Coronavirus is everyones biggest concern, but it does not mean we will not develop other health problems, such as gastro, appendicitis or injuries. We still need to see the doctor, but at the same time we do not want to expose ourselves to coronavirus, by going out. As a result, doctors have been encouraged to use Telehealth, (Telehealth is where you see a doctor via something like Skype or Facetime). Now you can see your GP by Telehealth under Medicare. As a family physician, I have been using Telehealth for many years. It will never take over from seeing a doctor face to face, but we can achieve a lot using a video consultation. As a doctor I need to gather a lot of information to work out what is wrong with you. If you can give me that information, I can perform a safer consultation via a video. If you have the right tools in your house, you can give me the information that I need and reduce the chance of missing something nasty. These tools have been around for many years and are not high tech. This week, we have created a special edition newsletter to highlight what tools can be used to help your doctor make a safe diagnosis. As mentioned before in this blog, these gadgets should be part of everyones first aid kit, to allow you to always see a doctor from the comfort of your own home, safe from the coronavirus. Online Health ServicesWhether you have the right equipment or not, there are many health services that you can access online. You can see a GP, get a blood test or even an STI check. Click on the button below for more information. For Clinic OwnersIf you are a clinic owner who is setting up a Telehealth service, please click on the link below and cut and paste the URL into an email or sms to be sent to your patients.
You can improve the quality of your Telehealth assessments by informing your patient population how to provide data that can help you make a diagnosis. Please note that your patients will need to be consented to receive communication via this process - Spam Act 2003)
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As you have probably noticed, if you have read my blog, I am pretty passionate about health technology. People may ask the question, why? It is a bit of a random topic, so why do I keep going on about how amazing it is? I am passionate because I am surrounded by it at work and can see how it can help people in many ways: it can improve your health, give you better access to healthcare or motivate you to make a change in how you live your life. But allow me to give you a personal example that shows how simple technology can really save lives. I have a family member who is ill. Really ill. Let’s call him Tom. He is 40 years old, has two young boys and has been diagnosed with a brain tumour. At the start of the year, he had a stroke because of the tumour and then spent the next 7 months in the intensive care unit recovering from it. He was unable to talk as he was breathing through a tube in his neck (called a tracheostomy). In spite of the stroke, his tumour was actually stable and not growing, so we got him home. We wanted to get him stronger with rehabilitation and get the tube in his neck out, to get him talking again. Unfortunately he was only granted carers to look after him for part of the day, so the rest of the care was needed to be done by the family. Because of this I set up Tom’s wife, let’s call her Emma, with some basic tech: a blood pressure machine, thermometer and an oxygen monitor and said any problems, call me. One Saturday night, it was 11 o’clock and I got a message from Emma. It was a video of Tom in his bed looking pale and sweaty and breathing very fast. Attached to the video was a note, “Is he ok? Trying to get a doctor, but he won’t be here for at least 4 hours”. I quickly asked her if she could use the blood pressure machine, thermometer and oxygen monitor and let me know the numbers. Blood pressure 109/73, pulse 120, oxygen saturation 84%, temperature 40 degrees. Ok, you budding doctors, what do you think? Can this wait 4 hours or not? With an oxygen level of 84%, Tom would not last 4 minutes let alone 4 hours. My response was to call an ambulance, NOW! She did and Tom was taken to hospital and given treatment for a chest infection. He recovered and returned home to his family within 3 days to continue his rehab. Those who work in health know problems like this always happen late at night, on the weekends when no doctors are available. Now you might say Emma was lucky because she had you to contact if there was a problem. But with the rise of the online doctor, everyone has access to a doctor where and when they need it. In addition, with some objective information in the form of a temperature, blood pressure, pulse rate and oxygen level, the correct decision can be made. There was no need to see him face to face to work out what needed to be done. He needed to go to hospital straight away. Without this information, we would have been guessing what the problem was and probably would have waited 4 hours for a doctor. Had we done that Tom would not have been here today. We are fully aware that he does not have much time with us but because of a bit of simple tech, his two boys get to spend a bit more time with their father, who ultimately will not see them grow up. Whilst this is an extreme example, it shows you why everyone needs a bit of tech in their lives. It really can be the difference between life and death. Blog post written by Dr Khurram Akhter. Khurram is an experienced primary care physician and a thought leader in the field of digital health. Disclaimer: This text does not serve as medical advice and if you have any questions, seek advice from your doctor. There is no doubt that medicine is a complex business. 6 years at medical school gives you the BASIC knowledge to work as a doctor. The next 10 years are focussed on adding to this knowledge and refining your skills. When you reach the “top”, the learning never ends, it just continues as science changes the way we treat people. Your GP or Family Physician has to learn different skills compared to your hospital doctor. When you work in a hospital you have access to blood tests, xrays and scans, the tools to help make a diagnosis. These can be done straight away but most importantly, the results will be back on the same day. In Australia and the UK, your GP can do the same tests but the results will not be back for a few days. So your GP has to decide whether a patient is well enough to wait for a few days for the tests to come back. If they are, the test can be done in the community. If they are not, they must go to the hospital now. Ultimately, your GP is a medical risk manager. What is of interest and may be a bit scary to know is that the physical tools the GP has to make a diagnosis are really quite basic, (we will go into what these are later). Much of the diagnosis is based on the GP’s ability to gather information from the patient by talking to them. They then confirm the diagnosis using the basic tools and decide on a plan based on how urgent they think the problem is. Let me explain in a bit more detail. When someone comes in with a problem such as a cough, I create a list in my head of about 10 things that could cause it. This list starts off with the worst case scenario, eg cancer. It then has the common causes of coughs and then the uncommon causes. Over the years I have learnt about all of the conditions on the list: what symptoms they cause, what you would find if you were to examine someone with the condition, what tests are needed to confirm the condition and how to treat the condition. With years of training I have honed the questions that I ask the patient. With each question a condition gets crossed off or may get added to the list until I have a handful of conditions that I have a strong feeling could be a cause of the symptoms. Once I reach this point I crack open my tool box to examine the patient. I am looking for particular signs that would confirm or disprove the condition that I am considering. This is where it becomes alarming to people out there. As things stand, the tool box I have is really basic. A blood pressure machine, thermometer, a wooden spatula to look in a mouth, a torch to look in an ear and eye, an oxygen monitor, a stethoscope and something to test your urine. That’s pretty much it. Some doctors have a bit more, but not many have less. What it means is that much of your diagnosis is based on your GPs skill and training to get information simply by talking to you. It is the interpretation of what you say and what your doctor finds with very basic tools that determines what your diagnosis is. Ok, that’s all very interesting doc, but what relevance is that to me as a patient? Well if you have those basic tools at home, then you can get your GP to interpret it remotely. The information gathering is mostly done by talking to someone which a GP can do online. If you can provide the information that the doctor would ordinarily get using the basic toolkit in the clinic, then, within reason, you can have a fairly effective consultation. Don’t get me wrong, there are times that you have to see someone in the flesh but much of the time you do not. Many online GP services will have the safety net of organising an in person review if there are ANY concerns. But for health problems that could be dealt with online, if you could provide the same information that would normally be checked in a clinic, you can obtain the nirvana of being able to access a medical review anywhere, at anytime and at YOUR convenience. No need to take time off work or find someone else to look after the kids just to be told, “don’t worry about it. Your cough will settle.” The number of times that I have had patients complain about having to take time off work to see the GP and all they get is reassurance and no antibiotics. I totally understand the frustration and this is why I feel that having the right tools at home and access to an online GP can make the assessment of someone with a health problem more efficient. So what information do I need to provide?
If in addition you have a digital stethoscope then your chest and abdomen can be examined. Add a torch and your throat can be examined. Companies are creating solutions that provide all of these tools in one piece of kit. A company called Tyto Care from Israel is doing this. They are launching in the USA but the UK and Australia must wait. Healthy.io produce a home urine kit that can check for urine infections and kidney problems, (not available in Australia, yet). None of these products are too expensive and for the cost of a big night on the beers, you can obtain a mobile GP clinic. Finally you can start avoiding the frustration that occurs when you have to break your routine to see your notoriously inflexible GP. The GP can do what they do best, which is talk and listen to you. They can guide you through using the necessary tools to obtain the information that they need and make a decision on what the next step will be. Sometimes you will have to come in for an in-person review. Sometimes you won’t. It will be up to the doctor to ensure he or she can make a safe decision with the information to hand. The bottom line is that if you know what information your doctor needs and can give it to them accurately, your life will become so much easier and healthcare will become like most other industries have become, easy to access at a time that is convenient to you. Blog post written by Dr Khurram Akhter. Khurram is an experienced primary care physician and a thought leader in the field of digital health. Disclaimer: This text does not serve as medical advice and if you have any questions, seek advice from your doctor. A few years ago, I worked as a family physician in the UK. We had a system where due to there being no appointments available we would ring a patient on the phone to determine how unwell they were and prioritise an appointment accordingly. It was an awful system but the NHS did not have the capacity to meet the needs of the community. People would ring and say they had a cough for a few days, a fever, and they were coughing up mucus that was yellow in colour. They also felt a bit short of breath. So, I ask you budding doctors, is this patient sick? The answer is I don’t know. In this situation you would use all of your skill to work out how unwell they are. Did they sound wheezy? Could they complete a full sentence on the phone? With as much information you would try and make a safe decision as to when you should see this patient. What we really needed however was some objective information. With the right tools available to the patient, it would enable a much safer consultation. If the patient said he had a temperature of 38.9 degrees Celsius that he measured on his thermometer, oxygen levels of 93% on room air and a pulse rate of 120 measured on his pulse oximeter, I would be seriously worried. If his blood pressure was 90/60 and if I could listen to his chest with his digital stethoscope and hear that he had noises indicative of a pneumonia, then I would be sending this man to hospital. All this equipment is freely available and relatively cheap to purchase. But I hear you say, I don’t live in the UK so I don’t need this equipment! The point is with the right tools, healthcare can become safe and accessible. You can access a doctor where and when you want to online (Telehealth) and they can do a safe and thorough assessment of your health remotely. The doctor needs certain information and if you can give it to them, they can make a safe decision. Don’t get me wrong, Telehealth will never replace seeing a doctor but I strongly believe it will become part of the journey when you are feeling unwell. So when you have that cough and are worried about it being something serious, you get online and obtain an opinion from a doctor who then has the information to reassure you or investigate things further. So looking at your current first aid kit, it would probably contain some plasters, antiseptics and pain relief. Now it should contain:
Having tools like the above can be vital in determining how unwell you are. I would argue these 6 things would be your basic first aid kit but I also have a colleague who is in his late 60’s and has a defibrillator at home. This is a machine that can shock your heart if your heart stops working. (They are found in most public spaces such as shops or airports and are very easy to use but are rarely found at home). He doesn’t have a heart problem but has it at home just in case. It is expensive but it could save his life. I am not suggesting we all do this but we should now be thinking outside the box about how to look after our health with the technology that is now available to us. Blog post written by Dr Khurram Akhter. Khurram is an experienced primary care physician and a thought leader in the field of digital health. Disclaimer: This text does not serve as medical advice and if you have any questions, seek advice from your doctor. |
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