With the pandemic the insurance companies have allowed to do telemedicine and many physicians are doing it and some patients demand it and feel that that is alternative to going to physician's office. I have my own frustrations with certain problems and when patients want telemedicine visits. Say one is short of breath, what can I do by talking to patient or seeing him/her on screen without being able to examine lungs and oxygen level and heart and so on. So sometimes we have problems with telemedicine visits. But I came across one example where one can do telemedicine and may be not do it. I know this statement is confusing and so let me tell you the story.
I had a call at midnight from some one that I know. His relative had some health issue and so he decided to call me . So I spoke to her. She is 36 years old female who had no major health issues . She had sudden left sided chest pain. It started in the front and went through the chest to back and also had some jaw pain and neck pain. She was not short of breath and had no fever . She had no history of asthma. I asked several questions and obtain the story. She was not contraceptive pills. She had no cough and she took ibuprofen and she still had minimal pain. The question was what was the problem and what should she do. I told her that there were 2-3 possible explanations. She may have musculoskeletal pain -simple. But I was more concerned about the serious diagnosis of blood clot in lung which is possible in young person especially when they are on contraceptive. I was more concerned about pneumothorax - or air leak and collapse of lung . So I told her to go to ER right away. I told her to let me know as to what happens in ER and told her to have them do CT scan of chest .
I got some more texts from them and I was told that the ER physician did blood tests to rule oy heart attack - a possibility of such is so low in my mind that I did not think it was even there. The test was OK and so was the cardiogram . They did not do CT scan but did chest X- ray and he told them that it was OK . He told them that it was muscular pain and they will do second blood test in 6 hours to make sure that there was no heart attack. I get a new text at 7 am . The radiologist had read the X- ray and there was a small pneumothorax - air leak - collapse of lung and they were going to admit her for observation and new chest x- ray .
So the telemedicine on just telephone not video -with me and my suspicion was correct , but to confirm the diagnosis we needed DIRECT VISIT to physician and ER.