COVID AND TELEMEDICINE

    Telemedicine has been there for sometimes now. But Most of the Insurance companies were not paying for any medical service that is done without direct contact -in person -patient care. I have done antibiotics  and other medicines advice and prescription without getting paid  and that is fine b. But I still don't like to do Telemedicine as substitute for patient bein seen with direct contact. There is difference between watching a movie on TV or computer and attending in person a Broadway play Or attending a basketball game in arena V watching it on TV is not same. But now a days in hospital many consultants are not only allowed to do telemedicine for COVID positive patients , and are encouraged to so . In the beginning it was to save on PERSONAL PROTECTIVE DEVICE . But it has continued. This story is related to that 

   I have known this patient for few years. She is in her early seventies  and has had COPD - smoking related lung damage  and also had weak heart . Her pumping action of the heart was 25% at one time . She had a device inserted called ICD and she had improved . She needed the battery change and so she had COVID test done and that was negative  and she had the procedure . Every patient that has any procedure .surgery, endoscopy done in hospital, has to have negative COVID test She had some problem after the procedure  and she was kept in hospital for 24 hours .She was sent home and then in 2 days she has some shortness of breath and so she came to ER. She had as expected COVID test  and that was positive . I am not sure how she had COVID when she had not gone out of house after discharge. She had many reasons to be short of breath - bad lungs and weak heart. But since COVID test was positive everything changes. Infection Disease specialist was called  and new COVID routine ordered were done by the specialist . He did not see patient . It was telemedicine consult  and she was started on Rendesvir  and steroids were started . The hospitalist also had seen patient. I have known her and so I was called  and I SAW HER IN THE ROOM  AND EXAMINED HER . I also saw CT scan and did not feel COVID had anything  to do with her symptoms  and if it was not for COVID she would be treated for lung and cardiac diseases. She did better with the treatment that I had started or may be due to the treatment of COVID .In any case she was better . But one day I saw her  and she told me she had bad night  and could not sleep and she could not be supine  and walking 5 feet she was short of breath. I asked her if she was seen by Infection Specialist doctor   and hospital doctor. She told me that it was telemedicine call from specialist and when she told her that she was more shor of breath, he told her that we will take it day by day. The hospital doctor saw her very briefly  and was talking to her from door . I saw her and knew what had happened . She was getting lot of fluid as ROUTINE for last 3 days  and with her weak heart she was not able to tolerate it  and so she was in congestive heart failure . I stopped her fluids  and gave her medicines to have more urine . When i checked her next day , she was like new person. Within less than hours of getting medicine she felt like pressure was relieved .

    She continued to improve  and new chest X- ray had nothing to show anything to suggest COVID worsening in lungs . So the Infection specialist  and hospital doctor who did telemedicine  and did not check patient miss the real reason for the shortness of breath. The routine set of orders sometimes need to be changed .