Page 14 - Boca Club News - December '21

Page 14, Boca Club News

From The Professionals’ Desks

Medical Matters: Telemedicine

By Richard Nagler, M.D., a member patients to other, further away locations. There are problems with However, there are many downsides to telemedicine. It
of Broken Sound Club and retired triage, separating real emergencies from more easily remotely distances patients from the doctor who is unable to physically
physician. After graduating from the managed less severe illness, long waits, crowding, avoiding examine them with a hands-on approach. All clues that an
University of Pennsylvania and New contact with contagious patients and staff shortages. Doctors can astute doctor can pick up when in the same room facing the
York University’s School of Medicine, communicate in real time with phone conversations and video patient are diminished. There are many examples of what is lost
Dr. Nagler served his internship and conferences safely encrypted with health information shared without direct physical contact during a physical examination.
residency at Baltimore City Hospital only by one needed to know. In this manner, a doctor can feel lymph nodes in the neck, axilla
and Johns Hopkins. He followed that Telemedicine can be provided not only by physicians but by or groin for signs of cancer; listen to the heart for murmurs,
with a Fellowship in Gastroenterology physicians’ assistants, nurse practitioners, clinical psychologists’ abnormal rhythms, lungs for rales and wheezes; palpate the
at Yale University School of Medicine, and was then Chief social workers and registered dieticians. It doesn’t require a carotid arteries for obstruction and the peripheral pulses for
of Gastroenterology at Fitzimmons General Army Hospital computer. A smart phone is fine. An MD app can be opened up, insufficiency. The abdomen can be palpated for a mass, abnormal
in Denver. He returned to the Yale Medical School for one choosing a doctor and speaking by phone, instant messaging or pulsations (detecting an aneurism), tenderness suggesting
year as an Assistant Professor of Medicine before opening by video. appendicitis or fluid (ascites), and both the liver and spleen felt
his own successful private practice in Internal Medicine and Medical records are easily accessible. The patient’s symptoms for enlargement. Breast examination is essential to detect a mass,
Gastroenterology. During that time, he also served for ten years analyzed, non-emergent medical care is appropriate for issues and in the prostate palpation of the prostate is vital. Using an
as Chief of Medicine at Huntington Hospital in Huntington, N.Y. like colds or minor coughs, usually viral where there is no need ophthalmoscope to diagnose cataracts, macular degeneration
Telemedicine is defined as the caring for patients remotely, to come to the doctor’s office and infect others. Basic questions and cancer, and a neurologic exam are all vital for diagnosis.
where the doctor and patient are not physically present with can be asked to help determine more serious conditions, such Evaluation of chest pain for a possible heart attack, a
each other (healing from a distance). It provides an opportunity as pneumonia, flu and COVID. Psychiatric problems can be fractured bone with application of a splint or cast all require
for physicians to connect with patients wherever they are, observed and insect bites, sore throats, conjunctivitis (pink eye) the physical presence of a doctor. When needed, emergency
monitoring health issues even over long distances. It has become dealt with. life saving care cannot be provided. Blood work, X-rays,
an $18 billion dollar industry, and although far from perfect it Blood pressure with a reliable home unit can be monitored. imaging tests such as CT or MRI scans cannot be performed.
is here to stay. Surprisingly, 75% of patients surveyed prefer Wearable devices, such as Fit Bit, can record on Bluetooth and As a result, the greatest risks with telemedicine are delayed
easy access to health care through telemedicine over in-person be captured on a digital dash board with other information such or missed diagnoses, especially cancer, strokes, heart attacks
interaction with providers. The average cost of a telemedical as weight, pulse rate, blood sugar, blood oxygen levels, eating and infections. In addition, doctors are at considerable risk for
visit is $80, an office visit $150 and an ER visit $1,750! habits and sleeping patterns – monitoring medications as to malpractice litigation. They also must obtain licenses to practice
With telemedicine patients in remote locations, those who are when and if (especially for seniors) patients forget to take their medicine in many states.
disabled or have no means of transportation can connect with a medications or take the wrong dose. Very useful is providing Other problems are the reluctance of older patients to
doctor without leaving home. With depression, anxiety and stress reminders for mammograms, colonoscopies and vaccinations. accept telemedicine, outages may occur, and there is always
situations, there are far less hospital admissions, it is easy to ask High quality images of skin lesions can be videoed for review. the potential for errors because technology cannot capture what
questions, they can report early warning signs and gain faster, Medical information can be shared with other providers and human touch can. There is an enormous expense for new health
better access to specialists. Patients in rural areas with limited coordination with specialists easily achieved. care systems, and resistance by providers to be trained and
access to health care can avoid travelling, long waiting times Physicians are able to see more patients, have a diminished embrace it. Telemedical parity laws are different state to state,
in doctors’ offices, exposure to other patients with contagious work load so there is less need to hire extra staff and increase as are reimbursement rates. Finally, telemedicine compromises
diseases in crowded waiting rooms, don’t have to miss work, office space. With electronic medical records, they are able to the doctor-patient relationship.
and there is no need for child care or elder care. monitor patients in real time, transmit digital imaging, do video Nevertheless, telemedicine is here to stay. But significant
This is mainly primary care medicine, simply on demand consultations and medical diagnoses in less time, and adjust shortcomings must be recognized and efforts to improve all
medical care at less cost. It avoids many ER visits where the treatment plans. There is better access, allegedly better outcomes aspects of it attempted in order for it to be more successful in
ERs are overloaded and sometimes shut down with transfers of and more revenue. the proper care of patients.

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