Those of you bashing telehealth - have you actually tried it?

[Ms. Toad]

In our family of 3, we have had 5 telehealth visits since COVID 19 reared its ugly head:

1. Hepatology for a rare liver disease (saved a 2 hour round trip to the specialist)
2. 2nd degree burn (avoided a trip to the ER)
3. 4-year breast cancer follow-up (saved a 2-hour round trip to the specialist)
4. Routine diabetes follow-up
5. screening for COVID 19 (avoided contaminating everyone else)

Insurance covered all of them.
Definitely has its limitation (i.e. if the doctor needs to put hands on, it isn't going to work)
Benefits include more time for conversation (both for our visits with the doctor - AND - the doctors had more time to spend with other patients since the visits tend to be shorter because all of the physical things (listen to heart, lungs, etc. don't happen.
Only one of these (the screening for illness) was possible before Ohio eased its restrictions on telehealth

It's not an alternative healthcare plan, but it is new (and good) thing that has come out of COVID 19.

[msongs]

1. have had online screening by kaiser doctor resulting in coming in for tests. worked well nt

[Kaleva]

2. I live in a rural area and it's a 2 hr drive one way to the nearest VA hospital.

[underpants]

3. I must have missed the bashing. Yes I've used it and it's great.

Part of my reset during the pandemic was actually going to the doctor(s). I needed xrays on my foot so that was out. Other than that I’ve seen a GP and rheumatologist via telehealth. Prescriptions set. I do have to go in for lab work.

[Ms. Toad]

28. After Trump's touting of telehealth

There were at last 3 threads which had nothing good to say about telehealth -most along the lines of poking fun at DIY surgery.

[NightWatcher]

4. I love it. I've seen my rheumatologist without having to expose myself to the office

[unblock]

5. it's great for things that don't require actual in-person procedures.

if it's just a follow-up, how's that prescription working out, any side effects, let's adjust the dosage, that sort of thing.

obviously you'd have to go in for a blood draw or other test, but you don't always need that. and when you do, that part can be a quick thing just for that, so you're in and out just for the test and no also for a long wait and a office visit.

mini-unblock had one for his growth (he doesn't produce growth hormone so needs injections). i can measure his height and weight easily enough. we did have to go in for a draw to make sure the injections are giving him the right blood concentration, but that was no more than 10 minutes, basically in and out. everyone had masks. you'd hope so in a medical building, but then again....

[catbyte]

6. I wasn't bashing it. I've used it, but it seems to be that thing's cure-all and it isn't.

[Ms. Toad]

29. Definitely not a cure-all.

I didn't hear the speech - I just saw the trash-telehealth-post speech threads here that semed totally out of touch with my experience with it.

[Sunsky]

7. Thanks for this

I think expanding telehealth is a great idea.

[The Velveteen Ocelot]

8. It's fine as far as it goes. I've used it a bit and have no complaints. But

it's not anywhere near a substitute for a comprehensive health system overhaul, like the GOP keeps promising as a replacement for the ACA and never delivers.

[louis-t]

9. trump acts like he invented it.

I assure you, he didn't. I assure you, he doesn't understand it.

[Beaverhausen]

23. That's exactly right

He never heard of it before so he thinks none of us have, let alone that we used it.

[lame54]

10. Can I bash their ads? - because they are horrible

[Ms. Toad]

22. It's my regular doctors using Telehealth.

2 of the 5 visits in our family were to new doctors (both connected to our insurance plans). The other three were with our regular doctors - just via the internet.

So I have no idea what ads you're talking about.

[samnsara]

11. i love it..hubby has to travel 4 hrs r/t every 3 months to talk with his cancer doc and

..as long as his scans are clean we can just do it via zoom

[Nululu]

12. Love it. Used it 5 times

Used it with post surgery, my GP, endocrinologist.

Works great, no problems.

I only wish I didn't have to go in for lab work but I can make an appointment for that.

[SWBTATTReg]

13. No one is dooming telehealth other than the fact that our idiot POS PINO recommended...

something that's already been around for decades and has been certainly in demand this year, so in effect, the idiot POS PINO recommended crap, as usual, that was already being used heavily and use is expected to get even more in demand.

What they do need, is fast internet access, at a reasonable cost, for all. The FCC could go a long ways towards getting this in place, but the committee has been locked into competing methodologies for years and years, being that 1/2 are republicans, 1/2 are democrats, which hamstrings committee results and accomplishments. By the way, some of the republican members are former industry bigwigs in the telecommunications industry, so they should have a heads up on this whole process (but I bet they don't being that it seems all republicans are incompetent or are so industry driven, and not public minded servants what-so-ever.

There have been initiatives to push fast internet access in rural areas (a slow process), and somewhat minor effects to make the internet more affordable in the urban areas, provide to more kids etc. via WIFI hot spots via schools and public libraries, as well as more competitors generally being more available in urban areas, all competing for the WIFI consumer dollar/revenues.

Perhaps w/ the increased demand for online schooling, more and more online access can be driven outwards customer drop lines (to hosting sites), more and more capacity can be enhanced to handle the increased volumes, etc.

I suspect capacity is already out there, being that fiber rings were pushed in a lot of different metro areas (kind of like rings around each major metro area), the main stumbling blocks are the pricing and/or steep tariff pricing of the internet, or similar services filed w/ the the public utility commission (PUC) in each state.

Perhaps if Congress and the idiot POS in the WH can agree on a comprehensive, widespread plan to fund and make the internet available to all (like in France), this would go a long ways towards make tele-medicine available to all.

[Ms. Toad]

25. When I signed on, I saw at least 3 threads

all bashing it as if it was a completely unrealistic concept - simply because Trump woke up to the fact that it existed and might be useful (to gain him some votes, even if he thinks it's total baloney)

There was not a single realistic, positive thing to say.

Internet access in rural areas is an issue.

[SWBTATTReg]

37. Personally, I think telemedicine is great, but it's been around for quite some time, it's not a new

concept (I was in the IT world, Telecommunications, which is why I'm positive about it, rump is not part of even my consideration/thought processes at all about telemedicine).

I'm more for it mainly because my folks (Mom and Dad) lived in a rural area, and all of their main specialists (medical in nature) all were at least a minimum of 50-60 miles one direction from their home, even dental (Dad). For two elderly persons to have to drive this distance (of which I drove several of these trips for them), it was too far and I didn't feel comfortable them driving such distances (my dad especially). Quite a few of these appts didn't have to have their actual physical appearance (a follow up, etc.).

[Ms. Toad]

38. It's not a new concept - but there were extreme restrictions on its use

prior to COVID 19. Those restrictions wre lifted in Ohio when it became clear people were skipping critical appointments either out of fear or misunderstanding of which appointments were permitted.

So old, but more used - and used in more different ways.

[Jirel]

14. It's disastrous.

My disabled clients have been forced into it because the clinics have been closed. Among other horror stories:

1) Cardiology consult following acute breathing problems, ER visit, possible COVID but no test - Telehealth was a joke. No BP or EKG possible. No oximetry. No way to listen to the heart. Needs stress test, but can’t be sent for one because no EKG has been done and breathing problems mean it’s not safe.

2) Primary care for morbid obesity, high BP, cellulitis all over, and undiagnosed but very serious breathing problem (had been on supplemental oxygen while they’d been figuring it out). Told by telehealth they won’t send for pulmonologist consult unless it’s an emergency (it is, but they have plausible deniability). Out of oxygen, but they won’t prescribe more without an in-person visit - and they won’t see anyone in person. ER would prescribe it, but he’s told not to go to ER because it’s “not an emergency” and besides, COVID. Because of this telehealth neglect, the client did finally end up in the hospital and has been in ICU for 6 weeks, mostly on ventilator.

3) Diabetic client needing wound care. Most visits are cut to telehealth with his SO doing care under telehealth direction. Winds up in ER with sepsis, then 2 amputations in short order.

Those are just some telehealth outcomes within my limited client load. To hell with it. It kills and maims.

[procon]

21. Why are seemingly acute care patients even

allowed to proceed with an e-visit with any of the symptoms you describe?

Sorry, but your anecdotal tale doesn't pass the sniff test. Any medical facility that responded as you describe would be inundated by lawsuits and complaints to state agencies, not to mention violations of existing national healthcare laws under the ACA and especially noncompliance with medicare requirements which could result in losing their operational accreditation. If you are a healthcare professional then you've already filed official complaints and made the necessary decisions to safeguard your license.

My e-visits are usually about a flair up of symptoms from chronic medical conditions. If I want to get an e-visit with my doc then I first have to pass through a series of screening questions to determine whether I can proceed or need to be seen in the office or urgent care.

If I had answered that I had any of the symptoms you listed, my clinic automatically shunts me to an RN who takes a brief history and advises me how to proceed.

[Jirel]

33. Too bad you don't get it.

Sniff all you want. This is the reality in this part of the country. Every one of these is a current client. Guess what? Texas has tremendous malpractice liability shields. Welcome to health care in red America.

[USALiberal]

24. FFS, I could name 10 cases handled wrong with a actual Doctor visit. Silly logic!! nt

[Jirel]

34. Oh, the rose-colored glasses!

You’re right. I can name a ton of incidents with in-person visits. But yet, most of those don’t result in near death, amputation, or worsened disability.

We are too complacent about health care. First we put up with doctor visits of 15 minutes or less. Then we put up with cheapening primary care to NO doctor visits, just PAs or NPs. And now, oh ye gods and little fishies, you poor things are jonesing to be further medically mismanaged by telemedicine.

Most of my disabled clients didn’t get that way by a terrible illness or accident. Most got there because of years of medical mismanagement by PAs, NPs, and telestupidity.

[Ms. Toad]

30. Being forced into it is a different matter.

What you're describing is a massive failure in health care, not a problem with telehealth.

None of the things you are describing should have been handled by telehealth.

1. An EKG should have been done in the ER if there was any suspicion of heart involvement. Same for oximetry when COVID was suspected - it should have been done imediately on the arrival at the ER, even if COVID 19 test was not available.

2. Cellulitis is a life-threatening emergency, in it own right. Any competent screening call to ask-a-nurse (or the equivalent) will tell you to go immediately to the ER. Do not stop, aside from possibly to draw a line around the edges of the cellulitis to track progress. Once you get there, the patient will be taken ahead of virtually everyone else in the waiting room. Not that I've had any experience with cellulitis or aything. Cellulitis IS an emergency. No comptent doctor would tell you otherwise.

3. Wound care is OBVIOUSLY something that cannot be done via telemedicine. If the SO is providing care. there should have been in-person training untl the SO was competent before allowing care at home. We've had to do several parts of care that normally are done by trained medical care providers. In each instance, we were not allowed to take over care until we could prove we were competent at it.

As I said, this is not a failure of telemed - it is using it for situations it is obviously not appropriate to be used for.

[Jirel]

35. We know what SHOULD be done.

But that’s not what IS done.

I don’t know what part of the country you’re in. Here, in red southern America where I am, this is par for the course. I spend an inordinate amount of time coaching people to be the squeaky wheel. Ignore the clinic’s insistence that they should not go to ER. Complain up the chain when things like in-person wound care gets canceled in favor of a wound care nurse talking an SO through the steps. You and I know what is right, and what’s shockingly bad medicine.

But you can’t force people to advocate for themselves. It takes time, sometimes time they don’t have. In the mean time, they get worn down by the system of lowering and lowering levels of care... including clinics wandering into telemedicine with few safeguards and supervision, and little planning during a pandemic. Obviously, it’s worst in communities with no health insurance, reliant on the minimal county and charity health care networks.

It IS a failure of telemedicine, because this IS what it’s being used for here, time and again. You can’t say it’s not telemedicine’s fault because it would be fine if (theoretically) used correctly. The fact is, it’s NOT being used correctly, on a mass scale, so that in this place and time this kind of bad practice has become the definition of telemedicine.

But even before the pandemic, it was being horribly misused here. A prime example was in the high-doctor-turnover area of county mental health care. Rural clinics were frequently between psychiatrists, so they started using telemedicine. I kid you not, st one clinic the setup was in a room with a window in view of the waiting room. The barriers were so thin that patient conversations with the psychiatrist could be heard by others. I had multiple clients bail on mental health care because they could not handle (reasonably!) the idea of discussing their problems over a shaky video conference setup that not only could be overheard by staff, but other patients.

I really don’t care that telemedicine could be done well, someday, funded sufficiently, administered effectively. My clients have been harmed by it over and over because it’s handled badly as a norm in this and surrounding communities.

[Ms. Toad]

36. That's like saying it's a failure of the fork

when you can't use it to eat your soup.

(1) No patient with the symptoms you described should have made a telemed appointment in the first place and (2) no doctors should have consented to the appointment.

What you are describing is a faliure of healthcare, not a failure of telemedicine.

The first two should have gone to an ER. They are both true emergencies - under Federal Law the ER is required to treat them. The last one failed in caregiver training.

You can't eat soup with a fork. The fact that some people are trying to, and not succeeding, does not make the fork a failure.

[in2herbs]

15. The Rs are strongly against tele-med because in rural areas drs. can RX birth control

w/o putting the woman to a whole bunch of trouble driving hours to see the dr. Birth control will be out of control, more like out of R control.

[Hoyt]

16. It will make a big difference in rural areas and save time elsewhere for

routine visits. Nowadays, physical exams are not as important as lab tests and diagnostic tests, many of the latter can be performed over phone/internet.

A hospital health system could set up outposts in rural areas — staffed by nurses and techs — to hook up tests and handle some hands on exams.

As you mention, up until CV19, the restrictions On telehealth were a pain and obstruction.

[Blue_true]

17. My last Doctor's appointment was telehealth.

For routine things like lab follow ups and prescription updates, it is good. But if a person has serious health issues, a face to face visit with a Doctor or Nurse Practitioner is the best course, IMO.

I honestly don’t think that it will substitute for rural hospitals unless there are clinics with actual Doctors or Nurse Practitioners that can deal with some patients face to face, with the examinations that those medical professionals perform on a person in their offices.

City people, or people in big population counties typically have a wealth of healthcare. I have five regular hospitals and a University Teaching Hospital within an hour and ten minutes of me, three of those within 25 minutes of me in regular traffic (waiting for lights, etc). So, as a person living in a heavily hospitaled region, my view is colored by that vantage point.

[Ms. Toad]

26. It's not a replacement for ER/hospitals.

It's a replacement for visits in which the doctor does not need to physically touch you - including some very serious conditions during periods when the conditionis stable.

My daughter's diseases are good examples. She has primary sclerosing cholangitis and ulcerative colitis. Both deadly diseases. She has to have a colonoscopy every year (so they put hands on her then), she also has to have semi-annual blood screens (to monitor status & screen for cancer), annual MRIs and annual ultrasounds. On top of that she receives infusions at home every 8 weeks. None of those can be done over the internet.

So when she is seen for the things that cannot be done over the internet, they also monitor and record heart rate, lung sounds, blood pressure. There is no need for her to be physically present with her doctor to discuss the results of her latest lab/MRI/ultrasound unless they find something unusual.

Her last hepatology visit was by telemedicine - and it was fantastic. It saved us a two-hour round trip drive, and it was one of the most productive and relaxed visit we've had with her.

[I_UndergroundPanther]

18. I can't try it

No web access and no computer. Poverty kinda makes it cost prohibitive.

The net needs to be a regulated and state utility.
And If I had my way it would be free to everyone.
The telecoms can fuck off and die.

[Ms. Toad]

27. Just curious -

if you dont have web access, how are you posting here?

I'm not making light of a serious disparity in access to the internet (and yes, it should be free to everyone). But it doesn't take much more bandwidth than posting here. My daughter's first telehealth visit was using her cell phone.

[TreasonousBastard]

19. It's further evolution of heath care and useful, but not a panacea...

For years your x-rays and other labs have been farmed out to labs around the world, and most of the time it works well. Local hospitals and providers don't have to deal with hiring 3 shifts of experts.

I've been in teleconferences with doctors and PAs for years, and personal visits have advantages but the televisits save a lot of time for routine things.

The VA has been having televisits at satellite offices where there's still someone around to take your BP and other vitals. Covid's been screwing things up, but that's not forever. (We hope...)

[Wounded Bear]

20. I'm about to try it Wed morning...

Last talk with doc was over the phone, so this is a step up.

[KentuckyWoman]

31. My doctor loves it.

He said about 30% of what he sees in office could easily be handled with an online or phone appointment. And he thinks patients are more relaxed in their own home and communicate better... leading to better outcomes.

I've had good luck with it for routine follow ups. I just have to be sure to get my blood work done ahead. Even a new cardiologist appointment started out telemed - sent for tests - 2nd appt was telemed. This third one was in office. I'm having an issue and she wanted to hear.

[Ms. Toad]

32. That's our experience, as well.

The visits (generally) have been much more relaxed.