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Urology Pearls: Telemedicine in the age of COVID-19

Shahar Madjar, MD

Recent events have made me think about all things ‘tele”. On tele-vision I watch shows broadcasted from afar. I recall peering into the sky through a tele-scope. I even almost tele-phoned my wife to ask if we were thinking about ‘Telepathy’ at the same time. What made me contemplate all things ‘tele’ was the Coronavirus pandemic which has been forcing doctors and patients to interact from a distance, via tele-medicine.

The idea behind telemedicine is simple. Instead of meeting in person, you meet with your doctor via telephone or video-conference. Even before the pandemic, telemedicine made sense. From the patient’s perspective, why bother traveling to the doctor’s office, register at the front desk, and spend precious time in the waiting room, when you can communicate with the doctor at the convenience of your home? Wouldn’t it be simpler, easier, and more economical to stay at home and talk with the doctor over the phone, or see him, or her, via video-conference? From a doctor’s perspective, telemedicine may be more efficient and allow doctors to expand their services to remote locations.

The Coronavirus pandemic has made telemedicine even more appealing. By using tele-health, patients may stay at home, reducing the risk of transmitting the disease, or becoming infected.

There are limitations to telemedicine, though. First, the doctor cannot perform a complete physical examination from afar. And a physical exam is important. How can a doctor identify a heart murmur without listening to the heart, or identify a prostate nodule without a digital rectal examination? Second, a lot of the information that is naturally gleaned in a person-to-person interaction is lost during a telemedicine visit–I’m talking about facial expressions, body language, and, possibly, inputs from relatives, friends, or caregivers who accompany the patient. Even when video-conference is used–with a patient typically sitting in front of the camera; his, or her face filling the screen–a doctor may have difficulties seeing “the whole picture.”

Then there is technology and patients’ attitude toward using it. While most patients have a telephone, many do not have a device–a computer, or a smart phone–that would allow them to effectively use video-conference. Others just wouldn’t use video-conference, or have technical difficulties using it. A few instances from my attempts to use telemedicine come to mind: One patient simply stated that he is “old school” and would rather use a regular phone. When I asked another patient if she had a smart phone, she asked me, “How can I tell how smart my phone is?” And a third patient, an elderly man with memory loss and hearing difficulties, was trying to operate his video-camera so we could see each other. Because of his memory loss, he forgot to put in his hearing aid. In a desperate attempt to hear me, he placed his ear so close to the video-camera, that all I could see on my screen, through the entire conversation, was his right ear.

With the help of the nurses who work with me, I was able to overcome most, almost all of these technical difficulties. We learned that if a patient is willing to make an effort, we could almost always establish good connection, and communicate in a satisfactory manner.

Here is my take: Over the past several weeks, I have been trying to integrate telemedicine into my practice in order to provide the necessary urology services during a pandemic. For now, despite its great appeal and technical progress, telemedicine can’t entirely replace traditional face-to-face medicine. For example, there is still a need for physical examination when patients establish care with their doctors, and on regular intervals thereafter. I have learned, though, that a lot of what I do–follow up visits to discuss lab and imaging results, for example–can be safely performed remotely, and that technical difficulties can be overcome. The COVID-19 pandemic has shown doctors and patients that telemedicine is a convenient, efficient way to deliver medicine. Telemedicine is here to stay, so tune up your computers and smart phones–your next meeting with your doctor might as well be a tele-visit.

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