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By Dr. Eric Rosenberg
When the pandemic hit, our routine habits of life came to an abrupt halt. We only ventured out of the house for essentials – to buy food or pick up necessary medication – always afraid of COVID-19 exposures. We pushed off appointments to a future, unknown date. These changes threatened to sink large primary care offices with scant telemedicine experience, so they countered their newly emptied waiting rooms with a rush to the emergency lifeboats of telemedicine. They saw video visits only as crisis intervention.
In this initial rush, telemedicine challenged providers accustomed to interviewing and examining patients in person. Years of knowledge and experience in their offices did not equip them for interacting with a patient only through a screen. Few learned the necessary video medicine skills of creating a conducive setting and approach to build rapport and trust, video physical exam techniques, and caveats – the skills taught by telemedicine groups with many years of experience. As patients became less reluctant to seek medical care in the office, many providers hurriedly limited telemedicine. That was a mistake.
What we have learned from this time of crisis is that telemedicine has many more benefits than its lifeboat role. For older patients in particular, avoiding the physical barriers of a trip to the doctor’s office means not having to secure a ride, maneuver and navigate a parking lot and a medical building, and wait in a medical office. During the pandemic, they can avoid exposure to other potentially infected people, and in a post-COVID-19 world, they can continue to receive excellent care in the comfort of their own home.
Telemedicine is especially well suited to medical issues such as behavioral health, which do not rely on physical exam or diagnostic equipment other than a video connection. Despite the pandemic, providers can continue uninterrupted care during a critical time that has been uncertain and distressing for so many. An additional benefit of telemedicine is that patients and providers are physically distant, so there is no need for masks that hide crucial facial expressions. Older adults particularly rely on facial expressions in communication, as they often have hearing or cognitive deficits. Interacting with and seeing the faces of caring providers is especially helpful in reducing their loneliness, feelings of abandonment, depression, and anxiety. Social interaction is also essential for cognition; in fact, many studies link reduced social interaction to cognitive ability losses. According to Dr. Suzanne E. Salamon, Associate Chief for Clinical Geriatrics at Beth Israel Deaconess Medical Center, “for helping to prevent memory loss, social engagement is very important. Talking and interacting with people takes energy and makes you work harder, which stimulates your brain.”
The pandemic disrupted the world of medicine in many ways, forcing the widespread, urgent uptake of telemedicine. However, providers with rudimentary training in telemedicine did not experience its great potential. Once properly trained to optimize the patient experience using the best communication and diagnostic skills, providers will achieve its true promise. It shifts the focus from provider-centered care, the default view designed for the care provider’s convenience, to patient-centered care designed to maximize patient experience and benefits. There is no doubt that telemedicine became a lifeboat at the beginning of this pandemic. Given its successes especially in behavioral health and senior care, it will continue to be an effective means for the provider and patient to connect through the pandemic and beyond.
About Dr. Eric Rosenberg
Dr. Eric Rosenberg, F.A.C.P. is Chief Medical Officer (CMO) of MediTelecare. Dr. Rosenberg is Board Certified in Internal Medicine and Geriatrics and has practiced primary care for over 33 years. In addition, he is well-known as an entrepreneurial healthcare thought leader.