Doctor Curmudgeon®: Pajamas, Cookies, Espresso, Telemedicine and I

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By Diane Batshaw Eisman, M.D. FAAP Doctor Eisman, is in Family Practice in Aventura, Florida with her partner, Dr. Eugene Eisman, an internist/cardiologist

Doctor Curmudgeon® has been experiencing the joys of Telemedicine for the past few weeks.

Telemedicine enables her to slouch in her chair, comforted by her favorite pajamas, sipping espresso while dropping chocolate chip crumbs onto her keyboard.

In bygone years, she had not advocated for this method of communicating with her patients. Without face to face contact in real time – so much was lost!

With telemedicine, she might miss the nuances in facial expression. The subtle clues that indicate that the physician must dig a little deeper, explain how important a symptom could be.

“Do you ever have blood coming from your rectum?” Instead of a brisk “no, “the patient may glance away for a second, and the “no” might not be quite as brisk.

With the technology of telemedicine the doctor could conceivably overlook that away glance …might not be aware that the patient was no longer keeping direct eye contact… could overlook her patient’s quick side glance to view an off camera occurrence or to quiet a furry companion.
Doctor Curmudgeon®, somewhat less cranky than usual, does recognize, that, especially today, there is a place for the occasional video visit.
However, things may not go exactly as she had planned:

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DOC: “So…tell my why you wanted to ‘see’ me.
PATIENT: “You really look different.”
DOC: “Why did you ask for a visit?”
PATIENT: “What happened to your hair?”
DOC: “What’s your problem today?”
PATIENT: “You ought to run a comb through it. Or a brush. Or maybe you need to give your hair a good wash.”
DOC: “Listen to me. You called our office line at 7 AM and asked, no you actually demanded that I call you as soon as I could. It sounded like something urgent, so we set up this call.”
PATIENT: “Oh, yeah, I did.”
DOC: (After an impatient few seconds) “So, what is going on? Are you in pain? Short of breath? Trouble breathing?”
PATIENT: “Oh, no doc, none of that.”
DOC: “Ok, I’ve got another patient to call. Just tell me what it is. Are you running out of a prescription?”
PATIENT: “You hit the nail on the head! I need a prescription”
DOC: “Finally. My heartfelt congratulations to you for your brilliance in being able to come to the point. Just tell me which one.”
PATIENT: “Aw, doc, you don’t have to be nasty.”
DOC: (With finger obviously pointing to the disconnect button on the call and now in a loud voice which most people would call “shouting.”) “What is the med that you need refilled?”
PATIENT: (Getting out of a chair and rummaging around on the desk) “I had the name right here.”
DOC: (somewhat calmer) “While you’re doing that…you were told to have your blood pressure, pulse, temperature and weight done before the visit…give me those numbers now.”
PATIENT: (still rummaging) “Ah, that isn’t important…I feel fine so all that has to be good…I don’t need numbers.”
And before the cranky physician could respond in this losing battle, the patient had a Eureka moment in which the name of the medication was now in his hand.
PATIENT: “It’s called Hydroxychloroquine…wait…I’ll spell it.”
DOC: (Now screaming) “Fortunately for you, I am NOT an idiot. That drug could cause all kinds of bad things, like problems with your heart…even death!”
PATIENT: “Well, the president is taking it.”
DOC: “If he decided to run naked down Pennsylvania Avenue…would you follow? Have you seen evidence of any scientific training…maybe an M, D. a D.O. …a Ph.D. in something?”
PATIENT: “You know, Doc. It’s a good thing I got a needle and syringe. I don’t need you. I’m going to protect myself. I’m going to inject some Lysol.”

Doctor Curmudgeon® is Diane Batshaw Eisman, M.D., a physician-satirist. This column originally appeared on SERMO, the leading global social network for doctors.

SERMO www.sermo.com “talk real world medicine”

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