Subscribe to The Podcast by KevinMD.

“In early 2018 when I started full-time telemedicine, I was quite reluctant about losing the physical hands-on evaluation, especially the palpation, percussion, and auscultation components in the physical exam, and the holding hands, hugs, and handshakes of in-person visits.

But thankfully, I remembered one of my favorite medical school professors who said how important history is in a diagnosis. He said nothing else matters as much as a good history from the patient.

I shed my trepidation and gave it a brave shot, and I’ve never looked back. I absolutely enjoy it. I enjoy not only the urgent care but also the primary care side of it. I also enjoy that I am showing up at patients’ homes nationwide rather than having them coming to my office at a Houston clinic. I love that so many patients know me by my name and choose an appointment with me, whether it’s an urgent care or a primary care issue. It is a truly fulfilling moment for a physician.”

Sabari L. Sundarraj is a family medicine physician.

She shares her story and discusses her KevinMD article, “A physician mom’s take on telemedicine.”

Did you enjoy today’s episode?

Rate and review the show so more audiences can find The Podcast by KevinMD.

Subscribe on your favorite podcast app to get notified when a new episode comes out.

Click here to earn 1.0 AMA PRA Category 1 CME for this episode.

Also available in Category 1 CME bundles.

Powered by CMEfy – a seamless way for busy clinician learners to discover Internet Point-of-Care Learning opportunities that reward AMA PRA Category 1 Credit(s)™. Learn more at about.cmefy.com/cme-info

Do you know someone who might enjoy this episode? Share this episode with anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show we have Sabari Sundarraj. She’s a family physician. Her KevinMD article is titled “A physician mom’s take on telemedicine.” Sabari, welcome to the show.

Sabari L. Sundarraj: Thank you so much. I appreciate the time and the opportunity.

Kevin Pho: We’ll get into your article in a little bit, but briefly share your story and journey to where you are today.

Sabari L. Sundarraj: Sure. I started out as a family practitioner right after my residency in a multispecialty group practice in Wisconsin, and it was a wonderful journey. The clinic, and especially my mentor there, Dr. Reynolds, always taught me that quality comes over quantity, and quantity follows it. That was his motto. I took that to heart, and that’s how I practiced my medicine from post-residency on. I started my own practice when we moved to Houston, Texas, in 2007, and we continued in solo practice for about seven and a half years before I joined another multispecialty group practice.

After we had our twins in 2017, I really wanted to spend more time at home. In early 2018 I made the decision to step down, not only from being an in-person family practice doctor; I was the anchor physician at my site, and I was one of the board of director physicians at Methodist in Houston. I stepped down from that position, and I went into full-time telemedicine. At that time, telemedicine was not as mainstream as it used to be, but I enjoyed the time at home, the breaks in between, and everything as a physician mom, and I absolutely loved it. Even though I went in with hesitation about losing our percussions, our palpations, and our auscultations that we are used to in clinic, I didn’t look back after that. I continued to enjoy it. I still practice it, but less time, because I’m doing utilization management full time at this time.

Kevin Pho: So you went into full-time telemedicine before the pandemic, where of course the pandemic popularized telemedicine. So yeah, when you were doing full-time telemedicine, walk us through a typical day. How many patients would you see? What are some of the most common cases that you would address remotely?

Sabari L. Sundarraj: Remotely, mostly they were urgent care patients. What I mean by that is sore throats and UTIs. Some are mainly reassurance-seeking parents or patients. They just want to know, “Hey, I’m having this symptom. I want to talk to a doctor and feel better about it. Should I run into the ER tonight, or is this something I can wait on to talk to my PCP tomorrow?” So very simple and straightforward is how it all started, at least in 2018. I know that once the pandemic hit, things started changing, because there were more COVID-related questions, more chronic symptom questions when patients hesitated to go in for regular care, and med refills, etc. But initially it was more simple urgent care: Is this a virus? Is it upper respiratory? Do I need an antibiotic? That type of visit.

Kevin Pho: All right, so you talk more about that in your KevinMD article. It’s titled “A physician mom’s take on telemedicine.” Now, for those who didn’t get a chance to read your article, just walk my audience through it, and share the story of why you decided to write it.

Sabari L. Sundarraj: Sure. I actually have to thank the Doximity Telehealth Fellowship staff and faculty for it, because they push you into getting into things that you have never done. They suggested, “Why not write a blog or an article for a journal, or something of that sort?” And that gives you fellowship credits. It doesn’t really give you financial credits, but that’s great, because that pushed me into exploring my writing skills. I wanted to write something about telemedicine, because it’s the Telehealth Fellowship. Then I realized, you know, so many physicians write about it. Maybe I should combine two or three things together, bring my personal and professional sides into it together, and write a physician mom’s take on it. I thought that would be more compelling for the audience, and it would be a different perspective from that side. So that’s how it all evolved, and I didn’t expect it to be such a big hit. Thank you also, because I got this opportunity from that too.

Kevin Pho: All right, so what is your physician mom’s take on telemedicine? Share that perspective with my audience.

Sabari L. Sundarraj: Definitely. We all struggle as physicians, as parents, not just moms, as dads, moms, to kind of balance it out. We feel so entangled in our practices, in our professional lives, that we feel like, “Man, I have to miss this. I have to miss a birthday. I have to miss that.” So we really struggle to balance it all out. Especially, our physical presence is more nurtured by our children when they are younger, as we all know as parents. And then we start regretting it later on in life: “Man, I miss that. I miss this.”

So to avoid that, yes, I mentioned the reluctance in the beginning, but I’m going to say that even though we have our reluctances, we are all good physicians. We know how to practice medicine. Even if we see a patient in person, it’s not like every time we percuss or auscultate them. If we think about it, in the office most of the time we diagnose by history, unconsciously, and that leads us into a physical exam. So that’s exactly how telemedicine is practiced. Once we get to the root of it, we will be less reluctant about it, and we can also plug our life’s interests, our personal choices, going for a nice walk, and all those into it, along with being good physician parents and good physicians. So that’s how this article evolved, and that’s my perspective on it.

Kevin Pho: How difficult was it for you to transition into full-time telemedicine?

Sabari L. Sundarraj: I’d say the good news for me is I joined companies. I joined Doctor On Demand to start with. They had their own established practice as a telemedicine company. When I signed up, I had told them about my solo practice in the past, which I took into the group practice at Houston Methodist, and their patients, etc., some of whom may follow me into telemedicine in the future, or may not, if they find out that I’m available on that venue. They were very welcoming about it, and they were very generous about it. They said, “Tomorrow, if you leave Doctor On Demand and you go to a different company, and if the patient ends up following you, it’s not like you invite them. That’s fine.” So that was very relieving for me as a physician, because that was my biggest concern. I didn’t want to feel that I was abandoning my patients. I told them that I would be available in telemedicine practice in some way or form. They just have to Google me and find me, because I had not yet finalized which practice I was going into.

So initially it was more virtual urgent care, and it was not hard to get patients, because they had an established practice. And then slowly patients started looking me up. Even Doctor On Demand patients started looking me up to see when I was on shift, and they used to schedule an appointment and see me at that time. They didn’t mind waiting a day if I was not on shift, for a certain reason that they wanted to see me for, which was really rewarding at the end of the day.

Kevin Pho: Do you miss seeing patients in person in the exam room and developing those longer-term primary care relationships?

Sabari L. Sundarraj: Definitely, I do, because it would be a lie if I said no. As physicians we always miss that. We miss the warm hug, or a good handshake, a pat on the shoulder, those types of things, or when the patient walks in and suddenly catches you in the hallway just to update you about something great that happened to them. All those I definitely miss. But I find fulfillment in other ways. I check on patients post-visit. I send them a text message through Doximity Dialer. I’m able to send them a secure text saying, “I’m checking on you to see how you’re doing.” Even though it’s a one-way text, I fulfill those types of little interactions that I have with patients virtually, in a different way.

Kevin Pho: Now, if you were to do this all over again, making that transition from a traditional family medicine practice into telemedicine, is there anything that you would have done differently?

Sabari L. Sundarraj: If this was a possibility in 2007, when I started my own practice, I probably would have done half and half. There would have been so many unnecessary visits and wait times that my patients had to go through for a simple urgent care thing that I could have solved virtually. They would probably have requested a virtual visit, taken a quick consult on the phone, and moved on with their lives, professionally speaking for them. So if I could do it over again, I would say I would do half and half, because we are in a technologic age, and we have to adapt ourselves to it.

Kevin Pho: We’re talking to Sabari Sundarraj. She is a family physician. Her KevinMD article is titled “A physician mom’s take on telemedicine.” Sabari, if I’m a primary care physician listening to you on this podcast, and I’m actually thinking of making that transition from traditional primary care into a more involved telemedicine practice, what kinds of questions should I be asking myself to make sure that that’s the right path for me?

Sabari L. Sundarraj: What I would do is HHS.gov, the Human and Health Services .gov. They have an excellent telehealth-specific, almost like a blueprint, if you will, for lack of a better word. They give you excellent resources about how to start a practice in telemedicine and what are the things to look for, every nuance, including legal considerations, state licenses, and what is going away post-pandemic and what is present, like waivers. So there are so many discussions on the HHS.gov website, and there are free webinars that they have. I would definitely research into it, and watch those and read up on that before I get into it.

And I would also probably intermingle it with my regular in-person practice, rather than just choose one over the other, and probably just change the ratio as time goes on, depending on patient needs at that time.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Sabari L. Sundarraj: I would say, just like anything in our life, we only regret things we didn’t do. We don’t regret things we did, most of the time in our lives. So this is one of them. I never thought I would like utilization management, because that’s the business side of medicine. As a practicing family physician, I used to think, “Wow, those medical directors don’t want me to order anything. They want me to not do anything I want to do for my patients.” Which is not true, I find out when I come to this side. I actually help them redirect into the right testing and other things per the criteria that are available, and many of them have actually thanked us during peer-to-peers. And I find myself, as a family physician, when I return to my full-time clinical practice from part-time of that, that I would actually use that to avoid wastage in medicine.

So that’s a very good example as a take-home message, that we should try every opportunity that comes before us. We never know what we are going to like and not like, and that includes telemedicine and any other clinical or nonclinical role.

Kevin Pho: Well, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Sabari L. Sundarraj: Thank you so much, Dr. Pho. Wonderful meeting you.