Sunday, August 16, 2020


   Withe COVID 19 , we have been doing telemedicine  and all the insurance companies are paying for it. I have often wondered as to the value of it. In certain cases this works fine , but then a telephone call that I make daily to many patients is not any different than doing telemedicine follow up that we are allowed and encouraged and get paid. I am not sure what is achieved by a cardiology nurse practitioner  calling patient for blood pressure follow up when she is or he is going to depend upon blood pressure reading done by patient at home or in a pharmacy. One could easily do same thing with simple phone call and then insurance companies would not pay for same call and same advice that was given . But now under the name of Telemedicine ,they will pay! I can understand follow up for sleep apnea as all that I see is compliance data  and that I can obtain from computer and ask patient on any problems related to mask or pressure.So that is required and there is not much more needed as physical examination. But I came across a patient  and that is the story for today. 

   I sa this patient may be 2 years ago and he has  had abnormal chest x- ray. He was smoker  and had quit many years ago . As usual I di the work up and he had PET SCAN and bronchoscopy and then breathing test  and then the suspicion  for cancer was very high and so I sent him to chest surgeon. He did not come back to me . He had surgery and it was cancer and he had part of the lung taken out and he also saw oncologist and no chemotherapy was needed. His son called me one day stating that he had coughed up blood  and he has he was afraid to go to ER and also worried to come to office. I had not seen him for 1 year and I was not sure as what had happened since I sent him to the surgeon. So I convinced him to come to office  and then did CT scan . The CT scan was OK  and there were no new lesions  and then I did bronchoscopy and I did not see any lesion and his coughing of the blood had stopped after first day and there was no evidence of any new or recurrent cancer. He has been followed by oncologist and they had done some scans too. So when he came for follow up after all the tests were done,, and it was not telemedicne follow up, i talked to him and the son. He was doing OK . He had sore tongue  and we had given him antibiotics  and I thought he may have had thrush. But I decided to look inside the mouth and I saw something. He had a lesion on his tongue. This was way at the back of the one side of the tongue.. If one had causal look he would miss it as it was on the side of the tongue  and at the back part. I told them that I am concerned about cancer of the tongue. I know how medicine works and so I called the PCP  and told that he must see ENT doctor ASAP. 

    He saw the ENT doctor  and had biopsy of the lesion  and it is cancer of the tongue. 

   I could not have detected this with TELEMEDICINE FOLLOW UP !

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