In this time of social distancing to reduce the spread of novel coronavirus, medical providers and systems are shifting face-to-face medical care to “virtual care” as much as we can to keep our patients and employees as safe as possible. We have been doing virtual care for years and have recently added innovations. Patients appreciate the convenience of getting care from their own homes and avoiding unnecessary trips to the clinic. And together we’re keeping our communities safer.
Most health care systems have consulting nurse services staffed 24/7 by registered nurses who are trained to assess patients over the phone, give validated medical advice and direct patients who need to be seen to appropriate medical facilities. They make getting advice easy and fast.
The largest volume of virtual care in my practice has been secure emailing through our electronic medical record system portal. I can send patients test results and reminders, and patients can email me questions like requests for explanation of labs, refill requests or discussion of symptoms and treatment options.
We have used scheduled phone visits for the past 20 years in my practice. Like email visits, these are conversations about symptoms, requests for medications or follow-up conversations on responses to treatment of a wide variety of illnesses. We are expanding use of these visits now to reduce the number of contacts and the potential for spreading infections.
Most of the work of making a diagnosis in any interaction with a patient in a face-to-face encounter or a virtual one is based on the patient’s history. Those are the details of the onset of an illness, its initial and changing symptoms, factors that make it worse and ones that make it better. With careful listening and follow-up questions, we develop a list of possible diagnoses. We then narrow that list down to the most likely diagnosis. In a virtual visit, we have to rely more on the story, but we might need to order additional testing to confirm a diagnosis.
At Kaiser Permanente, we recently rolled out a new form of provider-patient interaction that my organization calls Care Chat. This uses a smartphone or computer app to allow a patient to have a conversation with a provider using a real-time online chat. It also allows a patient to send photos when desired. It is staffed by physicians, physician assistants and nurse practitioners. Patients appreciate that it feels more private because you don’t need to say symptoms out loud.
Another service we have for our providers and patients is something that we call an e-consult. Using this, I can gather the patient’s story, examination, labs, X-rays and photos and ask a specialty colleague to review my question and the patient’s chart and suggest diagnoses, treatment or further testing.
I recently had a patient with a rash that was not improving. With a photo, my notes and what the patient had tried without success, the dermatologist was able to make a diagnosis and recommend a treatment plan overnight that worked for the patient, bypassing the need for an additional appointment.
Of course, there are times when a virtual visit is not enough and a patient needs to be seen and examined. When that is needed, a plan is created to accomplish it as safely as possible. Given our need to decrease transmission of the novel coronavirus, we are selecting tried and proven virtual care to get our patients cared for in a way they prefer and doing our best to lower everyone’s risk of getting sick.
Bob Riggs is a family medicine physician at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.
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