By Sabari Sundarraj, MD
I know most of us have started adapting to the new way of life in our practice. However, some of us are still skeptical. I'm hoping to reach out to the skeptical ones among us.
The reason I say that is I was in your shoes as I started my career in a brick-and-mortar practice. In 2017 when my twins were born and after a short parental leave, I returned to work. I was starting to get tired of watching my nanny’s videos during lunch hour on their developmental milestones rather than being there to enjoy them. I give kudos to all the physician moms who did it, who are doing it, and who will do it, but it is not my cup of tea.
In my case, my husband and I waited 18 long years to find gold. Our twins finally completed our family.
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 very favorite medical school professors used to say 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.
I need not explain how wonderful it is for a mom to be present when your infant becomes a toddler, a preschooler, kindergartener, and so on, especially as we’ve been shaken up by the pandemic for the last couple of years. Ten or 20 years ago, physician parents did not have this luxury of being clinically active while spending quality weekday time with their children.
I'm not saying telemedicine is here to replace traditional clinical practice, but it is a wonderful adjunct to the way we practice medicine and deliver care. I remember so many patients in my practice needing to go to urgent care to ask a doctor a nagging question because they did not have an option then to do a telemedicine visit.
During the pandemic, many physicians in the U.S. have volunteered to consult on patients who were overseas. Those patients have been guided to the right modalities and places of treatment when physical evaluation was not needed, saving valuable resources.
So many patients in rural and remote areas have expressed their extreme gratitude for having the peace of mind of 24/7 telemedicine available to them.
Sometimes I hear from my colleagues that patients hate telemedicine. My experience has been that most of them love it. They like to avoid long wait times, crowded parking lots, crowded offices, and they like the ability to check vitals in the comfort of their own homes when physical hands-on exams are not needed.
If you haven’t tried offering telemedicine in your practice, please consider it. I’m not advocating totally replacing your clinic practice with telemedicine, but rather the incorporation of telemedicine in what you do.
For example, I have read some negative comments in social media about concerns of antibiotic overuse in telemedicine. There are studies, however, that suggest virtual visits can lead to more appropriate prescribing compared to in-person visits. I can assure you bad apples are everywhere, not just in telemedicine.
I can tell my patients no when I feel it's clinically appropriate without feeling threatened. We don’t prescribe narcotics, controlled meds, ED meds, recurrent refills without checking care continuity, Z Pak, or Medrol Dosepack in any of the three major telemedicine platforms where I’ve practiced so far.
I do miss having colleagues across the hallway that I can chit chat with. But honestly, I don’t miss the office drama that sometimes comes with it. I don’t miss having overhead expenses other than my hardware, software, internet, and phone service. And I don’t miss the driving time.
I do miss the downtime or quiet time to myself, though. I miss moving around all day long, but I compensate for that with a standing desk, a stationary bike, a Simply Fit Board, and other things. I miss my quick stops for shopping on the way home. And I miss my loyal patients I had to leave behind in my on-site practice when I moved on to my telemedicine platform. I often think about each of them and how they are now. Some have contacted me on social media to update me, and as a primary care doctor, I’ll be eternally grateful for that.
However, I’ve had similar experiences in telemedicine that make it even more fruitful for me where, unlike on-site visits, telemedicine visits are 15 to 20 minutes or less. Developing such long-lasting relationships with patients via virtual visits isn’t as common, but sometimes more rewarding.
Thankfully the two-year pandemic precaution in a four-year telemedicine career has really made it easy for me with such adjustment, as so many of my colleagues and peers are in the same boat. I’m feeling blessed to feel “pandemic safe” by my ability to practice from my home.
I don’t miss the administrator knocking on my door to discuss production numbers right when I sit to have a little quiet time or lunch before afternoon patients get roomed.
I do miss the physician lounge meals and chats with peers. Perhaps there is an electronic solution to this as well. If we can communicate and care for patients this way, perhaps we can care for each other in this format as well. We know how physician burnout is affecting so many of us already and I hope we can find similar solutions for us soon.
As we all know, life is a never-ending compromise. One must try new things to move forward and adjust to this ever-changing world. For me the positives outweigh all the negatives. So, I will continue my journey for now.
Lastly, I think us telemedicine physicians have a major impact on patients’ convenient medical care. We serve them right in the comfort and safety of their own homes at their chosen times. We guide them when to go, and when not to go into an urgent care or ER. We have been a pandemic front line of sorts, and we have helped avoid clogging and delaying of vital in-person services for patients in acute need of those.
Thank you for taking the time to read this.
“Progress is impossible without change and those who cannot change their minds cannot change anything.” — George Bernard Shaw
Dr. Sabari L. Sundarraj is a board-certified family medicine physician in Houston who currently focuses on telemedicine and utilization management. She is a proud telehealth inaugural fellow with a Doximity’s telehealth fellowship. She can be reached at https://www.doximity.com/pub/sabari-sundarraj-md and she welcomes questions and feedback.