SPEAKER 1: Welcome to Mayo Clinic COVID-19: Expert Insights and Strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc. and is in accordance with ACCME guidelines.
SARA BONNES: I'm Sara Bonnes. Welcome to this discussion about some of the challenges that we may face with telemedicine. I have no disclosures to report. As you've heard from Dr. Anderson, there are many benefits to using telemedicine, particularly in the setting of a pandemic. However, we still have some challenges to overcome. We'll briefly review some of the technology barriers, some of the challenges in getting language support, the limitations of physical exam, as well as potential concerns about patient safety during the visit.
One of the big goals of telemedicine, even starting back into about the 1970s, was to increase access to care. There has been a significant focus on increasing access in rural areas or areas where there are limited subspecialists. However, looking at the Federal Communications website, access to care may still be limited if the only way patients can receive care are via technology. Particularly in rural America, about one quarter of Americans have limited or no internet access. And about a third of the population in tribal areas has limited access. So if you're transitioning from face-to-face visits to video visits only, consider the impact that internet access may have.
In addition, patients have had concerns about what the potential cost of a phone overage bill would be depending on their plan. We have had patients declining care or cutting off televisits early given the concerns that they may run out of minutes or may have a data overage. So consider this as you're visiting with patients regarding your potential clinic options.
Also, there are various reports indicating that it can be more challenging for patients with limited English proficiency to access telemedicine. Many of the instructions that we provide may be only in English. In addition, some of the platforms frequently used to provide telemedicine may not have easy ways to incorporate an interpreter into the visit. As we all know, it is not ideal to rely on a patient friend or family member to provide translation during a clinical visit. So again, there are a few things to consider as we work to increase access for all patients.
Once you have a visit going, or even as you're planning for a visit, knowing the intent of the visit will also be important. The physical exam is going to be not able to be completed at all when doing a phone visit and will still be significantly limited during a video visit. During a video visit, it is great to be able to see the patient and learn a little bit more about their home environment. But the physical exam techniques we were all taught during our training, such as inspection, auscultation, palpation, and percussion, will be limited. You can certainly have the patient move the camera to focus in on a specific area. But the focus can still be challenging, and you may not be able to tell exactly what you're looking at, depending on the patient's equipment.
As far as auscultation or measuring vital signs, there are a variety of tools that are available to connect into a telehealth platform so that you could virtually auscultate or perform other physical exam maneuvers. However, these may not be available at your institution or, depending on cost and how they're charged to the patient, may be prohibitive. Palpation and percussion will certainly not be possible given the physical distance.
Also, while you're planning these visits, it will be important to consider your licensure. Here in southeast Minnesota, we see many patients not just from Minnesota, but also from Wisconsin and Iowa. The rules about providing care to patients outside of your state or outside of a state where you are physically licensed will vary. Make sure that you've checked with your institutional rules before you proceed to offer care to patients elsewhere.
Also, one of the concerns for, potentially, is that it's convenient for patients to have a telemedicine visit while they're traveling. But what about the licensure issues or requirements if the patient is traveling out of state or country? These are things, again, to verify with your institution before proceeding to offer video or telemedicine visits to all patients.
One of the concerns that I hadn't anticipated initially but have seen come up more as we've done more telemedicine visits is patient safety. When a patient physically has to come into the clinic, they have to plan ahead. And we know that they'll be in our area and safe during that time. We have had patients, unfortunately, who are driving during a visit. Certainly, operating a telephone or a video device while also operating a motor vehicle puts the patient at risk for an accident. Make sure that you've thought about some of these things or have reviewed with your leadership team how to handle such a situation.
Patients may also be trying to multitask at home. It may not put them at physical harm, but it may make your visit more difficult if they're trying to cook dinner while also talking to you. And it may put them at risk, depending on the activities that they are trying to perform. Or it may put family members at risk if they're not able to pay attention to them during the time of your visit.
Patients have many sensitive topics to discuss, and the doctor's office can be a safe place to have these discussions. But now, if we're starting to have these at home, the patient may not have the privacy to open up and have these conversations with you without exacerbating discord at home. So consider the content or the discussion area and consider a safety plan for your patients before you proceed with these telemedicine visits.
In summary, telemedicine may be a great way to increase access for many patients, but we still have work to do to ensure that we are increasing access for all of our patients. Consider the reason for the visit to ensure that the desired tasks and agenda can be accomplished with a telemedicine visit. It's also incredibly important to review your institutional policies regarding telemedicine before setting up these visits. And don't forget, patient safety remains the first priority. So consider the patient location as well as the content of the discussion as you are planning and conducting these visits. Thank you.
