Virtual visits: Do the math

This week is Canadian Patient Safety Week and it will come as no surprise that the theme this year is virtual care. After all, wasn’t maintaining safety of both patients and providers during the COVID-19 pandemic the main reason we have seen the current transformation to virtual visits?

One of the best essays I have seen recently on how clinicians should evaluate how and when to offer virtual care comes from an unlikely source – the Canadian Urology Association Journal.

In the most recent issue, Editor-In-Chief Dr. Micheal Leveridge (@_TheUrologist), associate professor of urology at Queen’s University, has an editorial titled “The algabra of clinic and telephone medicine” in which he provides a philisophical take on where virtual visits fit.

Dr. Leveridge begins by noting his habit of directly interacting with the patient at the conclusion of an in-person visit. “When the bustling outpatient clinic era ended abruptly in March, these interactions vaporized with it,” he continues.

“Some seven months later, as we re-integrate patients into the clinic, we face the choice of reverting to the familiar before times or maintaining some proportion of virtual care”, he adds.

Dr. Leveridge notes that the main drawback to virtual care for the urologist is the loss the ability to perform a physical examination. On the other side of the equation, he writes, is the benefit to patients in saved time and travel when they don’t have to come to the clinic. “It has always felt problematic to me when a patient makes a 120 km round trip (never mind a 500 m walk) to discuss an ultrasound performed two weeks prior regarding a surgery performed four years prior.”

But another downside from some virtual visits, he adds, is accessibility issues for patients unfamiliar or unwilling to use the telephone or computers and the challenges for patients with physical or cognitive disabilities.

Dr. Leveridge then reverts to discussing the less quantifiable aspects of patient visits such as the personal connection many physicians feel they make that cannot be duplicated in a virtual visit. “I feel like I lose something important about who I am as a doctor when I’m on the telephone,” he writes but then adds “I really like telephone medicine though, despite the squall of paper and the curious persistence of a cord on the office phone, bafflingly chromosomed around invisible histones.”

He concludes by stating telehealth will clearly be part of clinic-based medicine going forward. However, he said, physicians must look at the equation and assess each patient and visit individually to decide what is right. “In a tossup, you can use your experience, your existing relationship, or (are you sitting down?) you can just ask the patient.”

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