York County Medicine Summer 2020 - 27

YO R K C O M E D S O C . O R G

of care, from follow-up care and wellness checkups to specialty
visits. This includes cardiology, endocrinology, gastrointestinal,
neurology, pediatrics, orthopedics, and much more.
In addition to convenience, telemedicine can give patients
access to some of the nation's leading experts without having to
travel for hours. And as the health care provider shortage becomes
more acute in the U.S., telemedicine is an excellent way to give
patients in rural areas access to leading specialists unavailable near
their homes. Dr. Shah is quick to add, however, exceptions are
made for in-person visits.
"It's not like we just shut our doors. We evaluate the patient the
best we can and make decisions based upon the virtual visit exam.
If it's urgent, but not emergent, we will see them in the office and
of course, if we feel the individual is in respiratory distress or chest
pain, we recommend they call 911."

Telemedicine Is Transforming Inpatient Care, Too

visits. They use basically the same equipment that patients use - a
smartphone or tablet with the app, or a computer with video and
sound capabilities. Their front office staff are also a significant part
of this form of care, as they do a lot of the legwork in setting up
the visit and connecting patients.
"I appreciate my staff and all their hard work. This is a team
effort and we can do this collectively. It's just not the providers
making this happen," Dr. Shah says.
When the patient and providers connect, they receive
undivided attention. Dr. Shah says that there are little
interruptions in conducting this type of visit since he is not in an
office with people waiting or his attention being divided to address
another emergent issue.
While patients and providers alike are navigating new territory
in how to deliver and receive care, the patient experience remains
front and center. What was known as a "bedside manner," has
become a "web-side manner." And so far, so good.

Primary care is not the only discipline using this technology,
however. Telemedicine has a tradition of providing inpatient
and emergency department care, too. By using telemedicine
carts-sometimes called robots-high-definition cameras and
microphones, as well as other tools, allow doctors remotely to
check the patient's heart, lungs, and other vitals.

Across the nation, more doctors have started providing
telemedicine appointments. At UPMC Pinnacle, for example,
more than 1,600 providers and their staff members went through
telemedicine training at the end of March, and more providers
continue to come on board.

For some of the most vulnerable people in our communities,
such as those living in long-term care and skilled nursing facilities,
telemedicine allows specialists to see these patients virtually at
any time of day or night to prevent unnecessary and potentially
dangerous transfers from nursing homes. With so many nursing
homes and long-term care facilities battling COVID-19 at
alarming rates, telemedicine is a welcome option.

Changing the Future of Health Care

In the primary care setting, Dr. Shah explains he and his staff
use this technology interchangeably to accommodate patients
and believe both to be advantageous. During video visits, doctors
are able to "see" the patient and perform an exam by checking
for pain, breathing difficulties, and rash. By phone, he can take
the patient's history and symptoms, but the assessment is not as
thorough. Still, he says, something is better than nothing. This is
especially true for patients who may be reluctant to participate in
any form of virtual visit.

For Dr. Shah's 100-year-old patient with underlying dementia,
who recently had a video visit with him (along with her family
present), it's already been embraced. With the support and
cooperation of her family, they worked together to set up her visit
and were pleased with the outcome.

"I've had a handful of patients who thought this form of
medicine was unusual; however, by the end of the visit, they were
surprised by how much we could accomplish, even with the exam.
Additionally, these patients asked if they could continue to do this
long-term and eventually avoid taking time off work."

Physicians Embracing the Opportunity

Most people today are familiar with Skype, Face Time
or Facebook Live at home, or teleconference at work, and
telemedicine is simply the same thing. But the coronavirus is ever
present, and medicine is one more service being redefined by the
Internet. It's likely after this crisis that telemedicine will no longer
be anything unusual. It will just be medicine.

"Dementia makes it harder to follow instructions. I was happy
to see her and not have to cancel, which we have had to do in the
past, because an in-person visit wasn't feasible. I'm happy this was
a potential option."
Vipul Bhupendra Shah, MD, is
medical director of UPMC Hanover
Medical Group and an internist
at Grandview Family and Adult
Medicine.

As the coronavirus spreads, physicians have been quickly
gaining the skills and the equipment to provide telemedicine

SUMMER 2020 | York County Medicine

27
http://www.YORKCOMEDSOC.ORG
York County Medicine Summer 2020

Table of Contents for the Digital Edition of York County Medicine Summer 2020
