“Should I cancel my business trip?” That is not the kind of question that patients typically ask their doctors. For most people, that’s not even a question they can ask their doctors, at least, not without an appointment, a co-pay and an anxiety-inducing wait in a crowded doctor’s office. As U.S. cases of coronavirus rose this week, I fielded some version of this question from countless patients via telemedicine. Technology and experience-based service models have shifted the power in medicine, and my patients can now pick up their phones, from the safety of their couches, and text me for my travel-related opinion as a benefit of membership in their health plan or job. What we discovered this week is that chat-first telehealth, essentially putting a doctor at a patient’s fingertips, doesn’t just help patients with aches and pains, it can help them make sense of concerns that are gripping the planet. “I have a 2-year-old and 4-year-old, and we are supposed to travel across the country this weekend, do you think we should go?” one patient texted me via telehealth. “What kind of mask do I need to buy for my mom? She’s going on a weeklong cruise,” another asked. “I have a fever, should I go into the ER?” was another question. Anxiety is the flavor of the month, and with the stroke of their thumbs, patients can ask their questions, get the answers that they need and have their fears allayed. The answer to the first two texts is really about an individual’s tolerance to risk: Toddlers on a plane are petri dishes during the best of times, and a mask on a weeklong cruise not only won’t help, it makes sipping a pina colada difficult. As for the third question, this is, again, where we are witnessing chat-first telehealth make a difference in ways we never could have anticipated. Our motto during these uncertain times is, “Check-in before you go in.” That fever might require medical attention, or it might require hydration and rest. Further text conversations will help determine the difference. Because chat allows patients to reach out to us at their own pace, they can keep checking in to report changes in their condition that can help doctors determine the best course of action. For one patient this week, symptoms pointed to a gallbladder problem that required a trip to the ER, where the patient was admitted for emergency surgery. For another, the patient was able to stay in bed, stay hydrated, and wait the fever out with little more than Tylenol and Netflix. This meant that the second patient didn’t risk exposure at an ER, while the first was able to walk into an ER with the confident declaration of, “The doctor sent me here,” and receive the life-saving treatment she needed. Even traditional telehealth models that rely on phone bots and scheduled callback times can’t quell the nation’s rising anxiety. The act of texting a doctor and receiving an immediate response has been a powerful salve to patient nervousness. As a physician, I am so proud to be a part of this. While the coronavirus epidemic is a terrible test of the global health care system, it has underscored the potential for chat-first telehealth to reduce the spread of illness by keeping non-emergency cases out of ERs and urgent cares, while allaying the fears that can often be worse than the disease itself. Sometimes “medical advice” isn’t technically medical. Doctors are sources of information and wisdom. They have a way of helping people to feel better about the decisions they’re making, and sometimes nudge someone facing a dilemma in one direction or another. This week I’ve been letting patients know that whenever they have any concerns that touch on this pandemic – or any other disease-related matter – we want them to see a doctor. We just want them to be able to do it easily and from the safety of their couch. Blake McKinney is an emergency physician and co-founder and chief medical officer, CirrusMD Source
