A Country Doctor Writes:

(Pictures below…)

Just over a year ago I wrote about mixing telemedicine with in person visits. 15 months into my new practice, I see very plainly how making the initial visit and maybe a few more as in-person housecalls, I am able to establish a stronger connection and a deeper understanding of my patients and their circumstances than I did in my office based practice. 

Now, I am blessed to do more and more of my follow-up visits using the technology of video visits. And we are adding new technology to let both our doctors and our patients listen to heart sounds together in real time, for example.

In some cases I do my video visits alone with the patient in their home in front of their smartphone, tablet or laptop. In some cases I do them with my assistant in their home, setting up the technology on her laptop, doing the vital signals and, soon, using a tech enabled stethoscope and otoscope. We already have the ability to do EKGs that way, too. 

When things work very smoothly, I can do video visits by myself while my assistant travels between patients who can’t manage the technology on their own. My territory is more than 3 hours from north to south, so it takes some sophisticated scheduling to maximize our efficiency and most of the time we do that really well. 

I’m really looking forward to starting to use the virtual stethoscope. There are a couple of ways you can use it. One is having the assistant record the heart sounds and send them to me so I can listen to them more or less on my own and then tell patient about what I hear, but I prefer the modality where the recording happens in real time and both the patient and I hear the heart sounds. I can then say “did you hear that irregularity in the rhythm? That’s a type of extra beat and usually they are very harmless“ or “do you hear that swishing sound, that’s a sign that one of your valves isn’t opening correctly”. Doing that in real time, mimics the in-office auscultation of the heart and enhances it by having us listen at the same time. I never really pictured that a remote visit in some ways can be more informative for the patient than an in-person visit.

I’m indescribably happy with my mix of old fashioned housecalls and modern-tech telemedicine. The fact that the only desk I have is at home is amazing, actually plural – two desks – my kitchen island and the small, white fold-out desk in my library at the other end of the house. 

My two Alabai rescue dogs are super happy. The younger one, the daughter, had some anxiety when I was in my old job and gone all day. She chewed on one of my favorite pairs of penny loafers. That never happens anymore. I have a wonderful work-life balance.