“Stay home, stay safe,” has been a rallying cry in many states since the onset of the coronavirus pandemic. The main reason is to attempt to minimize the spread of COVID-19 through person-to-person transmission. But a byproduct of the stay-at-home initiative is a reduction of emergency room and doctor’s office visits for any number of incidents that can happen while we’re out and about in the world. That’s crucial for overworked and mentally fatigued health care workers, and patients in dire need of immediate attention.
While sheltering in place is an effective weapon against acute illnesses and injuries, people with chronic conditions and prolonged maladies still need care. And even at home, accidents do happen. Telehealth, or health care that is done remotely over a smartphone, tablet or computer, provides present-day solutions for a new world of problems. It’s also the future of medicine.
“The tidal wave is here,” says Dr. Jerrold Kaplan, a physiatrist at Gaylord Specialty Healthcare in Wallingford. “Physicians, psychologists, therapists and patients are realizing the benefit of telehealth. [The pandemic] probably moved us 10 years ahead of the curve.”
In lieu of an interview, Kaplan arranges an “appointment” for me on a Thursday afternoon. Outpatient medical services coordinator Janice Shaw-Page sends an email that contains a link for me to click on at 2:30. When I do, the next thing I see is my face staring back at me beside an empty field for me to fill in my name above a button labeled “Check In.” After checking in, seconds later I’m face to face with Shaw-Page, who goes over patient and insurance information before gaining verbal consent to proceed. There are still the usual copays for “office visits,” and each physical therapy session counts against the allotted number designated by your insurance carrier.
After Shaw-Page places me on hold, the virtual equivalent of “have a seat,” medical assistant Chrissy Rutigliano pops up on the screen. This is where she would go over the reason for the patient’s visit, if they are in any pain, and what medications they’re taking, the latter being one aspect of telemedicine that’s indisputably better than an office visit. “They’re sitting in the living room and the wife will walk past and she’ll say, ‘That’s not true. You haven’t taken that [medication] in forever,’ ” Rutigliano says, adding that patients can just hold up pill bottles to the screen.
The doctor will see me now, and I get placed on hold for a few seconds before joining Dr. Kaplan in his exam room. Behind him are charts and diagrams he can use as visual aids with patients. As a demonstration, he holds a pen up to the camera and moves it back and forth, watching my eyes follow the motion of the pen. Kaplan instructs me to turn my head to the right, then to the left, up and down. He asks if I have any pain. No, but I do have some questions. Like, why wasn’t this technology embraced sooner?
“Physicians, psychologists, therapists and patients are realizing the benefit of telehealth. [The pandemic] probably moved us 10 years ahead of the curve.”
“With the COVID crisis, at the national level as well as the local level, most of those regulations that restricted access to telemedicine have really gone away,” Kaplan says. “We’ve had a partnership between the medical professionals and the government in terms of trying to provide an alternative care that’s safe for patients and provides excellent care without a lot of the regulatory hurdles that were there in the past.”
In a separate phone interview, Dr. Chris Grindle, a pediatric ear, nose and throat specialist at Connecticut Children’s Medical Center in Hartford, echoes Kaplan’s sentiments, including the idea that telehealth moved ahead a decade in less than a month. Before the pandemic, Grindle says there had been talk in committees at the institutional, state and federal levels about regulations and tiny details. “No one wanted to move anything along until all parties were satisfied,” Grindle says. “And we all know how that goes.”
In a matter of weeks, Connecticut Children’s was conducting about 500 video visits a day in more than 30 specialties, Grindle says. Prior to the pandemic the technology was mostly used for an occasional post-op checkup following minor surgery. One of the biggest difficulties is the most obvious — providers can’t do hands-on physical exams. But on one visit Grindle diagnosed a broken nose on a 9-year-old boy by instructing his mother where to touch to check for a specific bump. “In some ways this is the modern-day housecall,” Grindle says. The boy went in for surgery and is doing fine.
Many patients with chronic conditions already have internet-connected devices that provide real-time information to their doctor, Grindle says. “A lot of the insulin monitors and insulin pumps that our diabetic patients have, those are all cloud connected,” he says. “The information from their monitors goes up to the cloud and can come right back down to the physician.”
A major positive for people with chronic conditions during the pandemic is that they can have video checkups from their kitchen table without being exposed to the germs and viruses out in public. “You’re also not using any of the personal protective equipment which is so important for people these days,” Grindle says. “They’re not consuming any of that. They’re consuming their cereal.”
Back at Gaylord, I wrap up my appointment with Dr. Kaplan before checking in with occupational therapist Robert Anderson, who also acknowledges that telemedicine isn’t a substitute for direct, hands-on therapy. But he does believe that patients will perform better doing at-home exercises with him “in the room” than they would with just a health aide or family member.
Anderson is also able to see, first-hand for the first time, potential hazards and hindrances like throw rugs and raised thresholds in bathroom doorways for patients who have balance issues or use a walker or wheelchair. It’s much easier to give advice and recommendations when he can see a patient’s living conditions. “So far it’s been good and we think [telemedicine] plays a role,” Anderson says. “It even has some advantages.”