Curbside Consult with Dr. Jayne 11/1/21

Halloween is my favorite holiday, and I hated that COVID-19 pretty much killed it last year. This year, I decided to make a driveway treat station, keeping a table between the trick-or-treaters and me, and making sure to sanitize before lobbing candy into pillowcases and plastic pumpkins. (No kids’ hands in the bucket, thank you very much!)

I had a little less than half of the visitors I have in a “normal” year, but was glad to see people getting out. Lots of adults were in costume and running around with their youngsters, and more than one mom commented on my gallon of industrial hand sanitizer. What can I say? Old emergency department habits die hard.

I’ve been knee-deep in telehealth projects the last couple of weeks, so I’m always on the lookout for good articles or information. I thought this NPR article was interesting. It presents all the reasons why patients like telehealth, such as not having to leave home, not having to wait at a medical office, etc. However, it also presents data from a recent poll that found that 60% of patients would prefer to see their provider in person. This may be a sign that the pendulum is swinging towards traditional in-person office visits. As a physician, I agree that certain conditions are better handled in person, such as a new orthopedic injury, rashes, or abnormal moles. Patients who are nervous about telehealth or who have technology challenges are better served in person as well.

Still, I take issue with one of the quotes in the article, where a concierge physician mentions limitations during telehealth visits where “You may be missing that opportunity to be talking with the doctor who’s going to say, ‘Hey, by the way, I see you haven’t had your mammogram or you haven’t had your pap [smear].’” I would argue that’s not necessarily a limitation of the telehealth modality, but rather an issue of the patient and physician taking time to focus on preventive measures or reviewing potential gaps in care, which should be easy to accomplish regardless of the way the visit occurs. There’s not anything particular about a telehealth visit that should interfere with a physician accomplishing that discussion. Failing to review preventive milestones seems to me more like a bedside manner issue than an in-person versus telehealth issue.

The article wanders into the premise that maybe telehealth is only for when in-person visits aren’t available, such as in rural communities or where there are shortages of specialists. I disagree. What I’ve seen as a telehealth physician is that many patients prefer not having to interrupt their lives to participate in the frustrating operational exercise of interacting with a medical office. Especially with the overall labor shortage and people leaving healthcare in droves, the frustration factor of interacting with short-staffed offices is at an all-time high. Where offices may be adding greater access through telehealth, they may not be spending time fixing broken processes or making the patient experience smoother.

I had one of those frustrating interactions this week that made me want to tear my hair out. As a person who has had a couple dozen skin biopsies, I know when I see something unusual that needs to be checked out. Due to a busy schedule, I hadn’t been able to call my dermatologist’s office, but ended up checking in MyChart to see if they were doing online scheduling. It looked like they were, and I was excited, but when I hit the button to search for open appointments it told me that someone would be contacting me from the office. Two days later, in the midst of another busy day, I received a MyChart appointment reminder, for an appointment that was two hours from the current time. Since I can’t drop everything and run to an appointment, I canceled it online then immediately called the office to reschedule.

Due to staffing issues, the office has transitioned its scheduling to the medical school’s central scheduling line, and a fairly unprofessional phone staffer told me “I have no clue how you got that appointment, because your doctor is booking way out at the end of February.” I was treated like I was making the whole thing up. He told me that he would have to send a message to the office to “see what they want to do with you” and that someone would call in 48 to 72 hours. I didn’t bother to tell him that 48 to 72 hours would be Saturday or Sunday since I honestly didn’t think he would care. While on the call, I received a MyChart message from a nurse offering me the now-canceled appointment, and I responded that I had canceled the visit already and needed at least a little lead time for an appointment.

Several hours later, I received two hang-up calls from the office followed by a third that actually connected. This was a scheduler who was responding to the central scheduling message and was unaware of the previously offered appointment. I explained the whole timeline to her and that I didn’t think this was an urgent issue, but I didn’t want it to wait four months given my history. She was able to find a “work in” appointment at the end of November. Had I not been a physician who understood the potential seriousness of what was seeing and had the wherewithal to advocate for myself, I probably would have given up by this point. Had I been a worker who couldn’t take random calls from my physician’s office, the phone tag probably would have gone on for days.

It’s within this context and with this type of underlying frustration that people are experiencing telehealth. I’m sure it has an impact on their perceptions of how much better it might seem than having to go to the office, sit in a waiting room, wait some more in an exam room, and be ignored while people tend to phone calls at the check-out desk. Of course some offices manage this better than others, but the point is that patients are ready for a change and anything that is not the status quo is going to be welcome.

The bottom line is that we need to work to make all health interactions more streamlined, more valuable, and more patient and family friendly. While we are making things more convenient with telehealth, we also need to make them more convenient when patients choose or require in-person visits. Let’s optimize all those systems we paid big money for. Let patients update their histories and check in online before the visit rather than handing them the proverbial clipboard at the office and requiring them to write down information they’ve provided a dozen times before. Let’s figure out how to allow patients to self-schedule while simultaneously solving practice capacity issues so it doesn’t take a third of a year for a patient to be able to have a new problem evaluated.

Telehealth is part of the solution, but it’s not the only answer to the many problems we’re facing. Let’s challenge ourselves to try to find one way each month to make things better for our patients. Who’s with me?

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