Dark and Narrow

January is a weird month.

Deductibles start over for everyone and I end up with a ton of last minute cancellations when people realize the cost. It is particularly bad right after the financial drain of Christmas and it gets worse each year as deductibles creep higher and higher and higher.

However, the holidays are great for spreading illnesses so with a 5-7 day incubation time, spending a week or two trying to fight things off…. Well, now is when people start to need an antibiotic prescription so those empty slots are put to good use.

Most of these patients never come in for a physical so I try to do that at the same time as their acute visit if I have the time as it saves them a copay and preventive care visits don’t go towards their deductibles.

I said all of that to say that yesterday I was doing one of these physicals on a patient who had come in for a sinus infection when she made a comment about how her employer now has the “benefit” of teledoc so she might not be coming in for this sort of thing again.

For those of you who don’t know, teledoc allows you to have a Skyped consult from your desk with a strange doctor somewhere far away.

What she doesn’t necessarily realize is that her employer is not doing this out of the kindness and goodness of their heart. Oh, no. If you see your doctor from your desk, you are not missing work. And a Skyped visit would be cheaper than an office visit so they are spending less money on you in the long run.

“What do you think of teledoc, Doc?” she asked casually.

I felt myself bristling.

Why did I feel the need to justify my role?

And then I realized, some of what I do probably could be done by Skype. Rashes for sure. Maybe some sinus infections. Diabetes check-ups to some degree. Blood pressure. Anxiety/depression sometimes. Gastroenteritis.

Not that it would be better by Skype. I pick up all kinds of stuff during office visits that you would not get by Skype. Like the new heart murmur. New swelling in the legs. The breast mass. Plus there is the relationship side of medicine. I really like that and I think a lot of patients do, too.

There are many, many things that cannot be done by Skype, though. Technology won’t let them listen to a heart or look in an ear yet.

So why do I feel so threatened?

Because it is coming. The technology is being used with robot doctors in rural ICUs.

Am I just the equivalent of a robot?

Some days it sure feels like it, I will admit.

I like my easy visit patients. They keep me sane. I don’t want to lose that to some yahoo behind a computer screen.

The worst thing, and I have to be honest with myself here, is that I look down on doctors who do teledoc work. They are selling out their profession! I also assume that they are not good physicians, that they are lacking in knowledge or personality and cannot hold down a job in the “real” world.

The other issue I have is based on a conversation I had with an acquaintance. He knew what I do for a living. He said, very loudly in a room full of people as he looked at me, “I love the teledoc! I use them all the time. I already know what I need. I can just tell them and they give it to me.”

Heaven help us. It is a brave new world and I will have to be dragged kicking and screaming toward it, I am afraid.


164 thoughts on “Dark and Narrow

  1. Pingback: “Wise Wednesday”: Brevity of Time | Bohemian NERD*

  2. Our technology is outrunning our compassion. But there will always be people who prefer the real thing. I still have never used a ATM. I always go into the bank and speak to a person. Today I went to open a small separate account for expenses that require on line transactions only. The man who helped me was very patient. He said I wasn’t the only one who didn’t like to do financial transactions on line. He told me his wife is really low tech, and she’s not even old. 🙂

    Liked by 1 person

  3. I prefer the personal interaction with my doctor who is based just over 5 minutes walk from my home. Both the receptionists and all of the doctors are friendly and helpful and I can’t imagine replacing the personal interaction by conversations over Skype. I remember, about 10 years ago falling over a log in the woods and feeling my right wrist twist or break. A number of people told me that it was, probably only bruised, however when, after several hours it became even more painful I called the National Health Service advice line. I was told, by an operator that a doctor would call me back but, several hours later I received a call telling me that no doctors would be available until late at night and asking whether I still wished to have a phone consultation. I replied “no” and the next day went into hospital for an x-ray which confirmed that my wrist was, indeeed broken. I should have gone to the hospital in the first place!

    Liked by 1 person

  4. ARE YOU SERIOUS? Wow, that blows my mind. All I saw after the explanation of the “teledoc” is the number of medical malpractice lawsuits increasing and the cost of healthcare going up to compensate for the increase in the doctor’s med mal insurance. (Plus I don’t want sickies coming to work and infecting everyone else!) Sure, I do miss the days when I could call my own doctor and ask for a script of antibiotics because I knew I had a sinus infection and frankly didn’t feel good enough to sit in a doctor’s office. (But then again, my doctor knew me well enough to know I knew what I was talking about because I had sinus infections so frequently.) But I also understand why the laws changed to prevent malpractice and antibiotic abuse. This teledoc thing kind of reminds me of when I ask my pharmacist what they recommend…. I stopped doing that after they recommended me putting Neosporin on what turned out to be such a severe case of MRSA, I almost lost my leg and almost died when it got dangerously close to my femoral artery. This teledoc will not be a good thing. Bless you for sticking with your calling. ❤

    Liked by 1 person

  5. Loved your post! I don’t have time right now to read all the comments, so forgive me if I’m repeating someone. I would rather have teledoc WITH MY OWN DOCTOR than have another appointment with whichever new doctor/nurse practitioner/physician’s assistant has an opening. I really, REALLY miss the “good old days” (even 5 years ago) when we saw our own doctor more than we saw someone else, but I’m afraid (for us) those days are gone…and we live in a relatively small town. I comfort myself with the fact that our “regular doctor” is behind the scenes and would reappear if/when we are dealing with something serious, but sometimes I’m not even sure that would happen:(

    Liked by 1 person

    • You have a very valid point about NPs and PAs NOT consulting the physician. I have trained a fair number of them and a common thread is that they all are taught that they are just as capable as a physician. I can assure you that is not the case and the frightening thing is that they do not understand their own limitations.

      Liked by 1 person

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