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Melanie Denton Dombrowski: Things to know about telemedicine during pandemic

Melanie Denton Dombrowski

As “normal life” literally changes before us, the way we interact with our community has changed as well, at least in the near future.

Did anyone ever think they’d be able to pick up virtually any meal curbside, including a drive-thru to buy delicious spring strawberries at Patterson Farm? What about having beer delivered directly to your house by New Sarum Brewery? In some ways, we’re living the dream!

The way people interact with their health care providers has changed as well.  On March 17, the Centers for Disease Control issued guidance for health care practitioners, advising us to postpone routine care and cancel elective surgeries. That means that routine health checks like primary care visits with a general practitioner, dental cleanings, dermatologist and gynecologist appointments and routine eye exams have not happened for over a month.

Routine elective surgeries like colonoscopies aren’t happening either. I know you’re saying, “Oh, darn!” 

But so many of us in the health care community provide preventative and routine health care, which is critical, too. Eventually, we’ll be back to serve you. Right now, we’re doing more good for our community by staying at home and taking care of our patients virtually. It has taken some time to get used to how businesses here serve us, but heres whats happening with telemedicine, should you need to use it.

Early on, Congress passed legislation in response to the pandemic that allowed the expanded use of telemedicine or “virtual” doctor visits with the intent of opening access to care for patients without risking exposure. This was done in conjunction with postponing routine appointments, and it has truly allowed us to treat a number of emergent (threatening life, sight or limb) and urgent (not life threatening but requiring timely care to avoid adverse long term result) conditions that otherwise would’ve sent someone to an emergency room.

Here’s what I want you to know about telemedicine:

• Almost all insurance carriers allow it. Once Medicare relaxed their rules to allow more widespread use, private insurance companies followed suit. Virtually every company I’ve researched offers telemedicine services to their customers. Medicaid of North Carolina joined early this month. So, if you’ve got insurance, they’re likely covering for virtual  consults (computer or telephone) right now. If you’ve got a medical condition you’re concerned about, call your doctor so they can assess your situation and determine the best course for your care. 

• It’s not for everything. You will never hear me say that online eye exams or contact lens exams are OK. Virtual care is not the same, and not for every condition. It’s useful to triage (assess severity of an illness) and provide treatment for certain conditions. But there are some things that just cannot be done virtually. I can’t check your eye pressure and your dermatologist can’t biopsy suspicious lesions through a computer. 

• How can a doctor see me this way? All doctors follow a template for exams. That template is called “SOAP” and stands for subjective, objective, assessment and plan. The subjective portion is what you tell us, and what we’re able to determine by asking follow-up questions about your medical history, your medications and your symptoms. In many cases, when we have a really good subjective portion of the exam, we’ve already narrowed our diagnosis possibilities down significantly. Oftentimes, the objective, or the tests we perform and things we observe in-office are simply confirmatory. This is the portion that is somewhat limited virtually. These two pieces of the exam lead us to the assessment, or diagnosis and then the treatment, is what your doctor decides to do for your condition. With virtual care, we rely heavily on subjective findings, which brings me to my next point.

You can also help. Here’s how to prepare for a virtual visit with your doctor: 

• Ensure you have good lighting. Choose a well-lit room or a room with big, open windows and lots of natural light. Reducing shadows will help us see eyes, skin lesions, etc. better.

• Head to our website and fill out patient paperwork if you’ve had any changes in active medications, allergies or your health history. 

• Be sure we’ll be able to see what’s going on with your eye by removing any surrounding makeup. Tailor this tip to whichever doctor specialty you’re seeing. 

• Avoid using any “get-the-red-out” drops right before we see you. I need to see exactly how inflamed your eye(s) may be. So, be careful not to mask it.

• Have a list of any questions you may have. 

• Have contact info for your pharmacy ready in case a prescription is needed. 

• Have a pen and paper nearby in case you want to take notes. 

• Try to find a quiet room if possible. 

Of course, all routine providers are still available in-office should they determine an in-person visit is warranted. Just last week, I triaged a red eye via a virtual visit and knew I’d have to observe certain structures of the eye carefully in person. After seeing the patient, it was confirmed the inflammation in this case was more severe and of a different cause than a typical “pink eye.” Knowing that telemedicine has its limitations is important. 

It’s important to remember that this situation rapidly evolves, and each of us is interpreting the CDC guidelines with the advice of our respective governing boards literally hourly at times.

The goal is to responsibly and ethically service patients in the safest most sanitary environment possible. If you have questions about telemedicine make sure to contact your provider. 

Dr. Melanie Denton Dombrowski practices medical optometry at her office, Salisbury Eyecare and Eyewear, in downtown Salisbury. Email her at info@salisburyeyecareandeyewear.com

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