as rapidly as possible.
Result (she says): telehealth with men, quick; with women, prepare for the long haul.
But the good bits are legion. People love the convenience — the repeat script sorted and sent to the pharmacy, all while Netflix is on pause. Pathology forms organised and printed one week, results discussed the next, a face-to-face visit arranged only if needed. Perfect.
Blood pressure can be better monitored by patients at home with their own machines. Why do one reading every three months in a doctor’s office when you can do it three times a day at home?
Geography is no longer the same barrier. Patients who’ve moved to Sunshine have been able to “move back” to St Kilda. Someone even rang last week for a consult from Central Queensland.
And the relative anonymity of the phone has freed some with complex psych issues to open up, talk more often and more openly. Social anxiety makes getting out, travelling and sharing a waiting room far harder than staying safely at home, curled up with the phone.
The ease of taking and sending good quality pictures has made rashes and eyelid cysts a doddle. One man, anxious about a new painful lump on his backside, even managed to send a remarkably high-resolution pic of the offending swelling.
His relief that what I was seeing was clearly a haemorrhoid and not a rampant cancer was palpable, even if the offending lesion wasn’t. But perhaps not one for the family album.
Like my South Australian colleague I still want to see real people. There will always be a need for human contact, physical examination and all the extra benefits that derive from being with someone in the same space.
But unlike him, now that I’ve embraced telehealth and had the chance to explore her faults and virtues, I’m hooked.
This is no COVID-19 holiday fling. We’ve tried living together and we’re still happy. She’s a keeper.
Will changes to healthcare be the lasting legacy of COVID-19? How has the pandemic impacted your healthcare routine? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication in Crikey’s new Your Say section
Nick Carr is a Melbourne-based GP, author and broadcaster.
Good thing that chap’s lumbago wasn’t playing up.
What happens if a patient in remote Queensland does have a rampant rash, meningococcal say? Does the doctor ensconced in leafy St Kilda get a consult fee for telling her patient to dial triple zero?
“Time keeping is interesting. The patient who sits for 30 minutes in the waiting room without complaint will call reception seven minutes past their allotted telehealth time to ask why the doctor hasn’t rung yet.
Something about all these Zoom parties has created the expectation that guests will “arrive” within a minute or two of the invited time, and now the same is expected of their doctors’ telehealth appointments.”
This astounds me. Why is it that doctors get to have the punctuality of a cat? My time’s important too you know. This is one of the many reasons I ditched my old doctor. He could simply not ever be on time for a consult. I don’t know any other professional group with such marked disdain for being on time. It’s selfish, self-obsessed, and I hate it.
I tried a tele-health consult with my current doctor recently (she’s usually pretty much always spot-on with her appointment timing so I know you can do it if you want to) and she simply never showed up. I phoned the practice and they explained that the Telehealth system and their system were not fully connected and so the doctor actually had no idea I had an appointment. It’s basic stuff like that you need to address, that and being on time and demonstrating to your clients that you actually care about their time too.
“Blood pressure can be better monitored by patients at home with their own machines. Why do one reading every three months in a doctor’s office when you can do it three times a day at home?” How does that work Nick? I have a “good” brand of blood pressure meter from the chemist and I know how to use it. Yet if I take my blood pressure three times within ten minutes I get three widely different readings, one above the acceptable level for my age and one or two out of the three at acceptable levels. Within ten minutes. When my GP or his nurse tests me the level is always within the acceptable range for my age.
I am a GP, now in practice (from graduation) 50 years. I have been taking BPs all that time. Blood pressure changes all the time. Get up, walk around the house, it will be different. Have an argument, it will be different. A cup of coffee it will be different. Every minute or so. I consider the average of home-taken blood pressure readings much more significant than a single reading in the consulting room. Take 3 readings a day, at random times, having done different things before each reading (including sitting down stroking your pet dog). Write them down, bring the all in. I am interested in the average and the range of systolic, diastolic pressures, and the pulse rate. Much more meaningful than the reading taken in my office.
Thanks Glenn, that’s really helpful advice. I’m still doubtful about the meter I have, whether it’s up to the job when it gives different readings one after the other while I’m sitting there. It’s the second meter I’ve had, same Omran brand but this one slightly more expensive than the first. I have tended to just assume that the initial reading is wrong and go with the second or third one.
1. Is the cuff properly sited on the arm, with the artery index mark over the brachial artery?
2. If you are the patient, don’t watch the numbers go up and down. Wait until the machine finishes.
3. As the cuff constricts, DONT contract the muscles under it. Relax them.
4. If the readings are widely different in consecutive readings, with you at rest, then none of them can be trusted. But readings that vary by 2-10 mmHg are probably in the same range of low, normal, high or very high. So long as they stay in the same range, they are meaningful. If there is significant variation with different activities, at different times of day, that may be the reason to see your own GP. Do the medication doses need adjustment?
The inevitable move to #Telehealth, which is receiving a spur by the COVID-19 experience, is one of the reasons why we need to fix the NBN. Some telehealth can be done over a phone but the most sophisticated consultations require a good broadband connection.
It’s hard to imagine a more unhealthy place for a sick person to be than a doctor’s waiting room.
Never mind who would staff such a potential plague pit?