The number of remote doctor visits has increased in recent years. There are not enough doctors everywhere, so sometimes remote reception is the only option even in public healthcare, the expert says.
With a remote doctor fermentation has increased tremendously in recent years.
According to the statistics of the National Institute of Health and Welfare (THL), patients’ remote communication with doctors has doubled from 2019 until October of this year.
The number of remote doctor visits has also increased in private healthcare. According to Kela last year reimbursements were paid for private doctors’ remote receptions around five million euros, i.e. more than 12 percent of the compensation amount for doctors’ fees for the whole year.
We learned from the corona era that a doctor’s work can be done elsewhere than in the premises of a health center, says the chief doctor of outpatient care Kirsi Timonen From the welfare area of Päijät-Häme.
On the other hand, according to Timonen, it has been normal for doctors to handle part of their patients’ affairs remotely for years. The current resources have had to adapt to that, because there just aren’t enough doctors everywhere.
“In the equation of unlimited demand and limited resources, it’s always about the assessment of medical need,” says Timonen.
Timonen works at the Heinola social and health center, where the patient’s doctor’s guidance is always preceded by an assessment of the nurse’s need for treatment. When the patient makes contact, the nurse makes an assessment on the phone independently or with the support of the doctor. For example, in the emergency room, the doctor usually sits next to you in the same room.
“Sometimes it’s enough just for the nurse or physiotherapist to consult the doctor, and sometimes the doctor also explains the patient’s case with the patient himself,” says Timonen.
Elderly people may have IT problems when dealing remotely, but they usually know how to use the phone too.
According to Timonen, telemedicine work is often misunderstood.
“Remote reception is just a way of handling the patient’s case when the service in question is suitable for the patient’s treatment,” he says. “How many people run to the office of a generally healthy woman to get a course of antibiotics for a urinary tract infection?”
According to Timonen, similar types of situations that can be treated remotely include a stomach bug or a cold if the patient’s general condition is good.
According to Timonen, a doctor working remotely requires experience in what kind of diagnosis can be behind certain types of symptoms. The doctor must know how to listen to the patient and ask the right questions. If he is even a little unsure of what the issue might be, the patient must be able to meet face to face.
HS asked how Timonen would treat three different patients remotely.
Kirsi Timonen.
The doctor explains how he would treat three different patients remotely:
1) Swollen calf
“The symptom would require a good interview about what it is about and how severe the swelling is. Is the symptom bilateral or unilateral? Is it a completely new or long-standing symptom?
Swelling in both legs can be caused by venous insufficiency, heart failure, some medications, being overweight, or kidney failure. The nature of the new symptom guides further investigations and affects the urgency of the case.
As a new symptom on the other side, I would refer the patient to the emergency room on the spot. It could also be a blood clot or even a rupture of the knee bursa. If the patient has had swelling in the past and, for example, an existing blood thinner, I would wonder how and with what urgency the matter would be investigated.
Has the swelling in both legs started soon after starting a blood pressure medication that is known to cause ankle swelling? It could be treated remotely by changing the medicine.
Even if it were an acute worsening of heart failure, I would ask the patient to go to the doctor’s office. If it is a more chronic situation, perhaps the patient would have been instructed in advance how to increase the fluid removal medication.”
2) Prolonged cold and fever
“What the words prolonged and fever mean varies from person to person. According to someone, prolonged can mean a couple, three days, and according to another, it is a symptom that lasted more than a week. Others think that a fever is when the body temperature is higher than previously measured. According to some, a fever is only when the body temperature exceeds 38 degrees.
Other symptoms also affect the diagnosis, i.e. are there usual flu symptoms (runny nose, cough, sore throat) and are there any worrisome symptoms (general condition, high fever, shortness of breath, stiff neck, suspected pneumonia)? Are you taking any medications that may predispose you to blood count changes or more serious infections? Have you been abroad? Is it corona symptoms or is it flu season?
Based on the interview, I assess whether it is a mild symptom that can be treated remotely with home care instructions, or whether there is a need, for example, for a clinical examination, laboratory tests or lung x-rays.
3) Painful blistering of the shoulder
“It sounds primarily like shingles, although I’d like to see if it’s pimples or actually blisters. I would ask to visit at least the nurse’s office on site, where the doctor would come to look at the skin. Shingles is treated with antiviral drugs. In hoivakoti conditions, the situation could be handled via video, even with an image consultation.”
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