The power of virtual primary care

It can be life-saving

Many people, including doctors, believe that the scope of virtual primary care (VPC) must be narrow due to the limitations inherent in video/audio interactions. They think of virtual care as only suitable for minor self-limited illnesses. Some discount the value or benefit of virtual primary care and insist that effective primary care requires office visits. Here is an example of a recent case in VPC clinic on HealthTap that illustrates how the scope of practice and the benefits of VPC are larger than many realize.?

A middle-aged man used his mobile to access HealthTap's VPC clinic, asking for an evaluation of a scrotal swelling. He selected from a directory of available doctors the one who looked best for him. He selected Dr. Barbara MacFarlane, a family physician whose profile described not only her personal practice style, but also her training, board certification, Top Doctor awards, the >1,000 online answers she has given to informational questions, plus multiple glowing reviews from her patients. The video testimonial on her profile page also let this patient see who she is as a person and gain insight into her personality.??

This patient was able to make a same-day appointment, so later that day Dr. MacFarlane learned he had previously been seen for a scrotal swelling at a community health clinic, where STI testing was negative. She performed a video examination, and the patient shared detailed still images of his scrotal enlargement. She also noted swelling of the lower abdomen/pelvic area, and some thigh swelling and tenderness. She then worked with the patient – who had no health insurance and limited funds –?to make sure he understood the importance of obtaining a CT scan with contrast of the pelvis and abdomen, and discussed with him the most economical way to get that study. He was able to get the scan as an outpatient, and he shared the results and images via secure patient-doctor texting as soon as they were completed: He had a 10.3 x 7.1 x 10.9 cm mass on the left testicle, with areas of necrosis. He also had multiple pathologically enlarged pelvic lymph nodes with some encroaching on multiple major blood vessels.?

Dr. MacFarlane made the presumptive diagnosis of advanced testicular cancer with lymph node involvement, and told the patient how he could best get the life-saving care he needed. She gave him all the paperwork and documentation he needed, and advised him to go to the Emergency Department at UCLA medical center (near where he lived), where they would admit him and find insurance coverage for him. He was indeed admitted there, where Doppler ultrasound of the left leg revealed deep vein thrombosis, and a CT-angiogram showed no pulmonary embolism. He was discharged on rivaroxaban after a percutaneous lymph node biopsy was performed, and before the tissue diagnosis was available. And he was not given an appointment with an oncologist.?

Dr. MacFarlane found the best local expert for her patient, an oncologist with expertise in testicular cancer. She called the doctor and then sent a detailed referral note for her patient to take to his visit.?

Dr. MacFarlane was delighted to hear back from her patient after 6 months – he did have stage IV testicular cancer, but?he is now disease-free after treatment. He said to her "If it wasn't for you, I would have died".

For this patient in this case, the accessibility and ease of access to a primary care doctor was what enabled him to get the care he needed. And even though an in-office physical examination was not possible, Dr. MacFarlane was able to make the diagnosis, and then guide this patient to get the care he needed. This case highlights how access to a thoughtful, caring primary care doctor via virtual consultation can have life-saving benefits.

As I've written before, there are many hidden benefits of virtual primary care, and in many cases virtual primary care can be better than office-based primary care, because when what the patient needs can be delivered virtually, we should prefer virtual care: It is effective, accessible, easier to use, more time efficient, and less costly.?