Editorial
GREAT EXPECTATIONS Anna Evans Phillips, MD, MS
D
igital rectal exams cannot be performed via telemedicine. Nor can subtle palpation of a fluctuant or indurated wound site, or auscultation of the pitch of bowel sounds. Telemedicine is not the same as an in-person visit. I have had patients take telemedicine visits with me from their kitchen island, their living room, their back yard, their basement, their garage, and multiple individuals have done so from their car in the parking lot at their workplace. Patients have done their video visits while conference calls at work are held on mute, multi-tasking during their work-at-home days. They have taken telemedicine visits while grocery shopping, even while walking their dog. A diabetic patient of mine with bad vascular disease took his while chain-smoking cigarettes and drinking Mountain Dew. The coronavirus pandemic has pushed physicians to their limits in recent months and sometimes beyond, creating a sea of need into which many doctors have waded, armed with optimism, altruism, and perseverance. The expectation that physicians can and will rise to any occasion to meet a challenge where their talents might be of use continues to exist. And yet neither the challenges
nor the expectations have abated in the two-plus years we have faced the pandemic. The growth of telemedicine represents just one of the ways in which new demands are made of physicians, but our system has not yet caught up to acknowledging and accounting for what this means for clinical medicine moving forward. In recent months, the coronavirus pandemic has touched all of us: rules for entering grocery stores, sending children to school, attending a concert, have all changed…then changed again. Our expectations of how we fly in airplanes, how we shop for groceries and clothing and household goods, and how we stay in touch with our family members have changed during this time. Our expectation for what it means to receive high-quality health care from a physician, however, has not. Healthcare workers – specifically physicians—have been tasked with continuing on during the pandemic. There is no coronavirus exception for the measurement of the number of cases I start on time – despite the fact that there is additional personal protective equipment to don and added complexity for every aspect of the morning routine from daycare drop off to entering the hospital. There is no coronavirus exception for the
calculation of my adenoma detection rate that is performed to identify my skill as a colonoscopist, despite some patients delaying colonoscopy during the past two years to avoid healthcare environments. There is no forgiveness for the delay in a cancer diagnosis despite patients requesting telemedicine visits in place of in-person exams. There is nothing new with physicians stepping up when all else fails; but there’s been almost no time to reflect on how this duty and honor has been affected by the pandemic. The rise of telemedicine has facilitated access to health care and specialist care in an unprecedented fashion that in some ways has been a huge gain for the system. For those physicians in specialties with high demand, this represents a new expectation of availability and flexibility that may not be deliverable at the rate or quality at which it is desired. For a person with an anal cancer, a wound infection, or a distended abdomen, who prefers to have a video chat instead of driving to the office, their reticence to present in-person often results in diagnostic uncertainty and additional delay. They are often unwilling or unable to adequately show the area of concern via video that could have been examined in the privacy of the Continued on Page 8
ACMS Bulletin / July2022
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