In Healthcare, Let's Not Return To Normal

Earlier this week, I had a cosmetic emergency. I needed something, and I really did not want to wait a week. I pulled out my phone and discovered a store that previously offered only curbside pick-up had opened with limited hours and capacity. I put on my mask and had a glorious time shopping. Yes, the samples to test were gone, but I could still look at stuff, pick it up, and feel the joy of looking at shiny new objects. I cannot remember the last time I felt so thrilled to shop in a store.

Similar to my retail experience, I miss going into a local cafe and drinking unlimited iced tea refills while using their wifi to do stuff. I miss being part of a crowd, having a simultaneous experience. I miss many things and hope that someday, those things can be normal again.

I do not miss many aspects of medical practice.

Do we really need to drag patients 3 hours or more into a building to see us? Yes, a first visit should, in the best of all worlds, include a fairly complete physical exam. But in nephrology, a lot of my follow-up work involves making sure the patient is doing well and reviewing laboratory studies. That can be done quite efficiently via telemedicine with the patient at home. It's not perfect; we have to trust the family for blood pressure measurement, but they are monitoring it at home. If we trust them between visits, we should trust them all the time.

Yesterday, a member of my scheduling staff said they could not wait until we were back to normal and this tele-nonsense is over. I said I was planning to continue to use it. As a rural state, we have many patients who must drive long distances for face-to-face appointments. They have loved the chance to sit in their home and do it that way. I cannot imagine that they will not question the need to drive hours for a 15 minute follow-up appointment.

I sure do.

Also, part of the purpose of putting most of our children with kidney failure on home peritoneal dialysis is to keep them out of the center. If all is going well, why should they be dragged into our place? During the pandemic, we sent out home health nurses to draw their labs and collect fluid samples when necessary. We could cut back to quarterly in center visits (and time effluent collections for those visits), making kidney failure far less time consuming, especially for patients in school and parents with jobs.

The genie is out of its bottle. Rather than trying to put it back, we must get payors to realize that telemedicine in the patient's home is valuable and should be reimbursed. Setting up satellite clinics with on-site extenders is better for initial telemedicine visits, but often provides merely a more convenient commute for a patient. For me to tell a family that the labs are stable and no changes are needed? Bring on video messaging!