The Benefits and Fails of Telemedicine

"Life is like riding a bicycle. To keep your balance, you must keep moving. "

—Albert Einstein, in a letter to his son Eduard, February 5, 1930

In a doc group on social media, we were discussing the recent large changes in our daily work. Most of these started as off-the-cuff responses in a time when we did not know how to keep the novel coronavirus in check and matured into fundamental shifts in approach. The group of us decided that the biggest change was in the widespread adoption of telemedicine, which few of us were able or permitted to use before the pandemic.

We began sharing our most memorable telemed moments. During a cancer treatment discussion, a patient standing in his farmyard in order to get a good cell signal was accompanied on the Zoom screen by a ratsnake taking advantage of the telemedicine-based distraction to raid the chicken coop. Patients joining videoconferences from their beds…naked…with company. Folks trying to show their doctors physical evidence of their complaints, in one memorable instance jamming an iPhone into their underwear to point out a mass at the vaginal introitus.

Of course, everyone else has been shaken up, too, and there are lessons to be learned across professions. This great article in the New York Times talked about an uptick in mishaps and near-misses in commercial aviation in a time in which many pilots had been furloughed and then returned to flying. Said one pilot interviewed, who was laid off in March 2020 and later returned to duty, "It's not quite like riding a bike. " Pilots who had recently returned to flight status forgot critical steps that they used to perform like breathing, resulting in skids off of runways and flights at the incorrect altitude.

There have been losses in medicine, too, even though the tempo of our work took, at most, a temporary dip in the beginning when many would not come to a hospital where victims of the virus were being treated. For many of us, things instead accelerated to a nearly, or entirely, unbearable degree. Despite not being laid off, I can't help but think that many of us have lost something just like the pilots. I personally have lost a lot of trust in the common sense of some of my patients. Maintaining the correct altitude takes a lot more effort these days.

But we've gained a lot, too. I can have a high-quality consultation with patients who can't afford the gas it takes to get to the hospital but do have or can borrow a working smartphone, ensuring that at least some of the informational barriers to their care can be tackled. When a recent hurricane wiped out electrical power in New Orleans for a week, I was able to hold detailed video conversations with fleeing on-treatment radiation therapy patients the minute they crossed the Florida border, ensuring that as soon as they got to the heart of the Gator Nation, we were able to get them simulated, planned, and back on treatment with minimum delay. That would not have happened in February 2020 or prior, and it may have saved their lives.

Far more of my radiation therapy patients who are also getting immune-suppressing chemotherapy are willing to stay away from sick relatives and wear a mask in public, resulting in fewer hospital admissions and missed treatments caused by colds, stomach flu, and other common communicable diseases. I'm confident that this has also prevented deaths.

So, challenging times and circumstances so hard that they have made some of us leave the practice of medicine altogether can still result in good things. We should be deliberate and proactive in identifying and expanding on those silver linings.

In the comments, tell us about lessons you have learned from your experiences in the time of COVID-19 that you will carry forward into the rest of your career.

Please join the discussion below, but if you need to communicate with me offline, you can reach me at Medscape-Blogs@webmd.net.

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About Dr Kate Hitchcock

Kate Hitchcock, MD, PhD, is a radiation oncologist, biomedical engineer, and retired aircraft carrier driver who grew up as a Wyoming cowgirl. When she is not at the hospital, you can find her with Carolyn, Mary, Tyler, Nick, Marlee, and Colby the barking dog, enjoying the natural splendor of the great state of Florida. She thinks you should visit sometime and try to solve the puzzle of why the natives have so carefully shunted all of the tourists toward the House of Mouse. Connect with her on Twitter: @hitchcock_kate

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