Making Lemonade

May 21, 2020 at 03:04 pm by pj




The COVID-19 pandemic has been devastating to so many people and caused so much trauma in the economy around the world that it will no doubt be one of those episodes in history that changes society permanently. Like the Bubonic Plague in the Middle Ages, it is in the process of altering human behavior in untold ways that only future historians will be able to quantify. 


Many times, cataclysmic events have significant negative impacts, but just as often, there are positive outcomes that may not be immediately recognized. Making lemonade out of lemons may be a greatly understated analogy but I believe there is one significant result of this pandemic that will turn out to be sweet lemonade. 


The acceptable methods of providing medical care have traditionally been seen as face-to-face encounters between a person with a medical problem (patient) and an expert with diagnostic and therapeutic skills (physician) which not only improves the health of the patient but generates revenue for the physician or the organization that the physician is associated with. 


As technology has developed the ability for remote communication, including not just audio but video, the face-to-face encounters called medical evaluation and management visits (E&M codes) have remained deeply entrenched as the only acceptable method of medical care. Remote telemedicine has only been used in situations where there was no other option—the patient was isolated many miles from the nearest physician and if not for the telemedicine capability, they would not be able to access care at all. The idea of using phone or video to provide medical care, while attractive in managing time constraints for the patient and provider, are considered by the medical community to be poor quality and highly risky, not to mention undermining of the professionalism valued by physicians. 


However, the current pandemic environment has pushed telemedicine, in both audio and video forms, into a necessary and indispensable venue for care. Insurers are seeing that paying for these visits is not only possible but cost-effective. More importantly, physicians are finding out that there are many situations where an audio or video medium can be timely, convenient and effective in providing medical consultations or care. Patients are also discovering that the ability to connect with a physician in real time without having to travel to an office setting or take significant time out of their day to do so, is very desirable. 


Once the pandemic is past and life returns to some semblance of normal, the appeal of the telemedicine visit will not likely go away. It will, in all likelihood, become part of the mainstream methods of providing health care. Of course, the type of medical care provided in this way is limited to what can be determined accurately without physical examination. Physicians were taught in their training that 90 percent of a diagnosis is gleaned from the history and the physical exam serves mainly to confirm that diagnosis. Acute, minor complaints can often be handled without actually touching the patient. Touch is an important aspect of effective and therapeutic medical care, no doubt, but today’s time stressed patients and physicians are more willing to forgo that benefit for the expedience of a remote visit. Of course, the fact that the payers are now willing to recognize tele-medicine visits as legitimate, payable services, helps physicians to accept those as standard of care. 


Those of us in medicine considered “old school” may have a hard time with this adjustment, but today’s medical school graduates have become very accustomed to using the electronic medium for all kinds of business and communication. They will adapt very quickly to making it part of the normal routine. The challenge will be to identify those patient interactions that cannot be adequately handled without the hands-on approach. Just like the need to choose a method of communication carefully depending on the content of the message—text message, phone call, e-mail or face-to-face—the decision to use telemedicine or to see a patient in person must be a choice made intelligently and with purpose. 


Of all the lasting impacts the coronavirus pandemic will create in our society, its moving of telemedicine into the realm of acceptable methods of standard health care may be one of the most influential—the lemonade we can make of the lemons. 


Kris D. Gray, MD, FAAFP, Chief Medical Officer,