24 michigan MEDICINE® | Sept / Oct 2022 colleagues, “We must rediscover the nuances of palpation and noninvasive inspection. Substantial portions of this examination can be completed without instrumentation or prior experience.” The person without prior experience is the patient: “The clinician can provide instructions to the patient for sequential elements of the examination and then verify correct performance of each maneuver.”2 This collaborative spirit (which the author frames in terms of what Eric Topol, MD, of Scripps, has called the “activated patient”) aligns with the core principles of patient-centered care: “Patients are partners with their health care providers.”3 This partnership— facilitated by the practitioner while considering the patient’s emotional, social, and financial perspectives—is more than a remote-care convenience: “The activated patient is empowered to participate in their care in a manner hitherto unappreciated, and in so doing, they may well enjoy greater engagement and satisfaction.”2 Specialty Example: Surgery Surgical specialties present an unexpected number of opportunities for remote care, from consultative conversations all the way through postoperative evaluations. For instance, many post-op evaluations can relocate to the telemedicine space, where questions like how the wound looks and drain output can be evaluated. Such uses of telemedicine, when appropriate, improve the patient experience, and sometimes patient safety. After all, post-op patients don’t want to leave home, and sometimes safety is an issue. I know I’m not the only one who has ever made a house call during icy weather. If we use good clinical judgment, we can offer a version of the post-op house call to some patients with arguably comparable or improved patient safety. Reducing Medical Malpractice Risks Some of the state-to-state restrictions lifted early in the pandemic have resumed, so check with the relevant state medical licensing boards. It remains important to know where your patients are: Practicing medicine without a license is still illegal, and your medical malpractice insurer cannot cover you if you were doing something criminal, even inadvertently. We still see few medical malpractice lawsuits related to telemedicine, but those we do see mostly connect to diagnostic errors.4 Of course, the physical exam still matters: Even with workarounds and patient-assisted maneuvers, sometimes we need to lay hands on the patient. Moreover, since diagnostic errors often derive from communication gaps, we must remain mindful of the ways in which telemedicine amplifies communication challenges.4 That said, some methods of mitigating diagnostic error risks are contained within our challenge to embed telemedicine within workflows. Systems that require the physician to fulfill the role of a tech support professional and/ or medical assistant increase cognitive load. Such distractions increase the chances that a significant symptom will be overlooked. Further, systems that make it difficult to track referrals or test results amplify diagnostic risks. Therefore, better integrating telemedicine appointments into workflow serves both provider sanity and patient safety by optimizing patient-provider communication. You can engage experts like my colleagues at Medical Advantage to help your practice with this process. Telemedicine for Patient-Centered Care A recent survey found that 62 percent of responding organizations are expanding their telehealth programs, versus being in maintenance mode.1 This is the perfect time to rethink both what we need to do in person and how frequently we need to do it (e.g., ultrasounds during pregnancy), while accounting for the increasing availability of at-home gadgets, such as otoscopes and ultrasound solutions. Gadgets are one of the many aspects of telemedicine that raise questions about patient access to care. Patient safety researchers extol the virtues of programs that reduce device costs for patients in need, and they also promote reimbursement for providers who offer the substantial technology education and orientation some patients need to function as activated patients within the telemedicine landscape.4 Integrating translation services into virtual visits will also have an impact. The access question is two-sided, because for every patient who could not access a telemedicine visit for lack
RkJQdWJsaXNoZXIy MTY1NDIzOQ==