From little black bags to telehealth

Making home visits, my father would say, helped him understand his Florida patients in a new way.

There was a Marcus Welby quality to the way he was able to gain insight into their illnesses and potential health risks. He might notice a dangerous stairway, a tripping hazard around the house, or perhaps family dynamics that would give him a unique perspective on his patients’ health and their lives beyond his office.

I don’t have a little black bag to bring to my patients’ homes like my father did, but I have a different, powerful tool to help me meet my patients where they are: telemedicine.

The COVID-19 pandemic has catapulted telehealth into the spotlight.

Thanks to telehealth's flexibility, I have a digital medical bag, one that complements and improves my ability to deliver care. It offers continuity for millions of patients. Telehealth visits for Medicare beneficiaries went from the hundreds of thousands to the tens of millions from 2019 to 2020, federal data show. New York saw a 130-fold increase in telehealth from January to April of 2020, according to a state report.

Telemedicine has been a convenient, cost-effective tool when patients have hesitated to visit doctors in person. During the first wave of the pandemic, telehealth use for outpatient visits went up about 40% in my practice. Though it has now leveled off to about 10% of our patient volume, it’s been an incredibly valuable tool — one we’ll continue to need as the omicron variant fuels the latest COVID surge.

Telemedicine has pushed us to become more adaptable and creative more quickly, and it’s clear that there’s more for us to offer our patients remotely because some of these adaptations are here to stay: Patients want them, and they and their physicians are reporting satisfaction.

The use of this technology isn’t just a young person’s game. I’ve also been happily surprised by how quickly and seamlessly my older patients have adapted. In my experience, patients appreciate and enjoy having access to medical care in their own environments.

To be clear: Telemedicine doesn’t replace in-person medical appointments. But it gives us a clearer perspective of their experiences and helps us better accompany them on their journey to good health.

In my specialty, cardiology, we have several technologies to support telehealth. Patients can use watches and other wearable devices to monitor heart rate, rhythm, oxygen saturation and other metrics; external transdermal patches and minimally invasive devices monitor cardiac parameters, and computer-based stethoscopes listen to heart and lung sounds.

Remotely, we can measure everything from blood pressure, heart rate, and blood sugar readings to sleep patterns to meet our patients where they are. We can follow patients with all sorts of cardiovascular conditions, and importantly, we can triage patients from afar to decide whether they need emergency attention.

During some telehealth appointments, my patients show me their pill bottles so we can review their medications together. I’ve helped make sure they’re taking their blood pressure and monitoring it correctly. And I enjoy seeing how loved ones gather around my patients to lend them support.

I’m not seeing my patients in context when they solely come to my office. I need to understand them in their worlds because that’s where they spend most of their time.

The days of my father’s little black medical bag may be behind us, but his observations about how to gain perspective into patients’ lives remain.

Dr. Jeffrey T. Kuvin is chair of cardiology at North Shore University Hospital and Long Island Jewish Medical Center and co-director of the Sandra Atlas Bass Heart Hospital.