According to GPs, teleporces revealed that we are technologically handicapped, irresponsible and that we often lie

Doctors complain that during teleportation we can get under their skin no worse than during a traditional visit. However, we often do not have a chance to do so, because the conversation does not take place. If you can call your family doctor, specialists are hardly reachable by phone. That is why those who were to be specially protected are storming the clinics. They bang on closed doors or stay awake in hospital parking lots.

1. The development of telemedicine in Poland accelerated due to the COVID-19 pandemic. Patients and doctors have to get used to the new way of contact. As the doctors’ stories show, it is not easy
2. «I recently had an appointment with a patient registered by my wife and he went fishing. He was very surprised that I was calling and he could not talk because he scared the fish away from his friends »- the doctors write
3. According to doctors, patients do not take teleportation seriously. They are not prepared to talk, they do not answer phones, they call and send text messages late in the evening, they do not respect their time and their doctors’ time

Teleporady w dobie pandemii

With the coronavirus pandemic, televisions became the main area of ​​patient-doctor contact. It accelerated the implementation of e-techniques: teleconsultation, e-prescriptions, e-referrals and e-waivers. On the one hand, it is fantastic, because we save time and avoid infections, but on the other hand, clinics are closed to the sick.

– We should treat telemedicine as a branch of science – says professor Bolesław Samoliński, public health specialist, chairman of the Council of Experts of the Patient Rights Ombudsman – systematically monitor its operation. Introducing new procedures must involve education. It also has to be evolutionary, in line with a predetermined strategy. An order to switch overnight to e-prescriptions would be a mistake, because, for example, the elderly do not understand them.

On August 12, an ordinance of the minister of health was announced on the organizational standard of teleporting in primary health care. It will enter into force at the end of the month. The provisions concern, inter alia, the doctor providing teleporting to determine if it is sufficient to solve the problem or to inform the patient to report to the clinic. They also define the method of patient registration, forms of remote counseling, issues of work organization and guarantees of confidentiality.

Patients take phone contacts less seriously

Doctors call patients at an agreed time. Sometimes the connection is established and teleporting runs smoothly. Sometimes, after several unsuccessful attempts, they capitulate, noting it in the documentation. The patient may fall asleep, may be out of range, or the battery may be low. Examples of unsuccessful teleports were posted by medics on one of the Facebook fanpages:

1. I recently had an appointment with a patient registered by my wife, and he went fishing. He was very surprised that I was calling and he could not talk because he scared the fish away from his friends.
2. Recently, the patient had poor coverage, he was constantly interrupting the conversation, as it turned out, he was swimming on a pedalo on the lake.
3. Grandmother asks for a phone call in an hour, because she is currently harvesting potatoes in the field.
4. On the one hand, patients complain about teleports, and on the other … the patient calls that she has had chest pain for 2 days – I tell her to come to the clinic to have an EKG – “but I’ve been at the seaside for two months”.
5. The lady made an appointment at 8 am, the registrar says that the doctor will call you back in the morning. I call you back, outraged, because she is at work and cannot talk privately. And our clinic is open until 19 pm, she could arrange an afternoon teleportation. One patient was back at the store with nowhere to write down the prescription code. I told him I would text him, write a recommendation as a reminder. He did not agree, he decided that it would be a better choice to shout at the shop assistants to give him a piece of paper and a pen …
6. My hit is a patient who said there is no way to write down recommendations because he is sitting on a loo.

Conversations are tiring and patients are sending MMS or SMS messages to doctors at midnight. Those who are given a doctor’s private cell number for the convenience of both parties do not always understand that this should not be used. They call whenever they feel the need to.

– I often dial the number many times before someone answers, it happens that the other side is constantly busy – says Dr. Katarzyna Śleziak-Barglik, head of the POZ clinic in Ruda Śląska. – Conversations are also different. The patient’s reaction time is usually long, and the lack of pressure that someone is waiting for an appointment behind the door makes it even longer. Not everyone is properly prepared for my call. And these don’t have a pen, and these are pages.

On the other hand, many patients of specialist clinics cannot get through to registration. Due to the pandemic, they will also not enter the facility to book an appointment. Taken to a last resort, they resort to trying to contact a doctor in the parking lot. They wait for him before starting or after finishing work.

– We have security guards at the entrance – says a specialist doctor from a hospital near Warsaw. – No one will come in who is not employed. There are two telephones, always occupied. My patients call me on a private cell. I am fed up with this, but I will not refuse them, so I ask them to write an e-mail and then I will send it to my friend in registration. This is how records are kept. Not because there is such a procedure, but because the registrar is doing me a favor. And a patient who does not know my e-mail or cell phone is left without help. This is probably how it works not only with us.

– People complain that they wait too long for a phone call, but I cannot call everyone at once after eight – adds Dr. Anna Andrukajtis, a family doctor from the province. Pomeranian. – Every morning I get notes that this lady wants to be called first, this lady at eight o’clock, this gentleman after 11, and this one at 10.30, because then he has a break from work. However, when I previously have a patient on the line whose telepathing lasts 20 minutes, there is no chance that I will make it in time. I try later, but the guy working on the tape either doesn’t take his cell phone there or he doesn’t hear the bell. I am asking you to register a maximum of 20 people, because I know that there will be additional ones that need to be recorded, described, prescribed and sometimes seen. We have 3 telephones, one of which is for my own use, for teleportation. I shouldn’t have picked it up, but the patients I haven’t called call back, so I pick it up, whether it likes it or not, and I tell them to wait, because they’ve fallen out of line. Terrible struggle.

POZ doctors miss real visits

– At the beginning, it was difficult to get used to the lack of patients and when someone finally showed up, there was joy – says family doctor Paweł A. from the Łódź Province. – But now, when I think I have to go to the clinic and find 40 people queuing outside the office, I get a headache. In addition, I arrange 55 by phone.

– Remote diagnostics is quite a challenge – says Dr. Śleziak-Barglik. – I would be afraid of making a diagnosis over the phone by a young doctor, because he could expect that I would tell him everything on my own initiative. In most cases, patients do not mention what is most important, they need to be guided. An experienced doctor has half the examination behind him when the patient enters his office. Watching, seeing how the patient moves, what energy he has, whether his head is raised, what his expression is, whether he is not stumbling, is really half.

– Without seeing the patient, I do not know what his facial expressions are, says Dr. Anna Andrukajtis – I am afraid that he will not tell me something. Often patients are not able to articulate what hurts them and where, they confuse the concepts. I spoke to a young man who had phimosis, he fought it for two months and finally dared to call when he was home alone. It’s much harder to talk about it over the phone than to just show it to the doctor in the office.

The new solutions were to benefit primarily children, pregnant women, the elderly, cancer patients or those with comorbidities, as a visit to the clinic could result in infection.

– When the flu merges with Covid-19 in the fall, there will be a catastrophe – predicts Dr. Piotr C. – It is not known how to tell the difference, there are no quick tests. And if I admit a patient with coronavirus and he infects me, the clinic will have to be closed and 4 people will be left unattended. If a similar situation occurs in the second clinic in my town, it will be 8. people will not have a doctor. So maybe it’s a good thing we don’t see the patients. I was now at the Baltic Sea, a terrible crowd, people in queues for ice cream are falling on their heads. And in this crowd, only 6 people wearing masks. It must end badly.

Older people get lost in the nuances of telepaths

Patients aged 65+ have problems with using mobile phones – such observations were made by the majority of GPs. They turn them on and off, or they accidentally flip them on.

– Not everyone understands what is said to them on the phone – remarks Dr. Ewa F., a doctor with 20 years of experience. – I often repeat the prescription code several times. Finally I ask, did you write down? Yes. Did you write down your recommendations? How to take medication? Yeah. I breathe a sigh of relief and then I hear a question: doctor, can you tell me again how to take these drugs? Half an hour after the end of the conversation, the daughter-in-law or daughter calls, asking for the prescription code, because the mother gives a 5-digit one.

One of the doctors notes: “As far as cells are concerned, there is a technical disability in part of society. Patients are deaf and landlines squeak as if they were a hundred years old. Televisions roar in the background, you can’t hear anything. Most seniors did not set up patient accounts because they cannot cope with the trusted profile ».

– Guess how long it takes to spell and write the name of the drug nifuroxazite correctly – asks Dr. Piotr C. – And I would like to send patients texts or e-mails, e.g. with a request for a blood pressure measurement.

Never trust a patient on links

A physician who has only verbal contact with the patient must apply the principle of limited trust. For the good of the patient and himself. In case of doubt whether there is no improvement, he should order a control, physical examination. Then whatever happens, the conscience remains clear.

“We’re under censorship,” remarks Dr. Andrukajtis. – Everything we write may be used against us one day by ZUS, KRUS, NFZ or courts.

– I remember that during some training for GPs, everyone gathered in the room said that they were changing their profession – recalls Dr. Ewa F. – There were several hundred of us and we heard that all of us can be punished by the National Health Fund, because everyone has something in their documentation that is done wrong according to officials. This cannot be avoided if several dozen patients are treated daily. The only way to survive is to have such patients and treat them so that they never want to prosecute us. For years I have become close to my patients, I treat some of them as family, so when they come in, you know, I see them at any time, extending my working time.

– The National Health Fund is now looking for its millions – jokes a POZ doctor from Pomorskie. – It can stick to any formula. Pull out something that officials said should not have happened to the patient, such as writing a reimbursement prescription to the uninsured. If the patient says they are insured, they have to be entered, if I forget, I will pay a fine. Documentation can be checked for 5 years. All the diaper pants we check out are a lot of money. They recently checked a girl who was at our clinic 5 years ago. Her boss told her she insured her, and she didn’t. She got a medicine that costs worse, for a lump sum of PLN 5, and a full-price one PLN 7. The fine was 200 zlotys.

– We do not believe patients – emphasizes Dr. Anna Andrukajtis. – Even if the patient tells me his temperature, I don’t believe it. In the office, I would measure him. Recently, I asked a 15-year-old girl how much she weighs. She said that 70 kg, and when she came for the blood collection for the procedure, the weight showed 90. I often ask for photos, for example, of the legs from the beginning of the disease and after the treatment, so comparable, and I would like to point out that my cell number must be deleted immediately after the teleportation. And how many times when I ask what’s up in gastroscopy, patients say that everything is fine. I won’t believe it until I see the description. I once asked for a study to be brought in for photocopying. I look and helicobacter there. Treatment with two antibiotics, scheduled control in 3 months. So I ask, did you not see it? I didn’t notice, and where is it written? Here. And I haven’t seen that.

– Many people try to trick us to write out the sick leave – says Dr. Śleziak-Barglik and adds: – The patient coughs twice on the receiver, says he has a fever. I will not let him into the clinic anymore, so I should write out L4. I adhere to the principle of limited trust, I spend L4, but when the patient calls again and says that he has not passed, I invite you to the clinic. I do not need to issue an exemption without examination. I can… and I do this for patients who are quarantined, COVID positive, or I know that they are not cheating because they report complaints that I can expect from them. On the other hand, I do not spend a completely new L4 at a distance. I believe that if I put on a mask and a visor, I can admit patients at the same risk as when I go to the supermarket.

Teleporting will not replace traditional visits

All GPs agree that telepaths save a lot of time. On the occasion of prescribing medications, they do not listen to the life adventures of patients and their immediate and distant family. The patient is not needed to issue certificates for ZUS or KRUS, and when he had trouble in person, he always remembered something.

Some people appreciate the empty waiting rooms on Monday mornings, because the crowds in the corridors add to the stress.

– Television visits are definitely a great way to get a referral to a specialist – says Dr. Katarzyna Śleziak-Barglik. – If a patient wants, for example, a referral to a diabetologist because his sugar is incorrect, he does not have to come to me. I would also classify e-prescriptions as a plus, as well as modifications in the treatment of chronic diseases such as diabetes and hypertension.

– On the one hand, telepaths are OK – says cardiologist Dr. Paweł Basiukiewicz – but on the other hand, many people are not able to get to the doctor. And if you manage to make a call, you need to talk to a few specialists to get a referral for research. Everything is upside down.

– Our possibilities expanded – remarks Dr. Śleziak-Barglik: – For example, the daughter of a sick old lady calls me. He wants to talk, but he works a lot and can’t see me. I arrange a phone call, take out her mother’s file, look at it, and discuss. She is pleased because she learned something about the treatment, I am also happy because I learned something about a patient I have not seen for a long time.

– There are more profits than losses – summarizes prof. Samolinian. – On the profit side, we note the fact that you don’t have to bother to see a doctor. Sometimes patients need trivial advice or prescriptions, and then wasting half a day to get to the doctor, wait for yours, and be exposed to people infected with coronavirus or another disease, is much less wise than using teleportation.

The professor, like family doctors, notices the disadvantages in the form of the likelihood of missing some symptoms. He emphasizes that the official standards have not yet entered into force, and doctors working in hospitals are alerting that patients in worse condition than in the pre-telemedicine period come to them.

In summary, teleporting is best for patients who are recovering or stable, who take their medications chronically, and the advice is only for prolonging or consulting when the patient is unsure about something. However, for those who have emergencies, acute conditions, new symptoms or ailments, teleportation becomes risky.

– The most important thing is to build a clear dividing line until which teleportation is OK and from which it is not – says prof. Samolinian. – And everyone can decide about it. Both the patient, because if he feels very bad, counseling over the phone will do him no good, and the doctor who, knowing the alarm symptoms, decides to see the patient.

Were we ready for telemedicine before the pandemic?

– The pandemic surprised everyone – both patients and the health service. In March, only a few percent of medical facilities were ready to provide telemedicine services – explains Rafał Piszczek from the haloDoctor Medonet website.

– The system was saved by the introduction of erecepts a few months earlier, which should be considered a breakthrough step towards the development of telemedicine. Erecepta made it possible to build a number of telemedicine services and provide the patient with a prescription via SMS and e-mail, around which the entire telemedicine system could be efficiently built.

As Piszczek explains, it should be realized that even in March, telemedicine, even for the National Health Fund or the Social Insurance Institution, was a synonym for a patient’s telephone conversation with a doctor, often from a doctor’s private phone number.

– Globally, it was agreed that telemedicine works in Poland, and in practice, patients had quite different feelings when critically assessing the availability of specialists during a pandemic – he says. – After a few months, we have comprehensive solutions that can be easily implemented in a few days by any medical facility. I am talking about such a basic functionality: starting from signing up to a doctor for an online visit at a selected time, the possibility of sending your test results before the visit, sending photos, detailed description of the disease, and going on safely talking to the doctor on a special video chat. The doctor will issue a prescription or L4 in real time (if deemed necessary). At the same time, we are observing a dynamic development of home telemedicine devices which, together with a medical consultation, become a good complement to traditional visits – adds Rafał Piszczek.

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