What do family doctors think about telepathics? There is one major downside

It will be a year in March that we have been using teleportation. The beginnings were not easy, but we managed to get used to this form of contact with doctors. Confused patients no longer knock on the door of the clinic, the chaos is gone, but we still spend long minutes with the phone to our ear. There is also an ongoing discussion on the effectiveness of this form of treatment. Healthcare professionals say the pandemic leaves them no choice but now that vaccines are on the horizon, they are reconsidering whether and to what extent we need teleportation. And they agree on this point.

1. What are the pros and cons of telepathic advice from doctors? The doctors who spoke to Medonet say what causes the biggest problem when diagnosing over the phone
2. Dr. Izabela Banaś: – For me, the main disadvantage of teleportation is the lack of direct contact with the patient. Other family doctors are of a similar opinion
3. Patients and doctors had to switch overnight to online or telephone appointments. However, the institutions want to return to normal reception “live”
4. You can find more such stories on the TvoiLokony home page

Telemedicine is not that scary

According to some doctors, the Polish health care system has dissolved patients. On non-working days, in the evening and at night, it was possible to go to the night and holiday care facility, to the emergency room or to call the ambulance. As a result, yesterday’s partygoers, whose runny nose had just started, showed up on Sunday shifts. Patients came because they could; instead of taking aspirin, they rushed to the doctor. The lack of gradation of needs meant that the number of counseling services was irrationally high, and a cold consultation can be provided over the phone.

Teleporting became common at the beginning of the pandemic, but some clinics had practiced it before.

– Before the pandemic, there were facilities where telephone conversations with patients were conducted, e.g. about extending drugs or arranging a home visit, but they constituted a small percentage of all visits during the day – says Dr. Paweł Lewek, family doctor from the Le-Med clinic in Łódź. – However, in the conditions of an epidemic, this type of contact with the patient has become a necessity.

The clinics did not become breeding grounds for the coronavirus, but the forced limitation of doctor-patient contact resulted in delays in the diagnosis and treatment of chronic diseases. Patients delay in reporting disturbing symptoms or do not catch them, they often call when the disease has developed.

— At the moment, something really serious must be happening for the patient to recognize it himself and report it to me, worried. – says Dr. Paweł Lewek.

– Last month I had a patient who called for advice and it turned out that for the last eight months there was no contact with her, she did not visit us – recalls Dr. Marcin Strumiłło, head of the NZOZ “Lodzianka Clinic” in Lodz. – She was not seriously ill, so she did not stay in my memory, we did not seek contact with her, and it turned out that she needed advice earlier, but decided that it was a hard time to wait.

The fear of contracting the coronavirus is one of the main reasons for avoiding clinics. And how do POZ patients cope with the technical side of teleportation?

– When it comes to adapting to new technologies, they underwent combat baptism before the pandemic – notes Dr. Marcin Strumiłło. – In 2019, e-prescription came into use and those who had difficulties with the help of their neighbors or family learned to cope.

– Patients, especially seniors, when preparing for teleportation, write down the problems they want to talk to us about on a piece of paper – says Izabela Banaś, MD, PhD from the Department of Family Medicine, Medical University of Lodz and NZOZ Multimed.

– They got used to the fact that the clinic sets rules, and they have to adapt to them – says Dr. Strumiłło. – At the same time, from the beginning of the pandemic, I lack a coherent voice, even in the medical community, that teleporting is the right strategy.

But telemedicine is not only about visits by phone. Modern platforms are now available that make the doctor-patient contact easier. You can use, among others from online visits in the form of video chat. At haloDoctor.pl, you can also take advantage of free family doctor advice from the National Health Fund.

Telepaths forced changes in clinics

Since the clinics switched to teleporting systems, more telephone lines and telephones have become a necessity. Additional staff was also employed to operate them.

– We have increased the number of telephone lines and now every doctor working at a certain time has his own at his disposal – says family doctor, Dr. Honorata Błaszczyk, president of the Łódź Branch of the Provincial College of Family Physicians in Poland. – Unfortunately, patients still complain that they cannot get through, now due to an avalanche of phone calls asking about vaccinations.

– Our clinic has been operating in two ways since the beginning of the pandemic, patients are admitted after the initial telephone verification of the reason for the visit – says Dr. Izabela Banaś. – It is done by a doctor and thanks to this we can make appointments with patients at appropriate intervals in order to maintain an appropriate and safe distance in the waiting room. We provide injections, ECG, vaccinations for children and adolescents and everything that covers the scope of the family doctor’s practice, and I know that many facilities work just like that.

– My clinic is open – says Dr. Katarzyna Śleziak-Barglik, head of the POZ clinic in Ruda Śląska. – There is a trio at the entrance, the nurse makes an interview, measures the temperature, asks who the patient has an appointment with, what he wants to do and directs him further. However, I am aware that the facilities are completely closed and I would like to say that I would not like to work there, I cannot imagine diagnostics. The telephone clinic could operate for two months at the most, then the patient has to be seen.

– Solving technical problems related to the introduction of telepaths rested on the shoulders of the clinic managers – notes Dr. Strumiłło. – The procedures were created thanks to our invention, there were no general guidelines, we didn’t meet, we didn’t discuss anything. Each facility adapted telepaths to its own needs. They have potential, but we are still far from perfect, we are still struggling with the problem of arranging advice and calling back.

Teleporter as a qualification for a visit

While seniors still prefer face-to-face contact with a physician, younger patients highly appreciate teleportation. It is about saving time, these people usually do not have complicated medical problems, and often take care of formal matters. However, the use of telepaths also has its limitations.

– Seniors are usually lonely people and a visit to the clinic is for them an important moment of direct contact with another person – remarks Dr. Lewek. – With other patients, with the doctor. Talking, meeting… That’s what they really lack. After the teleportation is over, they ask when we will finally be able to meet the doctor. And instead of goodbye, I hear: let’s hope to see each other next time.

Doctors do not hide that telepaths are deceptive and often invite patients to the clinic to verify the diagnosis.

– In people between 40 and 60 years of age who do not report any ailments, we often find something – says Dr. Marcin Strumiłło. – Sometimes, during a medical examination, e.g. after taking blood pressure or after ordering additional tests, it turns out that the patient probably has some serious illness at the beginning. However, for this to happen, the man must be accepted.

– There are clinical problems and ailments that can be deceptive when heard over the phone – says Dr. Izabela Banaś. – That is why the doctor’s vigilance, experience and accuracy in collecting anamnesis are of great importance. It happened to me several times that an infection that looked like a viral one turned out to be after a personal examination of the patient with streptococcal angina. Therefore, a large group of patients reporting clinical symptoms are candidates for a physical examination. It all depends on the spectrum of these symptoms, whether they are acute or whether it is an exacerbation of a chronic disease, when appropriate treatment requires a visit to the clinic.

– I must admit that teleporting is a huge step forward, maybe it was introduced a bit too hastily, but still the patient benefits from it – believes Dr. Strumiłło. – However, they need to be done quickly. It cannot be that we sign up for teleportation as for a standard appointment and the doctor calls in 2-3 days.

There is no substitute for doctor-patient contact

Since the beginning of the coronavirus epidemic, GP clinics have had many new patients and they have been a real challenge for doctors.

– You can reduce the daily number of personal visits from 50 to 25, if the patient only needs to repeat the medications, make sure that he or she takes them correctly or consult the results of blood pressure or blood glucose measurements – believes Dr. Honorata Błaszczyk. – However, we have to be sure that the patient can handle it, and for that we need to know him. I believe that the first-time patient should be assessed personally. On the other hand, our long-time pupils are able to cope with simple ailments, take care of a child with a cold or indigestion, teleportation is enough.

— For me, the main disadvantage of teleporting is the lack of direct contact with the patient – says Dr. Izabela Banaś. – If I know the patient, it’s easier, without seeing the expression on his face, I can guess many things from the intonation of his voice. I have been practicing for over twenty years and have a regular group of patients, so when I hear their voice in the earpiece, I have them before my eyes and that is an added value, but not always enough.

– Telephone medicine has a chance to develop on the basis of our knowledge of the patient – agrees Dr. Katarzyna Ślezak-Barglik. – We need to know his capabilities. However, this relationship will not be built in a pandemic. For telemedicine to work now, it had to be done earlier. A patient who knows a doctor also has more confidence in the voice on the phone telling him to do this or that. The doctor giving advice should not be anonymous.

Not seeing a patient is a problem for every doctor, because non-verbal communication accounts for about 60 – 80 percent. diagnostics.

– Communication is more difficult – says Dr. Honorata Błaszczyk. – First of all, there are technical issues: poor sound quality, problems with using the phone, especially by the elderly, worse communication with hearing impaired people. Secondly, the patient is not always able to precisely describe his ailments and locate them. It is very difficult to describe skin changes, their color, shape and size. Sometimes it is impossible for the patient to perform e.g. body weight or blood pressure measurement due to the lack of appropriate tools.

– I have already summed up the year 2020 in terms of the number of advice provided – adds Dr. Błaszczyk. – Teleporces accounted for 49 percent. general advice. I thought this percentage would be higher, but home visits were 100 percent. face-to-face visits, as well as advice on healthy children and sick children up to 2 years of age and most older children. The principle followed by the team of my clinic is inviting the child to a stationary appointment.

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Teleporter: time saved or time lost

– As the epidemic lasts, we got used to teleporting – says Dr. Błaszczyk. – We have developed patterns of extended interview in order to obtain as much information as possible from the patient in order to make a good decision. Patients also learned to contact their doctor differently and know when to insist on a personal visit more.

On the plus side of telepaths, you can quickly issue prescriptions, certificates, and prolong medications.

– Patients often call from work or from some trips, we talk and if everything is fine, I give the benefit – says Dr. Lewek. – But it also happens that teleports, instead of saving my time, engage him. If a patient reports severe pain, I have to see him the same day.

Problems with getting a connection and interruptions in calls are undoubtedly a waste of valuable time, but family doctors spend most of their time serving patients suffering from COVID-19. Dr. Lewek says that in the event of dyspnea (in a patient who is not monitored under the PulsoCare program), the organization of hospitalization is on his shoulders. First, he calls the ambulance station to arrange transportation. The ambulance service transports the patient if the GP agrees the admission with the doctor on duty in the covid ward. So he calls more hospitals to find out where the place is. He connects to the nurses’ office, sometimes he gets a direct number to the doctor. When he finally catches him, he agrees to admit the patient. Then all he has to do is call the emergency room dispatcher, give the hospital and the name of the doctor who approved the admission. Finally, he must notify the patient …

Co z teleporadami po pandemii?

Counseling centers want to gradually open up to patients. Prerequisite: Staff must have a second dose of Coronavirus vaccine.

— We want to take the first step towards patients when all clinic staff are vaccinated with two doses – plans Dr. Błaszczyk. – We will not open up completely, we want to be more accessible. We will continue to encourage first contact by phone and teleportation. However, it will be possible to invite the patient to the office more often. I believe that the current form of the initial assessment of the patient’s needs in the form of telephone contact with a medical worker, i.e. with a nurse in registration, and then in the form of teleportation, should also work well after the end of the epidemic.

– Probably in 20 – 30 percent. we’ll stay with teleporadach. For many people this form of contact with a doctor is suitable and advisable, says Dr. Lewek. – A direct telephone communication network between doctors would also be useful, so that cases could be officially consulted, e.g. with a specialist from the ward to which we refer the patient. Such an additional internal network for use by healthcare only.

— When group ‘0’ gets a second dose of vaccine, I see no reason for clinics to be closed – believes Dr. Ślezak-Barglik. – I think the procedures will change and the patient will call for a prescription or referral to an ophthalmologist or orthopedist. A referral card is often not enough, and a short phone call always gives you a chance to be refined.

– At the beginning of the year, a large group of seniors ask us to issue health certificates in order to take advantage of various forms of subsidies, e.g. from social funds – adds Dr. Banaś. – It is more convenient for them to call, meanwhile, they had to come earlier, sign up for registration, wait in the queue … And this is a kind of administrative visit, which should be carried out as part of teleportation. All kinds of referrals for sickness pensions, applications for a disability certificate, extension of the application for rehabilitation allowance, certificates for insurance companies, matters related to the treatment of chronic diseases, including applications for the supply of auxiliary equipment and medical supplies, e.g. diaper pants, catheters, etc., if we have complete medical documentation, here telepaths do their job.

— The teleports will stay because they relieve us a bit – summarizes Dr. Ślezak-Barglik. – Already now, most of my colleagues are telling patients with chronic diseases: if everything is okay, call me in three months and we’ll see you in six months.

This may interest you:

1. When is teleportation enough and when to go to an appointment? Expert Council
2. In 2020, telemedicine flourished. Everything «thanks» to the pandemic
3. Free teleportation of a family doctor at the National Health Fund. Check how it works

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