- Joined
- Oct 24, 2011
- Messages
- 23,128
- Reaction score
- 10,900
- Location
- Where faults collide
- Website
- doggedlywriting.blogspot.com
This article discusses something I've wondered about since routine medical exams have gone online because of Covid. This was something that was starting to happen anyway, as it allows doctors to cram even more appointments in each day and it probably saves money not to have to do all that other stuff.
https://www.npr.org/sections/health...es-the-physical-exam-what-are-doctors-missing
It's occurred to me even before I read this article that there are some things a doctor won't be able to do online:
--listen to a patient's heart and lungs
--palpitate their abdomen, thyroid gland etc. for lumps, ascites, and swellings, test a patient's muscle tone
--see any body part that is inaccessible to a web cam
--notice subtle differences in a person's skin tone, coloring etc. that may be indicative of some ailments
--test reflexes
--look in their ears and up their nose with the otoscope/auriscope (whatever the pointy thing with the light is called)
--maybe get a really good, well-lit look at the back of their throat
--notice edema and swelling in extremities
--blood pressure, pulse, O2 saturation (unless the patient has a pulse oximeter and spygmomanometer at home)
--Anything that the patient doesn't specifically mention but the doctor may notice and ask the patient about in an exam room
--collect scrapings and samples and cultures
--get a patient's accurate weight (not the weight they tell the doctor based on a less-accurate home scale paired with wishful thinking)
--and sometimes things just come up during a face-to-face encounter that don't over the phone or on webcam.
Plus there is the whole relationship, emotional support thing that is stronger in person for many people. As with teaching, a move to online instruction definitely changes the nature of a relationship-based profession in many ways. If these changes stick around after the worst of the pandemic has passed, what will it mean for doctor-patient relationships, job satisfaction, and our approach to diagnostics in general. My brother is an oncologist, and he says he often doesn't need to perform an exam on his patients, because the information he needs comes from their tests. But he feels the office visit is important to get a real sense for how they are doing overall, and some patients are concerned if he doesn't examine them, as it's part of a ritual they find reassuring.
Also, could virtual visits lead to important tests not being ordered because the doctor misses a symptom? Or conversely, could it lead to increased costs, because doctors might get overly-cautious and order tests for things they couldn't rule out with an online exam?
Has anyone had an experience with online medicine since the pandemic started, or before? If so, what was missing?
For me, certain routine dermatological appointments that involve injections for a chronic condition I have (alopecia areata) had to be cancelled entirely for several months, as there is no way to do those over the web and the dermatology department was closed to all but online visits for a while. I had some moderate anxiety over this, because I occasionally get bald patches on my scalp (the flares happen every couple of years, and lucky me, I started one around the time the Covid crisis was taking off). They often resolve on their own with time, and over the past decade or so they generally don't show, as my hair is thick enough to cover them. But when I was in my early 40s, the condition came out of nowhere and progressed rapidly to complete baldness while I was waiting for my first dermatology appointment. I was bald for about two years, which was lots of fun (not). An experimental trial (since discontinued) allowed my hair to regrow, as might some changes in my own body (hard to say there), but there is always that lingering worry that the same thing could happen again and a few bald patches that move around on my scalp could turn into complete baldness again if I can't get the topical injections.
https://www.npr.org/sections/health...es-the-physical-exam-what-are-doctors-missing
It's occurred to me even before I read this article that there are some things a doctor won't be able to do online:
--listen to a patient's heart and lungs
--palpitate their abdomen, thyroid gland etc. for lumps, ascites, and swellings, test a patient's muscle tone
--see any body part that is inaccessible to a web cam
--notice subtle differences in a person's skin tone, coloring etc. that may be indicative of some ailments
--test reflexes
--look in their ears and up their nose with the otoscope/auriscope (whatever the pointy thing with the light is called)
--maybe get a really good, well-lit look at the back of their throat
--notice edema and swelling in extremities
--blood pressure, pulse, O2 saturation (unless the patient has a pulse oximeter and spygmomanometer at home)
--Anything that the patient doesn't specifically mention but the doctor may notice and ask the patient about in an exam room
--collect scrapings and samples and cultures
--get a patient's accurate weight (not the weight they tell the doctor based on a less-accurate home scale paired with wishful thinking)
--and sometimes things just come up during a face-to-face encounter that don't over the phone or on webcam.
Plus there is the whole relationship, emotional support thing that is stronger in person for many people. As with teaching, a move to online instruction definitely changes the nature of a relationship-based profession in many ways. If these changes stick around after the worst of the pandemic has passed, what will it mean for doctor-patient relationships, job satisfaction, and our approach to diagnostics in general. My brother is an oncologist, and he says he often doesn't need to perform an exam on his patients, because the information he needs comes from their tests. But he feels the office visit is important to get a real sense for how they are doing overall, and some patients are concerned if he doesn't examine them, as it's part of a ritual they find reassuring.
Also, could virtual visits lead to important tests not being ordered because the doctor misses a symptom? Or conversely, could it lead to increased costs, because doctors might get overly-cautious and order tests for things they couldn't rule out with an online exam?
Has anyone had an experience with online medicine since the pandemic started, or before? If so, what was missing?
For me, certain routine dermatological appointments that involve injections for a chronic condition I have (alopecia areata) had to be cancelled entirely for several months, as there is no way to do those over the web and the dermatology department was closed to all but online visits for a while. I had some moderate anxiety over this, because I occasionally get bald patches on my scalp (the flares happen every couple of years, and lucky me, I started one around the time the Covid crisis was taking off). They often resolve on their own with time, and over the past decade or so they generally don't show, as my hair is thick enough to cover them. But when I was in my early 40s, the condition came out of nowhere and progressed rapidly to complete baldness while I was waiting for my first dermatology appointment. I was bald for about two years, which was lots of fun (not). An experimental trial (since discontinued) allowed my hair to regrow, as might some changes in my own body (hard to say there), but there is always that lingering worry that the same thing could happen again and a few bald patches that move around on my scalp could turn into complete baldness again if I can't get the topical injections.