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Medical School Nurse Interviews

Patient Care in Telemedicine

Eileen Wee, 05 Sep 2016
Dr. Jennifer Winter
Doctor
Online Physician
Show Bio
Patient care in the field of telemedicine comes with its own unique set of challenges due to the absence of face-to-face communication and physical examination.

In the second of this interview series, Dr. Winter elaborates more about how patient care works in telemedicine and how different clinical situations are handled, such as immediate medical emergencies and patient follow-ups.

In part 1, Dr. Winter provided a sound introduction to the lesser-known world of telemedicine, from the way patients are examined to what an average day in telemedicine is like.

Q: How many patients are seen per day or shift, and how much time is spent with each person?

Like regular clinics the patient flow would vary. There is definitely a higher influx on the weekend as the patients have no access to their regular doctors until Monday. I personally would see from a range of 10 a day to as much as 60. The average although is about 20 patients and that would be a good day.

Since I do the asynchronous form of telemedicine there is no number of minutes spent with the patient as this is non-real time messaging. To avoid the patient needing to ask several follow-up questions, I would answer as their question as comprehensive as possible. We get an influx of similar cases so you more or less know on what the patients are concerned about and what else they would like to know so you tell them everything in that one message. So personally it may take me around 15-20 minutes, depending on the case, to reply to the patient.

Q: Should you prepare for it to be a regular shift or an occasional one?

They are really like regular clinic hours. You have a long line of patients and you begin to answer the ones who sent their answers first. You need to look through all the questions first to see if some emergent case is lined up so you could deal with that one before the rest. There are several of us who are online, depending again on the time zone, to answer these patients but there is always one, for the lack of a better term, “emergency finder” doctor who would go through the questions to report the emergencies.

Q: What happens if a patient contacts you with a medical emergency?

Patients are not always aware that what they are experiencing are emergencies and that they should call up an emergency hotline or immediately proceed to their nearest emergency room. Like in the hospital we would have on-call duties.

Since we are doctors from different time zones and we cater to patients from different zones as well, we fill in hours where we can monitor the questions coming in. When we review a case and see that it is an emergency, we hit the “report an emergency” button which then immediately sends an automated message to the patient saying they need to seek emergency care. I would usually follow this up by messaging them directly and explaining why I think they need to seek emergency care and further urge them to do so.

Q: Do you often follow up with the same patients as some doctors do in physical clinical settings?

A few do. There are some who follow-up to let you know how their actual doctor’s visit went and if they have a few questions which they weren’t able to ask their doctor. Then there are those with anxiety issues and come to you often as they feel comfortable with the way you handle their problems.

Though generally this relationship isn’t long term as you would point them to a doctor who can physically assess them, order the needed tests and treat them. This type of service was never meant to replace an actual doctor’s visit, just to supplement it. MIMS

Watch out for part 3 of this series!

Expert Interview with Telemedicine Practitioner Dr. Winter:
1. "An Insider’s Introduction into Telemedicine” - Expert Interview with Telemedicine Practitioner Dr. Winter (Part 1)
2. “Patient Care in Telemedicine” – Expert Interview with Telemedicine Practitioner Dr. Winter (Part 2)
3. “Experiences in Telemedicine” – Expert Interview with Telemedicine Practitioner Dr. Winter (Part 3)
4. "Getting Started in Telemedicine" - Expert Interview with Telemedicine Practitioner Dr. Winter (Part 4)
5. "Myths, Misconceptions, Realities of Telemedicine" - Expert Interview with Telemedicine Practitioner Dr. Winter (Part 5)
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