Telemedicine, My Foot!

Telemedicine, My Foot!

Are you skeptical of telemedicine like me? Let me qualify that. I did a recent video exam for an existing condition with a doctor I knew. And it was fine. Nothing new, nothing scary.

But the other night I noticed a puffy, bloody-ish bruise on the top of my foot. I’d not ever had a bruise like that and it happened to be the foot of the leg where I have a bad arthritic hip. And though I’ve never been a hypochondriac, maybe it’s my age, but I quickly turned into Woody Allen in “Hannah and Her Sisters.” Allen’s neurotic character, Mickey, had had a headache or something and was convinced within an inch of his life he had a brain tumor.

I was convinced that my bad hip (get ready for some pure neurotic irrationality here), was, like, bleeding down my leg internally, and the blood was reaching my foot, which would surely have to be amputated.

So I called my girlfriend Anne Marie. She didn’t like the sound of it, either. “Zan, go to the ER,” she said. Arg! No way! I hate doing that. You have to wait forever—and in this case with a bunch of people who probably have Covid-19, my anxiety (mis)informed me. And I’d have to pay a bundle. I have a crap, expensive health plan. And it’s not a broken leg or anything. I’d be embarrassed. I bargained with Anne Marie: how about urgent care? “Yes!” She said like a good friend, knowing she couldn’t push too hard.

So I looked up the places covered by my plan. Ugh. The only one affiliated with an institution I trust or had heard of had closed at 5. Not because of covid, mind you. Because of looting. Oh what a time to be alive.

But, as I tooled around the site I came upon another option: I could see a doctor virtually. Well, ugh again. As I said, I’d done this for a known condition with a known doctor calling from an office I’d visited before. But I didn’t like this idea at all. To be blunt, I imagined I’d be calling into a vast, unknown void surely staffed by inferior has-been doctors (sorry, doctors). And how can they possibly diagnose from a photo or video? I’d be a fool to do it. I mean, I might be facing amputation, and even if I wasn’t,  should I leave a swollen mound to a 13-inch screen?

But, I could appease Anne Marie. And, I was worried. And unwilling to sit for hours at an ER. The money thing kept pressing on my brain, too (although, despite my crap health plan, I am grateful to have one at all). Furthermore, my plan promised a board-certified physician. So, maybe I’d just try this newfangled telemedicine thing, I thought. And, it turned out, it was free. Normally there would be a $5 co-pay, which had been waived during the pandemic…..Hmmm, appeasing Anne Marie was looking better by the moment.

Telemedicine is everywhere right now as consumers and providers seek to avoid face-to-face visits, lest they contract the virus. “According to a McKinsey & Co. survey conducted in April, consumer use of telehealth exploded during the pandemic, going from just 11% of U.S. consumers using it in 2019 to 46%,” reports Yahoo Finance.

So, yes, I signed up. After filling out a brief medical history, I indicated I was ready to see a doctor, clicked enter, and prepared to wait for hours.

Not five minutes later I got the notification. The doctor will see you now. Wow! That was fast.

I had submitted a photo of my foot, even though I was sure the so-so light wouldn’t give a true idea of the severity of my injury. But the doc went right to it.

“You have a spontaneous hematoma,” he said after about five seconds, explaining that I’d basically broken a blood vessel, which was the reason for the discoloration. That was it. That was all. The doc exuded confidence—he was an emergency medicine specialist in my state—as if he’d seen millions of these before. I wanted to hug him. No ER visit. No bankruptcy. No amputation! Not even an infection, he said. And no urgent care facility where a friend’s friend once went only to discover months later that the sliver of glass she’d stepped on was still inside her heel. Not making that up.

And Anne Marie would be appeased.

The doc and I went on to discuss that I had had no recollection of hurting my foot, twisting it or anything, and he said that that rather confirmed his diagnosis. Indeed, after the call I googled it: “Occasionally, a hematoma may happen spontaneously without any identifiable cause or recollection of any specific injury or trauma.”

Holy cow! Seems like the doc hit it. And we agreed that it might have happened because I was, in fact, limping to favor the bad hip and walking on the foot in an unusual way. He also explained that, like any bruise, it would turn different colors and likely yellow after a few days.

This little detail was key. Despite all of the above, I still had my doubts. I mean, you don’t entirely overcome your Woody Allen-ness in five minutes, at least not without some physical proof. Maybe my photo wasn’t clear enough after all. Maybe the doctor was just wrong.

But, while it hasn’t actually turned yellow yet, its purply redness is fading and the swelling is all but gone.

Is telemedicine perfect? I’m sure many share the concerns recently expressed by pediatrician Cyndie Hatcher, MD, in the Boston Globe. Among her objections: “…pixelated video visits don’t convey the nuanced nonverbal cues of caregivers suffering from depression, or signs of pediatric developmental abnormalities. Nor do they allow the privacy required for spouses or kids looking to disclose violence — weekly reports of child abuse are down more than 50 percent in Massachusetts. Food and housing assessments often get forgotten and vaccines delayed. We all feel uneasy about each lost opportunity to help us improve the lives of our patients.”

And, it’s obviously not for everything. I wouldn’t go virtual if I broke my leg, though they say I can start the process online. And yes, I’m seeing a doctor in person for the bad hip. And my spontaneous hematoma was just one experience, my experience. (Here is one of many articles that might help to determine if a virtual visit is for you.) But it was a great one. Sign me up, I’m a convert. I’ve never had strong feelings about technology one way or another—until now. What a fine use.

The pandemic has forced us to do many things we don’t want to do. It’s a tragedy, period. But it has brought advantages, and I believe the expansion of telemedicine is one of them. It’s still an emerging field and no one really knows where it will go, though by all accounts it appears to be here to stay. “The healthcare industry is notoriously slow in adapting new technologies, but COVID-19 may prove to be telehealth’s watershed moment,” Fast Company writes.

Indeed, maybe telemed can make a dent in healthcare costs and help make it easier for more to access care. It did both for me in this instance. Maybe it can mean more equitable care for people who can’t afford a health plan at all. Researchers found in 2018 that low-income and rural patients are least likely to access telemedicine, possibly because they lack access to providers who offer it. But in April, the Federal Communications Commission established the Connected Care Pilot Program with $100 million to support telehealth services for consumers, particularly for low-income Americans and veterans.

“I am hopeful that this pilot program will both provide targeted assistance to communities in need as soon as possible and pave the way for a broader commitment to improving health care and connectivity for low-income people,” said FCC commissioner Geoffrey Starks.

I hope Starks is right.

That would make it quite a time to be alive.

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