by Tracy E. Hill, Ph.D.
According to physicians at Johns Hopkins University (Annals of Internal Medicine August 11, 2020), telehealth medicine may not be as productive for older adults. Although JHU states that loss of hearing is mostly to blame, I believe there is more to it than that.
Many older adults did not grow up with technology or find it cumbersome. And even those who aren’t Silver Sagers may find it difficult to navigate the various components of a telemedicine appointment. In either case, let me tell you how telemedicine can go terribly wrong. My mother was recently scheduled for a telemedicine cardiologist appointment. She has dementia and can no longer decipher how to work her IPhone, get messages off her landline phone answering machine or quickly and efficiently log into her MacBook. My mother does not have a Zoom account and cannot recall her Skype account or password. Even without dementia, mom was never that technological savvy and managing such an appointment would be difficult at best. How did this cardiologist appointment work out? Well, not so great using telemedicine and it was not even due to my mother’s tech deficiencies.
The appointment was scheduled to begin at a certain date and time. Apparently, there was also a phone call scheduled fifteen minutes prior, to ‘pre-screen’ mom with questions about her overall health. Yet, I had no idea this pre-screen call was expected. As I was driving to mom’s to help her navigate the telemedicine call, the doctor’s office called me for the unexpected pre-screen questions. Being mom’s caregiver I easily answered the requisite questions. The physician’s assistant then told me the cardiologist would be calling me and mom at the appointed time. We waited. And waited. And waited a bit more (more than 90 minutes), until I finally told my mother that I simply had to get back to work. While we waited I had called the cardiologist’s office twice to inquire what the delay was, yet no one was able to provide an adequate response.
My mother was disappointed that she was not able to “see” the doctor. I told her we could reschedule. Back at my office more than two hours later, the cardiologist finally called. I was not happy. Again, I answered all the questions and based on my answers, changes were made to my mother’s medications. He never spoke to my mother nor requested to do so. Although she would not have been able to answer many of his questions, I thought as a courtesy and out of respect he should have involved mom in her own care.
Several days later, I took mom to her primary care physician for an in-person appointment. Upon arrival mom’s temperature was taken (as was mine for COVID screening), her weight was noted, and a nurse took her vitals with a handheld bp cuff. “145 over 75” she reported. Wait. What? No way. I take mom’s blood pressure several times a week with the mandatory electronic bp monitor that the cardiologist had me purchase nearly a year ago. Week after week, time after time, mom’s blood pressure is 230 something over 90 something. I asked the nurse to take it again. She stated, “145 over 71.”
“That’s impossible,” I told her and explained. I asked the PCP do it one more time and it was even lower. The PCP explained to me that my mother’s electronic medical record indicated that in the past year visits with her PCP, gerontologist, neurologist and her cardiologist—her blood pressure had consistently been in the low to mid 100’s over 70’s. The long story short is that the telemedicine visit with mom and her cardiologist was based on information provided over the telephone. Her prescriptions were radically changed based on this “visit.” I called the cardiologist to explain about mom’s visit with the PCP and discuss if her blood pressure and heart medication changes should be reconsidered. He was unavailable. I also left him an email message through the patient portal.
When you hear from him, can you let me know which medication prescription I am supposed to give mom? And I have a reliable (although not valid) electronic blood pressure device to sell if you’re interested!
Photo by National Cancer Institute @nci