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Telemedicine: The why, what and how

Many of you have been using Telemedicine services in the era of Covid pandemic.  Although it is a service that has been around for years it has certainly gotten a lot more publicity lately.  It is definitely a needed service in our current environment but there’s actually many reasons you may find yourself in need of telehealth services even before our era of social distancing.

I actually decided to transition to a virtual practice months ago; way before the threat of Covid was even known and with no idea that telemedicine would be so needed. For anyone unfamiliar, telemedicine or telehealth visits are video conference calls between a physician and a patient.  This should be done on a HIPPA compliant device although these rules have been waived by our government temporarily.  There are many platforms that your doctor can use to provide a safe, secure connection.  Once you are on a video chat your doctor can address any issues you have just as they would in a face to face visit.  The advantages are no drive time, no wait time, and it’s the comfort of your own home!  The disadvantages, especially for pediatrics, is the inability to diagnose certain ailments like an ear infection, strep throat or urinary tract infection with any certainty. (Although I do think technology and tools will decrease these barriers in the near future.)

This was my hesitation initially, how do I give the best care without actually touching the patient and seeing them face to face? So let me share with you my reasons for wanting a telehealth practice even pre-covid!  I get phone calls about once or twice a week from friends asking me for advice about their kids, mostly quick questions that I could help with and I was happy to do so, but that made me think.  What if you don’t have a friend that’s a pediatrician, where are those people getting their questions answered? I knew there was a need for a quick and easy way for parents to get their questions answered by a reliable source. I also truly love being able to guide and counsel parents.  I love talking to parents about the exciting milestones to come, how to discipline, how to pottty train, sleep train, etc. but in the modern era of medicine this was becoming increasingly more difficult.  The standard patient visit is 10 minutes and they are often double booked.  Once a patient is escorted into a room and the specific reason for the visit is addressed, there is no more time for counseling.  There is no more time for parents to share their fears and I could take the time to reassure them.  As a pediatrician and a mom this was extremely upsetting to me. With a telemedicine visit I could take as much time as needed to counsel parents and give advice, there was not a roomful of sick patients in the waiting room.  Lastly, shit happens!  Kids can get into all kinds of trouble and it’s usually after hours! If your child bumps his head, hurts a limb, has an earache or high fever after five…what are the options?  You may or may not be able to talk to a physician on call.  They may have a call service?  Not all bumps/bruises/falls need to be seen right away, not all ear aches need antibiotics but at the same time if you do need to be seen is it better to go to an Emergency Room or an Urgent Care?  This was another area that I felt my service could be very helpful.  If I could get a family through the night without having to go to the Emregency Room, that’s a visit well worth it in so many ways!

Now, if you do need a telehealth visit here are some key ways to prepare.

  1. Weigh your child.  A recent weight will be helpful if any medication is needed, including over the counter meds. If your child is an infant weigh your child and yourself together and subtract your weight.
  2. Check a temperature. This is vital information for your pediatrician as well as good for you to know.  I’d recommend having a thermometer on hand at home, especially now. If your child is over 6 months of age, a temporal thermometer should be acurate enough.  But for younger children (especially under 2 months) and to be really accurate you need a rectal thermometer.
  3. Check you child’s resting heart rate and respiratory rate. For the heart rate, you can find their pulse either on the inside of the wrist or the side of the neck, use your index and middle finger, not your thumb.  Count for 1 minute or less and extrapolate to number in a minute.  The respiratory rate is the number of breaths per minute,  this can be checked with by counting their chest movements in and out, for younger kids you could use their stomach.
  4. Your doctor will want to know if  your child been eating and drinking normally and how often have they have used the bathroom.  If they are not well you need to pay close attention to all three of these things.
  5. Make sure to let anyone new you see about any chronic medical conditions, along with hospitalizations, surgeries, and brief birth history.  Also have a list of medications your child takes either regularly or on a as needed basis and any allergies. Even if your child wheezed once in the past this could be pertinent information. In this case your provider will appreciate having more information rather than less!

 

There still may be some limitations to ultimately diagnosing and treating your little one on a telemedicine call and a face to afec visit may be required but there is certainly a role for telemedicine in our modern era of technology and certainly in the current era of Covid.

 

 

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