Telemedicine Replacing In-Person Medical Exams
With the fears surrounding COVID-19 keeping more people at home, patients are going to the doctor for checkups and even illnesses less than before. To compensate for the loss of in-person care, more clinics and health professionals are using alternative methods for treatment. However, with the rise of telemedicine, there is cause for concern.
Telemedicine has been seeing increased usage for some time, but that process has gained traction with the pandemic. New parents who didn’t want to get their little ones out would call a number that put them in contact with a nurse who would listen to their symptoms and advise care. Elderly patients might get a call from their doctor to refill prescriptions rather than being seen in person.
Today, telemedicine is moving more to the forefront of treatment for all kinds of people. Doctors are using video visits for routine wellness checkups and prescription refills. It is allowing more people to get medical care without increasing the risks with contagious illnesses.
The Concerns with Telemedicine
Doctors have voiced some concerns when it comes to treating patients online. Besides the fact that they are unable to interact with the patient and offer support and comfort in the same way, it can also be hard to diagnose the person in the same way. Along with hearing about symptoms, doctors look for signs in the person’s behavior to help them provide an accurate diagnosis or at least guidance on the next step or right test.
For example, a patient with a heart condition could be difficult to diagnose over a video because the doctor can’t touch their legs, listen to the heart or take the blood pressure to provide an accurate diagnosis. Some symptoms can be indications of various illnesses, such as a headache or dizziness. An exam would be necessary to know what is causing these common symptoms.
Another concern is accuracy of information provided. If a patient sends a picture of a rash to their medical provider, it may be blurry or in dark lighting. The doctor may have a difficult time determining the cause because they can’t clearly see the details.
In situations where a doctor cannot make a confident diagnosis, they must decide if they will prescribe treatment from the video exam or phone call or if they must require a physical exam. Standards and requirements haven’t been set for telemedicine, which leaves it up to the normal liability that a doctor has. There is also the concern about neglect or abuse from medical professionals, which is fairly easy to determine with in-person visits. However, it can be more complicated with video visits.
The rate of growth for telemedicine has been increased due to the coronavirus. However, laws and standards haven’t had the time to catch up. Doctors are concerned with protecting their reputations and practices while still providing adequate care virtually for their patients. This is uncharted territory that has the potential for much good and danger of malpractice as well.
Delay in Cancer Treatment Increases Risk of Death
According to new research, when cancer treatments are delayed for patients, it can increase the risk of them dying by 10 percent. Much of this delay is due to COVID-19 concerns and certain procedures and treatments having been put on hold at some point during the pandemic.
A doctor at the London School of Hygiene and Tropical Medicine provided an estimation from research done that approximately 3500 deaths would result which could have been avoided. The patients involved were diagnosed with breast, lung, bowel or esophageal cancer. The deaths might not happen right away, but they would take place over the next five years.
Research involved looking back over the last 20 years at other patients who had been diagnosed with various cancers and their treatments. As the data was reviewed, it should that delaying procedures such as surgery, drug treatment or radiotherapy could increase the risk for death. The study concluded that the risk for death in patients with cancer would increase when treatment is delayed for them.
Experts in public health are estimating that nearly half of cancer cases are going to the hospital in later stages. For those more aggressive cancers, the options available become more limited to patient comfort rather than aggressively fighting the cancer. It is quite possible that the cancer can go from being treatable with a good prognosis for a cure to be non-curable and a lower life expectancy.
Reasons for the Delays
While the pandemic has been largely responsible for the delay in treatment, the underlying reasons vary. For some, it is the patients who are too afraid of exposure that causes them to not seek treatment for abnormalities. In other cases, hospitals and clinics are overwhelmed with patients and a shortage of staff, which causes delays in scheduling treatments.
Some medical facilities stopped providing treatment for many illnesses during shutdown. Many doctors believed that a few weeks’ delay wouldn’t change the outcome for the patient. In some instances, this has been found to be untrue.
The more aggressive a cancer is, the less time a patient has to seek effective treatment. Certain cancers grow quickly. Once they metastasize, hope for recovery dwindles significantly. Many patients believe they have no other option if their doctor tells them they must wait for treatment. However, that can be a deadly recommendation.
Until a vaccine is found for the virus, patients will be living with a new normal. They need to get screened for cancer, especially if they have symptoms. Screening may look different than in the past with many using virtual visits to talk to their doctors. At the same time, doctors cannot delay treatment with the hope that the virus will go away soon. If a patient is told they cannot have a treatment, they do have the option to seek out a second opinion. As immunocompromised patients, they must continue to be aware of the risks with COVID-19 and work with their doctors to find safe and effective treatment options during this difficult time.
Risks in Hip Replacement Surgery May Increase Based on Method Used
While there are three ways to perform a hip replacement surgery, risks increase based on the method chosen by the doctor, according to research. Patients need to be aware of these risks and the options available to them.
Options and Risks in Hip Replacement Surgery
Research shows that anterior hip arthroplasty may come with more risks than posterior and lateral methods. With the two latter methods, the surgeon has better visualization and extensibility. These two methods do come with some risk, such as limping, which is caused by the splitting of abductor muscles with the lateral approach. There is also a higher risk for dislocating the hip when the posterior method is used.
While the anterior method of hip arthroplasty reduces the risks from the other two methods, it causes some serious concerns of its own. There is a greater chance of fractures and infections as well as injury to the nerves.
A study was conducted by researchers at the Sunnybrook Health Sciences Center, which is located on Toronto, Ontario. The research was retrospective of surgeries that had occurred between April 2015 and March 2018. Patients had the procedure done for osteoarthritis.
The researchers took a 1-to-1 ratio of patients who had undergone hip replacement surgery through the anterior method with those who had taken one of the other two approaches. Scoring was done based on several criteria.
- Status of the patient’s health
- Characteristics of the hospital
- Statistics of the doctor
Once scores were assessed, the patients with similar scores were compared based on the anterior and either lateral or posterior method. Based on matching, nearly 6000 patients were assessed. Findings showed that those who had an anterior hip replacement surgery had a 2 percent chance of complications within the first year while those with either the lateral or posterior method had only a one percent chance for complications.
More Information is Needed
While this information is valuable, it does come with some limitations. For instance, there was limited data on protocols given post-op. The data showed that patients who had the anterior method of surgery spent between 1 and 3 days in the hospital whereas the patients with the other methods spent 2 to 3 days.
Anterior hip replacement surgery is a newer procedure being done in the Ontario facility, which could account for some of the differences. Experts state that there is a noticeable learning curve for this procedure.
However, the data does provide surgeons with some important data to allow them to have a detailed conversation with patients who are considering or need hip replacement surgery. They can make an informed decision based on the most current data.
Hip replacement surgery may be recommended for patients with osteoarthritis if other treatments haven’t made improvements. The condition often causes stiffness and pain in the hip. It may also limit the person’s ability to manage their normal routines and limit mobility. A hip replacement may allow them to enjoy their everyday activities again without pain or limitations.
Some Ambulatory Surgery Centers Not Being Monitored for Safety
A recent report by the Office of Inspector General showed that about two-thirds of the ambulatory surgery centers (ASC) are not being surveyed as required by Medicare. This lack is troubling because it could mean a lack of safety and quality requirements being met.
Federal agencies have specific requirements for how often ASCs are to be inspected. A total of 15 states didn’t meet the highest priority requirements, which is to have at least one-fourth of the ASCs in the state surveyed each year. Seven of the states came close. Over half of the states didn’t get inspected once every six years, which is the second requirement from Medicare.
Some of the states that have failed in their responsibilities also have some of the highest populations:
- New York
Why It Matters
These state agencies have a critical task to ensure that Medicare beneficiaries receive quality care when receiving medical procedures. They provide many services, including invasive surgeries, with increased risk of complications. Many of these complications can be lessened or avoided when the facility meets minimum required standards.
More ambulatory surgery centers are in existence today, and they are performing surgeries with higher risk. Of those states that met the required minimum inspections, several significant problems were found.
According to the report, about 75 percent of the facilities had a minimum of one deficiency. Around one-fourth had serious issues. About 20 percent of the deficiencies came from lapsed infection control. These issues pose a serious threat to the patient.
These deficiencies show the need for continual inspections to prevent them from going undetected for even longer. One example of deficiencies was having surgical equipment not sanitized properly. The result is an increased risk for infection with a patient after surgery.
Some other examples of issues that were found when inspections were conducted include not having medical records for some of the patients and not following procedures. They often had problems meeting requirements for patient rights, environmental controls or pharmaceutical needs. Some facilities failed in all three areas.
The most common procedures performed at these facilities which are reimbursed by Medicare are colonoscopies and cataract surgery. Medicare also reimburses for placing a pacemaker in a patient in the ASCs. It plans to allow knee replacements and some cardiac surgical procedures in the next few years.
One concern is that fewer deficiencies were found from 2013 to 2017, but it may be due to less aggressive inspections rather than improved compliance. There are 14 issues which the ASCs must meet to receive reimbursement from Medicare.
The report is important because it is the first time one has been done in over 17 years. The information allows regulators to determine what needs to change to ensure safety of patients at these ambulatory surgery centers. It is critical that patients trust the safety and expertise of the ASCs and staff if they need to have a procedure done at one of these facilities.
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