Last week I was in Brighton for a board membership meeting of the charity I am involved with, called The Virtual Doctors. We discussed how to improve healthcare access for more people in Africa. Currently we are working with Malawi and Zambia, and we hope to expand to more countries in the future.
Healthcare provision is changing, how patients access healthcare is changing and this will naturally impact how pharma companies interact with key stakeholders. Today’s blog focuses on digital health, telemedicine and our need to put things in boxes. I also share a story about patience, patients, time and love.
– A day in the life of a telemedicine provider
– Let me put you in a box
– Digital health and technology Tyto care
– Patience in a room without time
A Day in the Life of a Telemedicine Provider
A colleague sent me an article from the website Second Opinions on how physicians perceive working as telemedicine providers.
Topics of the interview included the pros and cons of working remotely, key challenges that are faced when managing remote patients, key personality traits that make a physician likely to enjoy working in and succeed in remote settings, as well as information on scheduling visits, and long-term patient care. One physician also listed the key factors he checks to make sure he can trust a telehealth company: 1) ensuring the company follows corporate practice of medicine laws 2) checking ethical billing practices 3) ensuring the team is mindful of patient and provider needs.
Benefits of providing remote care include a better work-life balance, as visits can be scheduled to fit with other commitments, this translates into the ability for healthcare providers to spend more time with their young families. Key differences between remote work versus seeing patients face to face included the observation that patients seen remotely appeared to be more focused and less stressed. The doctors hypothesised that this might be, because they were being consulted in the safety of their own home. In addition, some doctors observed there are fewer no-shows for digital appointments than there are for face to face.
Asked whether performing 100% telemedicine would work to manage most patients, some doctors said they preferred to offer a mix of services, including seeing patients face to face at least once in order to perform a physical exam, but then doing follow-up visits remotely.
One of the most challenging aspects of providing telemedicine, according to the doctors interviewed, is that it is hard to know if you missed something unless you are also the patient’s primary care physician. I would suggest that this is true for any specialist providing support to a patient for a specific condition, even face to face. You can find the entire article here.
Let me Put you in a Box – on Labels
A few weeks ago I was asked “Are you Swiss or German?” I replied with a question: “Why do you ask?” The response was: “I am trying to figure out whether you are Swiss, neutral, with no strong opinions about anything or…” the speaker, paused, reflected, and changed the topic. I smiled. The speaker has known me for a while, and he realised he didn’t need to know my nationality to know the answer to his question. Putting labels on people and situations helps us manage uncertainty and leads us to believe that once we have assigned a person, a situation or a company to a mental folder, we don’t have to think about that topic again. What we believe of other nationalities often falls into this category.
Naturally, I label situations too. Sometimes, I find myself sharing a thought from one of these old mental folders, and as I speak, I realise that I no longer believe this thought. While it’s always a surprise, it is also a wonderful way to learn about how my thinking has changed.
Labels and gender pronouns are also very much a topic of the moment. A friend told me his child has refuted male/female pronouns, on one level the desire to live a life that is free of the constraints of societal gender expectations seems to have played a role in this decision. I could very much relate to what he told me.
The world is complex, ever changing and overwhelming and so we put things into boxes in the hope that that will make things simpler. It’s a natural impulse and helps us make sense of things around us. However, it’s important to remember, boxes are a crutch.
With the exception of cornflakes, the world isn’t made to fit into boxes.
Digital Health and Technology TytoCare
Healthcare is changing and there are not enough healthcare professionals. This is true for many African countries where in rural areas there are few trained physicians, but also increasingly in every other country. Telemedicine is one way to get healthcare to patients.
Since the Covid pandemic, telemedicine has been booming, but even before, for example in Switzerland, you could reduce your insurance premiums if you called a telemedicine service before visiting your physician. The telemedicine provider triages you to the correct speciality. This weekend I experienced telemedicine in my family. My mother called the telemedicine services and explained my dad’s health. The conclusion the remote doctor reached was absolutely different to the one I and a medical colleague reached. This highlighted to me how much you can miss when a non HCP is reporting symptoms and you can’t see the patient.
One of the challenges of remote consultations is of course that a doctor cannot easily examine a patient, which in the example of my father would have changed the remote diagnosis dramatically.
An Israeli company, TytoCare, has come up with an elegant solution. TytoCare provides a telehealth platform along with an integrated exam kit that incorporates a tool that can function as an otoscope, a stethoscope, and a camera that can take close-up photographs of skin lesions as well as photographs of the oral cavity. This tool is provided in a hard case.
TytoCare is used to support patients with chronic conditions. Patients can perform self-examinations using the toolkit, the data is then saved in the TytoCare app and can be submitted to their physician for further assessment prior to an online consultation.
TytoCare could also help provide improved healthcare for rural populations by giving health workers in these communities the ability to share exam results with more highly trained specialists and to get a second opinion without having to refer patients to hospital. The approach is also used to support community nurses who, when visiting patients, would like a second opinion and quick access to a doctor.
I recently saw a demo of the system. The tool seems intuitive to use, the software pretty straightforward. It is another interesting approach in making healthcare accessible to more patients. Link to Tytocare website.
Patience in a Room without Time
Recently I lost a friend. Eva was vivacious. A force of nature. Despite a degree in psychology, she never stopped working as a nurse. Eva was passionate about so many things. She was loving, supportive, opinionated and fiercely loyal to her patients, her friends and her family.
In the last months as I visited her, I watched the light, her light that always burned so brightly, fade from visit to visit. As I sat by her bed, I asked her if she would prefer me to be silent or if she would prefer me to talk. She said, “I am too tired to talk much, but I am happy to listen.”
In those few visits we didn’t talk about death, we talked about life. We talked about families, friends and our childhoods and work experiences. Despite her fading energy, her spirit was still fiercely alive. She was so present with me, despite her exhaustion. As she lay in her hospice bed and I sat beside her, our conversation covered the same topics we would have covered in a bar; the setting was different, but our friendship was the same.
As I think of her now, the memory of her is strong, and I am grateful for the time I was able to spend with her. One visit I said, “Eva, a friend recently said to me, Isabelle, have you thought about the friends you have lost over the years?” I told her that this question had made me sad. Eva replied, “It’s true, Isabelle, you may have lost friends, we all have, but think of all the ones you have gained.” Eva was one of those later-in-life friends, and her vehemence, despite her weakness, touched me. I still smile at her wisdom, the memory of her saying this, and the love she was able to give me in that moment.
On that visit Eva told me that there was no clock in her room. She said, “I am too weak to hold my phone anymore, I cannot unlock it. I sleep a lot and when I wake up, I never know if it is morning, afternoon or evening. I feel disorientated, I am really struggling.” Back when I travelled to San Francisco I remember arriving in my hotel room, having a nap and then waking up in twilight, looking at the LED figures outlining 04.00 on the bedside alarm, frantically trying to figure out if it was 4am or 4pm. I could relate to how Eva felt in her hospital room. A room that had apparently fallen outside time. I said, “Can’t the nurses put a clock up?” She said, “Ha, they said it is a philosophical question that they have been discussing for a while in team meetings and that they haven’t yet reached a consensus.”
I mentioned the situation to another friend. This friend said, “But she is in a hospice, why does she need to know what time it is?” The answer is: it doesn’t matter, she does. Patient needs are not abstract, philosophical issues, they are real. When patients tell us what they need, we should listen, even if we don’t understand. In general, perhaps we should focus less on why someone feels a certain way, if it’s hard for us to understand, and instead just try to listen and respond appropriately. Eva died on Easter Sunday.
I hope, as ever, that my blog provides you with some useful insights. I look forward to hearing your thoughts. And of course, if you have a challenging project or would like to discuss coaching to help you achieve that next level, do reach out and we can arrange to chat.
Very best wishes
Isabelle C. Widmer
Photo by National Cancer Institute on Unsplash