Last week marked something of a medical milestone, with more than 10 million telehealth services delivered since the expansion of services on March 13.
So it was a surprise when I heard a South Australian GP saying, “I’m not doing any telehealth”. He went on to detail a series of patient presentations that could not have been done without physically seeing the patient. Oh, a series of four.
The contrast with my own experience, and that of my colleagues, was so great that I decided to get all scientific. So I audited my practice. Which meant going back and counting (and not stopping at four).
Since I was released from quarantine and allowed back to the practice, I have “seen” 334 patients. Of the physical health consultations, 65% have been by telehealth, 35% face to face. The proportion of telehealth for predominately mental health consultations was a bit higher, at 80%.
The bad bits? The toughest part is not the medicine, but the voice quality. It is amazing that in 2020, with all our advances in technology, it is still so hard to get a decent quality phone connection.
It’s near impossible to assess someone’s pain when every third word drops out, or their voice is so muffled it sounds as if they’re talking through a pair of Scandinavian hiking socks.
It seems even harder to get people to actually use their devices properly. I swear some people stick their phone on speaker and try to conduct the consult while doing the washing or walking the dog. Please don’t expect me to diagnose the cause of your halitosis when all I can hear is the rustling of a poop bag.
Video calls are a rarity. Experience shows that most of the allotted time is spent with the patient baffled by various settings, and the subsequent picture is of little use unless they have a sinus problem, the one time a close-up of their nostrils might be helpful.
Time keeping is interesting. The patient who sits for 30 minutes in the waiting room without complaint will call reception seven minutes past their allotted telehealth time to ask why the doctor hasn’t rung yet.
Something about all these Zoom parties has created the expectation that guests will “arrive” within a minute or two of the invited time, and now the same is expected of their doctors’ telehealth appointments.
And here’s a gross generalisation, pointed out to me by one of our female doctors. She reckons that women are more used to settling back for a long chat on the phone, while men see it as a rather distasteful device, for making arrangements and to be abandoned as rapidly as possible.
Result (she says): telehealth with men, quick; with women, prepare for the long haul.
But the good bits are legion. People love the convenience — the repeat script sorted and sent to the pharmacy, all while Netflix is on pause. Pathology forms organised and printed one week, results discussed the next, a face-to-face visit arranged only if needed. Perfect.
Blood pressure can be better monitored by patients at home with their own machines. Why do one reading every three months in a doctor’s office when you can do it three times a day at home?
Geography is no longer the same barrier. Patients who’ve moved to Sunshine have been able to “move back” to St Kilda. Someone even rang last week for a consult from Central Queensland.
And the relative anonymity of the phone has freed some with complex psych issues to open up, talk more often and more openly. Social anxiety makes getting out, travelling and sharing a waiting room far harder than staying safely at home, curled up with the phone.
The ease of taking and sending good quality pictures has made rashes and eyelid cysts a doddle. One man, anxious about a new painful lump on his backside, even managed to send a remarkably high-resolution pic of the offending swelling.
His relief that what I was seeing was clearly a haemorrhoid and not a rampant cancer was palpable, even if the offending lesion wasn’t. But perhaps not one for the family album.
Like my South Australian colleague I still want to see real people. There will always be a need for human contact, physical examination and all the extra benefits that derive from being with someone in the same space.
But unlike him, now that I’ve embraced telehealth and had the chance to explore her faults and virtues, I’m hooked.
This is no COVID-19 holiday fling. We’ve tried living together and we’re still happy. She’s a keeper.
Will changes to healthcare be the lasting legacy of COVID-19? How has the pandemic impacted your healthcare routine? Let us know your thoughts by writing to [email protected]. Please include your full name to be considered for publication in Crikey’s new Your Say section
Nick Carr is a Melbourne-based GP, author and broadcaster.