- Intensive care unit (ICU) telemedicine consultations reduce ICU and total hospital mortality with no significant increase in hospital length of stay;
- Specialty telemedicine consultations reduce the time patients spend in the emergency department;
- Telemedicine consultations for outpatient care improve access and a range of clinical outcomes.
Another study of a progressive care unit in a large hospital system in Florida found the use of telemedicine led to a 20% reduction in mortality.7
For me, telemedicine has provided a way out of the endless cycle of phone and electronic messages. I used to while away the hours writing carefully constructed missives to patients who sent complex questions through our patient portal. I still do, but now I’m equally likely to set up a telemedicine appointment. I would have felt guilty asking such patients to take a half-day off work to come into the clinic, but I feel no such guilt asking them to turn on their computer.
Piloting the Plane
There is an expression used to describe the innumerable ad hoc solutions we invented during the pandemic: It’s like trying to fly a plane while you’re building it. This expression is particularly apt for describing our transition to telemedicine. Previously, we were told that telemedicine was impossible, because the hurdles were insurmountable. Then, suddenly, we were doing it.
For program directors, the challenges have been even greater; we have had to teach trainees to fly the plane when it was already aloft. Through convergent evolution, many of us have come up with similar solutions. And now a number of resources have appeared to teach trainees how to complete a virtual physical examination.8
The Association of American Medical Colleges has already developed a set of telehealth competencies, and telemedicine curricula already exist in other specialties. This past year, most of us struggled just to get the camera on our laptops to turn on. In the future, rheumatology training programs will need to address the subtleties of telemedicine, such as determining which patients are appropriate for remote visits and how to communicate empathy through the screen.9
These issues are relevant to all of us. I am certain of little in life, but I know this: Telemedicine is here to stay. This year, almost half of all patients have experienced some form of telemedicine, and three-quarters are interested in using telemedicine in the future. McKinsey estimates that $250 billion of healthcare services could be delivered in a virtual environment. This transition would lead to 2–3% cost reductions through improvements in efficiency and management of chronic disease.10
The next hurdle will be cementing all of the pandemic changes that made the transition possible: telehealth payment parity and the ability to see patients across state borders loom high on my list. But we should also not neglect the role of program directors in training fellows for this new reality. Previously foreign concepts, such as webside manner, will become increasingly important additions to our curricula.
I’m also expecting my trainees to train me. Having trained exclusively in a virtual environment, medical students have become adept with certain skills, such as establishing rapport remotely. Growing up with this technology has given them a certain fluency with this technology that I will always lack. I hope the next time we face a pandemic—because who among us is not secretly expecting COVID-28?—my trainees will have trained me to be a better virtual physician.
Or at least not to be so tongue-tied.
