Telemedicine--what might doctors miss during online exams

I think you're right about that, frimble. It's also possible some of the students don't realize their actual teacher actually looks at the scan, and it's not a robot or someone who works for the software company.

I didn't call the student out individually, but in the announcement reminding the students (yet again) that they needed to use a mirror and scan their computer slowly enough to be visible to me, I reminded them that I do have to personally view the scans, and I see them performing it, so they should take that into consideration.

Also of help, perhaps, to the folks in their jammies (one had their romantic partner still sleeping in the bed next to them), and the one gal who had her web cam pause on her cleavage and, ah, pelvic area (which was clad in very tight short shorts that were like being transported back in time to the 70s). I am not of an inclination that is remotely impressed with such a view, so I don't know what she thought she was doing.

Another unexpected consequence of exam-proctoring software.

When looking over a flagged student's test-taking video/audio file, I heard the sound of what sounded like a child being beaten in the background. The video is focused on the poor, flinching student (who is over 18), but the audio picked up sound of a child screaming while an adult male is screaming at them, with smacking sounds. It was loud enough my spouse stuck his head in the room to see what the hell it was. It went on for several minutes until the student disconnected from the test (yes, I am letting her take it again).

So, I don't know for sure whether the adult was hitting the kid in the background hard enough to leave welts or bruises (the us official definition of abuse--you can hit your kids and verbally abuse/threaten them all you like here), but it sounded horrific to the point where I felt ill and was kind of crying. I also don't know for sure the age of the person being abused in the background.

We are mandated reporters as college teacher, which means of we have a reasonable suspicion of child abuse occurring, we must report it directly to CPS. It is also kind of a moral responsibility, imo. So I put in the call and was told, after having to explain why I was even able to witness this snippet of my poor student's home life and could hear the possible abuse without seeing it etc. I think the social worker was still confused, as she doesn't know what test proctoring software is or what it records. But since I don't have access to my student's address or family phone number, they can't follow it up.

So now I'm going back and forth with my dean and other people on campus trying to get this student's address so I can call CPS again and maybe make this report. Also the added fun is the campus remediation folks want me to share this video and audio file, but I'm not even sure it's possible with this software, as it is supposed to be confidential between student and teacher. And it's so hard doing all this via individual e-mails with people not on campus and while protecting this poor student's privacy and (hopefully) my anonymity. The last thing I need is some vengeful abusive parent trying to burn my house down or poison my pets, or even assaulting me. It also occurs to me that if the CPS can follow up, but they don't have enough hard evidence of abuse to do anything, then it could be even worse for the victim and for the other household members. I don't know this person doesn't abuse my (over 18) student too.

I know we all hear horror stories about kids being taken from loving parents because of a dog bite, a fall from a tree, a kid going to the park by themselves, or something else an overly-vigilant CPS person freaks out about, but most of the time the errors are in the other direction, because they are understaffed and funded.

This is a slice of a student's life I would never see without this software "bringing me into their homes" for the duration of an online exam. This is just the eighth of about 120 exams I need to grade, by the way, so I can't help wondering if there will be others whose background noise flag their files and it turns out to be someone committing a crime in the background. It also breaks my heart to think of the stress some families are under right now, and how hard it must be for victims of abuse at any time, but especially right now with abusive spouses and parents home most of the time and stress levels high.

If someone needs to see it, I'm sure we'll find a way. I do have screencast on my computer, which I used to record powerpoint lectures, and that would likely work for this.

Adding to the weirdness, the records office sent me the student's home address, so I could include it in the CPS report.

Well, the address is in my neighborhood. But google maps cannot find a house with that number on the street (I checked so we could avoid walking past that house when walking the dogs, since I don't want student to know where I live in case CPS comes to the door and someone in the house vows revenge on the person who turned them in).

I checked with the records office again, and that is the only one they have, and the incorrect address is listed in two separate places. The records folks at the college are checking with the high school to see if they can get something from them, but the clerk I was e-mailing with said she expects the high school records will be wrong too. So we might be at a dead end again. Even if the address is only "off" by one even number or something, the people might be reluctant to look it up. Not knowing the name of her other family members puts it at a dead end, unless the high school comes through with something.

The student did indeed go to our neighborhood high school, so I suspect her family does indeed live near where the fake address is. Whether it's a persistent confusion about their real address, or a deliberate fudging, I've no idea.

Is deliberately giving a fake address on your college paperwork a thing for some reason? Or are there really people who don't know their own actual addresses?

Assuming she is even staying with her actual parents at this time. The student herself is over 18, so who knows?

Yes, for any exam or condition that requires a doctor to auscultate or palpitate (two wonderful words, those), it seems telemedicine is lacking. Some patients may have things like sphygmomanometers, pulse oximeters, even stethoscopes at home, and they can relay information to doctors. But not everyone does, nor has the knowledge to use them properly, and not all such devices are equally accurate.

As I understand it, the yearly physical is not something health care providers encourage as much as they once did. This interests me, because I thought preventative medicine saved lives and money both, and if you don't catch something early, well...

Our Kaiser is allowing patients to come in for exams and procedures that can't be done remotely, like eye exams or my alopecia injections. They require masks and have tightened their protocols (the first time I went in, they ignored a couple that had their masks pulled down and were eating their lunch in the waiting area), but they have also gone from having someone scan your temp and asking you screening questions at the door to asking you to call and confirm that you don't have a fever or other Covid symptoms within 24 hours of going in.

Veterinarians are not doing telemedicine, from what I've seen. They're in a different situation, of course, where the patients themselves are very unlikely to transmit the virus, and vets also rely more on exams, because their patients can't tell them what symptoms they are experiencing (and owners aren't always reliable observers either). They take the patient back for their exams while the owner waits in their car, and payment and instructions/consults are done over the phone. Some vets say it's nice just to have the patient without having to deal with the owner directly, but others say it's much more inefficient to not be able to ask about things as they come up during the exam. As a pet owner, I know I sometimes remember things to ask or mention while I observe the ongoing exam.

It's also much slower, so the waits at vet clinics and emergency facilities have lengthened, and the wait for appointments have too.

I've been waiting at vet clinics a lot over the past couple of weeks, because one of our cats has just been diagnosed with a congenital heart condition and my 7-month old kelpie pup (whom I had big plans for with regards to agility and maybe herding) has just been diagnosed with hip dysplasia

Between the pet issues, and navigating the intricacies of the mandated reporting system (and its limitations) and just feeling like shit over seeing the conditions so many of my students are forced to live in (something distance technology has made me privy to), it has not been a great week. I may need to call my doctor and ask if I should up my Bupropion dosage.

I'm also sad about the way Covid has damaged my relationship with some people. Just talked to a friend who's been out of the state (in Wyoming with her parents, where she stayed after having to go home for a funeral) for a while, and she gleefully announced that she was able to head over to that Sturgis bike rally (she is also not a spring chicken being a few years older than I, who is also not a spring chicken). She grew noticeably colder when I expressed a certain amount of shock and concern over this. Sigh. So many folks I thought I knew are turning out to have not a lick of sense right now, and they are eating up very partisan crap with regards to lockdowns and risk assessment, but that's a topic for a different thread.

I hadn't heard of frozen shoulder either. I always think rotator cuff when I hear about shoulder pain and stiffness.

I hope that's what Mr. JJ's issues are, anyway, and exercises relieve it without a need for surgery.

This article isn't directly related to telemedicine, per se, but it discusses something I've been worried about since this Covid-19 crisis got underway here: people not getting needed health care because of the pandemic.

https://www.npr.org/sections/health...ties-miss-needed-medical-care-during-pandemic

In some cases it's because people can't find a health care provider who is taking new patients right now. In other cases it is because people are afraid to go to the urgent care or ER with acute, even alarming, symptoms because they are afraid of being exposed to the virus or of diverting health care resources if their condition doesn't end up being a true emergency.

This latter is something that's bugged me, because over the years I, my spouse, and several other people we know have gone to the ER with symptoms that had the potential to be life threatening, but they were ultimately discharged without hospitalization with the underlying cause of the symptoms remaining mysterious. After hearing about those ER frequent fliers everyone hates, and about how difficult it is for health care providers right now, I'd feel very bad if I went to the ER with chest pains or severe stomach pains and it turns out it isn't a heart attack or appendicitis or something that needed immediate diagnosis and care.

Also, with fewer routine screenings for cancer and other diseases (that require seemingly healthy people, or people with certain symptoms, to come in for physical procedures or tests) means there may be a bunch of later-stage disease diagnosed down the road.

Our health care plan charges a 100 dollar emergency visit co-pay if you aren't hospitalized, which I gather is to discourage frivolous ER visits. We can afford that, but for some folks even 100 bucks is more than they have right now, and some plans charge far more. This also probably plays a role in some people deciding to wait it out (and maybe dying or being treated after a condition has progressed and become more expensive and invasive to treat), though that's an issue that goes beyond the current crisis.