Walking gingerly, one small step at a time like an old man, I slowly made my way down our icy driveway to the mailbox this morning. The cold wind circled around my neck and the sleet pounded against my cheeks. March was surely coming in like a lion here in the Northeast.
Inside the black metal mailbox were the usual bills and journals, but also a small post card. I brought it closer to try to read it through my wet eyeglasses. It was from a company looking for primary care physicians for telemedicine services.
Telemedicine is an integral part of rural health care. When an accident victim has a CT scan of the brain or cervical spine in the middle of the night, a radiologist in a different time zone reads the images while our own radiologist gets his well-deserved sleep. The specialists who fly or drive here to do consultations sometimes use the hospital’s teleconferencing capabilities for virtual follow-up appointments. We even have telepsychiatry with doctors from Boston and the southern parts of our state.
“Telemedicine for primary care doctors”, I thought as I inched my way up the slippery driveway in the bitter cold sleet storm. I imagined myself in my slippers and cardigan, comfortably doing telephone consultations by the fire. I saw myself poolside in my swim trunks, sipping from one of those parasol drinks, making money on the phone while working on my tan.
I have already done some telemedicine. Last weekend my daughter sent me a picture on my cell phone with the question what kind of rash my grandson had. It was a classic case of erythema annulare. He happened to have an appointment with his doctor a few days later, and I understand the diagnosis was confirmed in person then.
Then I remembered I had been less successful a few weeks before that when my granddaughter had a host of symptoms, including a fever and, as my daughter added: “She won’t eat”. It all sounded pretty viral to me, so I gave the usual advice. A couple of days later, I found out the child had a flaming case of strep throat.
I asked sheepishly “How sore was her throat?”
“Real bad, didn’t I say that?” My daughter seemed puzzled.
“I only heard that she wouldn’t eat”, I said.
“Yeah, because her throat was so sore”, she answered.
A visual would definitely have helped there. If it was that hard to diagnose my own granddaughter over the phone, I can imagine the challenge of trying to do more than the simplest triage over the phone with a complete stranger who is paying for the call.
I kicked the snow off my boots and entered the glassed-in front porch. My eyeglasses were frosted on the outside and fogged up instantly. I took my boots off, put the journals on my reading pile and the bills on the staircase to the upstairs. I turned the post card over one more time, shrugged to myself, put it in the kitchen trash and poured myself another cup of hot coffee.
not a bad GFR?”
