AMID the isolation, personal hardships, anxiety and uncertainty, have you seen any bright side to the COVID-19 pandemic?
Since starting work in emergency telemedicine well before the pandemic descended, I have been able to see many advantages to working from home, while (electronically) visiting patients’ homes. I’ve been able to assist all sorts of people, from newborns to centenarians, without those people having to attend hospital. Although the evidence is still emerging, my impression is that this has prevented unmeasured harms.
I’m aware that this is not the usual narrative. We have heard of concerns that our patients’ reluctance to attend hospital during these times has led to a noticeable decrease in emergency department (ED) attendances and concerns that this may result in harms from delayed or missed diagnosis and treatment. However, these narratives – emphasising something “missed” – often fail to provide the balancing stories of overtesting and overtreatment avoided.
Take the frail elderly patient from residential aged care – prone to falls, commonly anticoagulated, perhaps with dementia. A perfect storm. Another unwitnessed fall occurs. Did he hit his head? Everyone wants to avoid a “missed” subdural haematoma – a condition that generally occurs slowly. In doing so, we may move a stable person from their familiar surroundings, often in the middle of the night, to a strange place of noise and bright lights, invasive procedures and strangers. We might think “thank goodness the CT is clear – Mr C can go back to the nursing home,” while the reality for Mr C is that the transfer made him cold, hungry and disorientated, he hit two nurses, and was held down to be sedated for the scan. Now he has skin tears and an infection or injury from the catheter that was placed because he wet himself. When he gets back to his own bed, he keeps the staff and other patients awake all night, only finally settling when the morning arrives.
Meanwhile, in another home, a toddler has hit her head while playing. She has a bump on her forehead, and her parents are worried. It’s nearly bed-time – she has stopped crying but is starting to get drowsy. Should they go to the ED? Does she need a scan? Should they call an ambulance? She is just starting to settle to her normal self, her parents are tired – they could all do with a good sleep. How easy will it be to clinically assess her in the ED? Like Mr C, little Olivia will be rushed out of her familiar surroundings, confronted by bright lights and strangers prodding her, maybe kept in a crowded area of the ED overnight.
I have had the privilege of helping patients and their families in both these situations. Through audiovisual technology, I can assess the patients in their own surroundings, have rational discussions with their families and carers, make plans together that balance the real risk to the patients not just the fear of “missing something”.
Although telemedicine had already found its place to improve access to health care, the opportunity to extend its reach – motivated by the pandemic – has revealed further advantages. Communication technology doesn’t replace the interpersonal interaction – it extends it.
Dr Sue Ieraci is a specialist emergency physician who has worked for 35 years in public hospitals and now works in telemedicine.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.