(TNS) - “Most of medicine is taking a good history. Always has been,” says Dr. Robert W. Zavoski, the chief medical officer of First Choice Health Centers, which operates a number of medical clinics in East Hartford, Manchester, and Vernon.
Zavoski was explaining how physicians can continue to care for their patients in a world afflicted by the new coronavirus, where traditional doctor visits are far more risky for everyone involved than they were just weeks ago.
There is widespread agreement in the medical community that “telemedicine” will have to play a much larger role in the diagnosis and treatment of disease than it has in the past, at least until the COVID-19 threat recedes.
The word telemedicine brings to mind modern computer technology, but a telemedicine visit can take the form of a traditional telephone call, in which a patient can respond to questions from a nurse or doctor and give the medical history information Zavoski was referring to.
Many providers, including First Choice, offer the option of two-way video communication between doctors and patients.
“Physicians use a lot of visual cues,” says Dr. Robert Carroll, who chairs the Eastern Connecticut Health Network’s emergency medicine department. He cites problems like a rash or minor cut as things a doctor may be able to look at during a video conference with a patient.
Carroll also says a doctor may be able to pick up important non-verbal cues even in a telephone call, such as noting that a patient sounds short of breath.
Questioning replaces touches
He says careful questioning of the patient may provide some of the information a doctor would get by touching the patient during an office visit.
“I can’t push on your abdomen and ask, ‘Does it hurt here?’” Carroll says. But he adds that he can ask the patient precisely where the belly pain is.
Zavoski said doctors can diagnose many conditions simply by thoroughly questioning the patient about symptoms and medical history.
In the case of “established patients,” he adds, doctors also have information from their medical records, which are now more readily accessible, via computer, than they were in the days of paper medical charts.
On-call doctors have dealt with patients over the phone for generations, Zavoski says, adding that many doctors have helped patients through illnesses at home without ever seeing them.
One familiar routine in doctor visits is taking vital signs — body temperature, blood pressure, pulse and breathing rates, to which some doctors add measurements like blood oxygen saturation, blood glucose level, height, and weight.
Many patients may be able to take their own temperatures and pulses and provide height and weight information, while some may have equipment for measuring other signs, such as blood pressure or blood glucose levels.
Zavoski says a doctor can, but doesn’t have to, enlist the patient to provide that type of information.
A judgment call
Still, not all information a doctor may need is available in a telemedicine visit — and many types of treatment may be possible only at a hospital or doctor’s office. It is up to the doctor to make the judgment when to ask a patient to come in, Zavoski says.
He says physicians are always weighing risks and benefits, a calculus that has been altered by the risk of contracting the new coronavirus in a setting visited by other patients.
Some medical payment programs are also changing in response to the growing need for telemedicine.
Zavoski said Connecticut’s HUSKY program for the poor is now paying for telephone visits.
But Dr. Ron Buckman of Bolton Family and Sports Medicine, says Connecticut doctors are generally being reimbursed at only a fraction of what it costs to provide telemedicine visits. He called on the state’s leaders to follow the example of Massachusetts, where the governor’s emergency declaration required all insurance companies and other “payers” for health services to cover telehealth testing and treatment.
The ConnectiCare health maintenance organization has offered telehealth services in partnership with two outside companies at least since 2016. It is now temporarily allowing its members to use these services, MDLIVE and Teladoc, for covered medical and mental health services without copayments, coinsurance, or deductibles, according to ConnectiCare spokeswoman Kimberly Kann.
“We are also offering in-network telehealth services, including a phone call or virtual visit with an in-network doctor for something not related to COVID-19,” she continued in an email to a reporter. “These virtual telehealth visits will be covered. There is no cost-sharing, including copayments, coinsurance, or deductibles,” through May 31.
In addition, ConnectiCare “nurse care managers” are calling members “who may be vulnerable due to medical condition or age” to give them information to help keep them safe, Kann wrote.
Zavoski stressed that, during the pandemic, people who fall ill should call a health-care provider before doing anything else “to keep everyone around you safe.”
©2020 Journal Inquirer, Manchester, Conn.
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