In an effort to curtail the spread of the coronavirus worldwide, most governors in the US declared shelter in place orders. Within the medical field, aside from emergency rooms and COVID-19 testing centers, physicians worldwide had to adopt telehealth platforms to continue to provide medical care for their patients. Analysts at Forrester Research predict that total telemedicine visits will surpass 900 million by the end of the year, with over 200 million appointments in 2020 alone as opposed to the 36 million that was originally predicted.
The expansion of telehealth services was inevitable given the risks that began to unfold towards the beginning of 2020. Transitioning to remote patient-care for non-emergency situations eliminated the transmission risk of SARS-CoV-2 within a doctor's office, which was vital for patients and medical professionals alike. Personal protective equipment (PPE) supplies were dwindling and had to be preserved for hospital staff.
Although social distancing is still heavily encouraged, shelter in place orders have been lifted and industries are slowly beginning to reopen. Physicians are approaching the transition back to life as it was with tremendous caution. Telemedicine, while it has become integrated into the fabric of many practices, is not being utilized as much as it was at the height of the pandemic.
Yet, as a patient with a chronic illness that could place me in the high-risk population for COVID-19, I have to wonder if the precautions are enough. I recently had a follow-up appointment with my immunologist, who specializes in managing patients with Mast Cell Disorders. I have many observations and questions from my visit that I hope ongoing research will soon be able to address:
I was fortunate that I was able to drive to the appointment - what about those that do not have a car? Would I feel comfortable using a rideshare service or public transportation? There was a parking spot available outside of the office - would I be concerned if I had to use a valet? I opened the front door using a tissue that I promptly disposed of - was this enough? I borrowed a pen to fill out some paperwork and washed my hands immediately after - could something as simple as this be the deciding factor in whether I get COVID-19 or not? I wore a mask not just for the duration of the appointment, but the entire time I was in the building. While I did not make direct contact with my physician, it was not possible to remain six feet away at all times in a cramped office space - were the masks sufficient? Was the ventilation system for the building functioning properly? These questions are also highly relevant with regards to pharmacies and blood testing labs, as many chronic illness patients rely on their services for their day-to-day health.
The medical professionals also took all of the necessary precautions. There was a sign posted on the entrance that required every patient and staff member to wear a mask. Flyers were posted on most of the waiting room chairs so that social distancing rules could be maintained. Every instrument was lathered in rubbing alcohol before being used, including the thermometer, blood pressure cuff, and stethoscope. Nonetheless, the uncertainty of COVID-19 lingered in my mind.
Personally, I prefer to have a doctor's appointment in person. There is a certain feeling of attention and responsiveness that you may never be able to replace with telehealth. Going to a practice where I have been a patient for over 5 years also provides comfort in its familiarity; we understand how the typical appointment proceeds. It is noteworthy that many studies have shown that social interaction is critically important for health, and it is difficult to determine how virtual interactions contribute to this area. However, it is important to recognize that the pandemic is not over; rather, many states are experiencing a resurgence of cases.
As for now, I hope that there are ways to further improve the standards for telemedicine in order to provide a more similar experience to that of a traditional appointment. Can wearable monitors provide information to more closely simulate the data acquired in person? Is there a way to more closely replicate a physical examination over the phone?
With all of the uncertainties that still remain, I cannot give any suggestions as to whether you should schedule an appointment to be held in person or via webcam. Choose what you believe is right for you at the discretion of your physician. My only advice is to be careful, stay healthy, and wear a mask.
What do you think about the future of medical care? Feel free to share your experience in the comments section of this blog or in the new forum discussion on our website.
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