The George Washington University School of Medicine and Health Sciences, MS1
May 20, 2020
The idea of telemedicine is not new. In 1879, an article was published in the Lancet that talked about using the telephone to reduce unnecessary office visits. In 1925, a cover of Science and Invention magazine showed a doctor diagnosing a patient over the radio. Since the 1920s, the radio has been used to give medical advice to clinics on ships (1). Zoom and Webex appointments may be new, but the idea of telemedicine is not.
The COVID-19 pandemic has skyrocketed progress on telemedicine, in part thanks to the swift passage of insurance coverage for video and non-video calls. This has been beneficial for many specialties, from infectious disease, to hematology and oncology, to therapy appointments as well as to programs like Alcoholics Anonymous. Those who previously had to travel hours to get to their physician wouldn’t have to anymore. Those who are at an increased risk for complications of SARS-CoV-2 do not have to put themselves in unnecessary danger.
In the field of Hematology–Oncology, telemedicine has been extremely helpful; our patients are often some of the most vulnerable to COVID related health complications. Many of the oncology patients are over the age of 65 and those who have a cancer diagnosis are generally considered to have a lowered immune system. In addition, those who are actively taking chemotherapy agents often have no immune system at all. Any excuse to stay at home and not put themselves at risk is seen as an advantage.
However, this technology is new for many and pushes a lot of patients and physicians out of their comfort zone into uncharted territory. In my experience assisting patients and physicians with Zoom telehealth visits, I've recognized that most of our patients are in their 60s and above. My most recent patient was 96 years old. Most patients have been able to set up their conference with no issues, but many are still not used to the technology and experience many challenges.
I have spent over a half an hour on the phone with some patients before their visit to walk them through the steps of setting up the call and making sure they have completed the necessary consent forms. Occasionally we are not able to set up the call and have to do the visit over the phone or not at all. Without the help of medical students like myself and medical assistants, many patients may slip through the cracks. In addition, many of these patients are isolating at home alone without family or friends that would normally be there to help them. Even with our help, some are not able to participate. With the high-stress environment of the medical field right now and many people working from home, there may be no one available to check-up on them.
As we continue to use telehealth and this becomes the norm, more and more patients will become comfortable with this technology. We are already seeing this start to happen. But for now, there are still many patients that are being lost in the hustle and bustle, especially in the older populations. As a medical student this is frustrating, because I see many practices not helping these patients and I feel useless in my ability to help. So I continue to help in the way that I currently am - one patient at a time.
1) Board on Health Care Services; Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington (DC): National Academies Press (US); 2012 Nov 20. 3, The Evolution of Telehealth: Where Have We Been and Where Are We Going? Available from: https://www.ncbi.nlm.nih.gov/books/NBK207141/