I was a bit nervous as I had never done this before. I wasn’t even sure what I was going to do once I saw him. The only certainty in my mind at that time was that this was not the Norman Rockwell image of the physician-patient encounter that I proudly displayed in my office. He was my age, 40 years old, living on Nantucket with his wife and two kids. “Traveling off the island isn’t my thing,” he told me at our first encounter. It was that statement that had brought us to today. A ringing sound snapped me back to reality. A big green button appeared on my screen and flashed “ANSWER.” I didn’t realize as I entered the visit that my perspective on the practice of medicine was about to undergo a sea change.
This was my first televisit. Telemedicine had blossomed at Massachusetts General Hospital several years earlier in the psychiatry department. “Makes sense,” I thought, as the laying on of hands was less essential there. For me, an adult congenital cardiologist, my ears, my hands, my exam were my rock. I was nervous to swim off that foundation and “doctor Skype,” sure that I was about to flounder desperately.
I first met my patient, in person, when he presented to the local emergency room with palpitations, but with one look at his multiple cardiac surgical scars, he was transferred to MGH. He hadn’t seen a doctor in 20 years and via the ED, he found me. He had atrial fibrillation, and his rugged complexion I would get used to seeing on screen was pale when he heard he had to stay overnight so the cardiologist could evaluate him. His wife was on FaceTime with him when I entered his hospital room, and I heard the kids and dog in the background. I explained to all of them that the childhood surgeries left him repaired, not cured, and that arrhythmia was par for the course. He didn’t seem to hear me until his wife hollered from the iPhone over the dog’s barks, “Will he need more surgery?!” “Not now,” I answered. His color returned immediately. He soon thought it fitting that an irregular guy like him had an irregular heartbeat.
At that point, I never considered that I would one day be the one on FaceTime with my patient. My daydream of that first in-person encounter faded as he now appeared on my computer screen and the green “ANSWER” button evaporated stylishly. His wife and kids clamored onto the couch and into view. The dog sounded muffled, not allowed to enter the tele-experience this time.
I was surprised at how much I enjoyed that first televisit, and the many to follow. He could not afford to come to Boston to see me. It wasn’t monetary, it was the time away from work and family, the inconvenience, stress, and memories of a medicalized patient who spent childhood in the hospital, which made office visits less than ideal. He would of course come to MGH for testing when needed, but real conversations, ones about the repeat surgery he did eventually need (as is often the case in adult congenital heart disease), happened with me at the office, and he surrounded by family and the comfort of being in his own space.
I have since embarked on televisits with varied patients of all ages, often each with a unique need, filled by telemedicine. Televisit patients have been relaxed, comfortable in their own element, often with family members present who I haven’t had a chance to meet. We all felt connected.
“Concierge medicine for anyone,” my patient once mused. Even if I didn’t know what to say, most patients were ready to ask their questions, seek guidance, discuss their care, just as they would in an office visit. Following that meeting, for those who had limited physical mobility, or simply found it harder to get into the city for a visit (find a ride, pay for parking, sit in traffic) the appreciation for our televisit was palpable. It was as if I had given them a gift, or freed them from an obligation. In fact, it was I who was grateful.
In the traditional office model, these particular physician-patient relationships would never have lived up to the Norman Rockwell ideal. Uncertainty still exists for me at the beginning of some visits, not knowing if I am missing something essential by being at a distance. I will be the first to bring someone in if something seems amiss and acknowledge that challenges abound. I sometimes picture myself floating in a sea of missed diagnoses, vague reimbursement promises and skepticism from friends.
But with each additional visit, my resolve grows as I see, as I feel, patient and physician-centric engagement in medicine. With the addition of telemedicine to my practice, the modern era helped me resurface in the image of the doctor, the caregiver. My career, my calling, changed with a click.
Ami B. Bhatt is a cardiologist.
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