The World Has Gone Virtual and So Has Much of Medicine: Specialist Consultations

Part One of a series

We FaceTime or Messenger Video with friends and relatives, even with our loved ones. I do this with my American brother from my exchange student year every couple of weeks and with my lady friend almost every night. That does not take the place of time spent doing things together. But if we just want to talk, a video conversation is for most of us more satisfying and feels closer than a telephone call.

Since the pandemic and continuing now, one of the gastroenterology practices in Bangor has been very open to doing video consultations with new patients. In their specialty as in many others, the patient history provides 80% of the diagnosis. Their new patients have usually had a CT scan of their abdomen and sometimes even a local colonoscopy or upper endoscopy, so palpating their new patient’s abdomen is not usually necessary. If a procedure is necessary, it is almost never done at the initial consultation anyway, even if that is done in person, but will be scheduled later if it is needed.

Traditionally in medicine, procedures have paid much better than cognitive work. And the number of questions we asked and how many elements of our physical exam we documented helped determine our reimbursement. But for a long time, there has been a provision for charging for a visit where more than 50% was spent on counseling and education. As we move toward value-based care, clinical outcomes are mattering more than how exhaustive our investigation was.

The pandemic provided an opportunity to get paid for telemedicine and value based care does not incentivize us to start from scratch and turn every stone if we can tell right off the bat what ails our patient based on what has already been asked and documented.

Especially in remote and underserved areas like the one I practice in, it is such a blessing to be able to get a telemedicine consultation for a patient who can ill afford traveling hundreds of miles and perhaps staying overnight in a motel just to have a 30 minute consultation with a specialist.

I welcome seeing more of this for the benefit of my patients.