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Monday Dec 31, 2012

Technology Brings New Meaning to Being There for Patient

As families gather and celebrate the holidays, I am reminded how things change and yet stay the same. We look forward to folks coming home, but travel is getting harder. Sometimes, we need to reach out through texting, tweeting, Skype, FaceTime, Facebook and other virtual methods. They may not seem as intimate, but they allow distant connections to be maintained and even grow.

Family medicine is all about nurturing relationships. How we care for our patients is also being affected by social media technologies. I recently experienced a powerful example of how modern technology let me be there during a difficult time for one of my families, although I actually was far away.

Serving on the AAFP Board of Directors takes me away from home and my practice frequently to attend meetings. A few weeks ago, I was sitting in the Academy's boardroom in Leawood, Kan., when one of my residents back home in Tennessee texted me a question from the emergency room about a patient. My resident did not know I was away, and she asked if I was available. I texted back to say "no" … and "yes" and would do what I could remotely. Due to the Health Insurance Portability and Accountability Act (HIPAA), I asked only for my patient's initials. Because of my relationship with my patients, with just that information, I knew exactly who the resident meant, and suspected I knew the problem.

The 91-year-old woman with altered mental status who was the subject of the resident's text has been my patient for about seven years. I first met this dynamic, independent, well-educated former teacher when she started to slow down. Sadly, her cognitive function was doing the same. I diagnosed her dementia while she still understood the devastating losses ahead of her. I worked with her four children, who all live in different states, to help everyone cope with the huge changes. We communicated by phone, e-mail, home visits and appointments over the years. As her disease progressed beyond what they could do at home, I coordinated care as she moved into an assisted living facility one month ago.

Just before I left for Kansas City, her daughter had e-mailed about one of her meds at the facility, and I had noted a discrepancy that I addressed. But now my resident was seeing her for confusion. With that information only, we quickly went through the possibilities, including a stroke, infection and trauma, but I suspected that the medication might still be wrong. Ultimately, that was indeed the problem. That text conversation allowed me to direct my patient's care quickly and efficiently through my resident, saving time and unnecessary investigations.

During our Scientific Assembly in October, the Academy asked, "What is your best moment as a family physician?" Nearly 300 family physicians responded with tales of delivering babies, helping patients make important changes and offering hope to those who needed it.

My story is a different kind of feel-good moment, but it points out how relationships and technology can grow together. The impact we make in people's lives is profound. We need to be there for our patients and families even when we can't be there physically. My knowledge of my patient's situation and willingness to use e-mails, texts and calls made a difference for her and her family, from the beginning of her disease through this latest ER crisis.

So, what is your best moment as a family physician?

And what will you do in the New Year to make a difference for your patients?

Reid Blackwelder, M.D., is President-elect of the AAFP.

Comments:

Dr. Blackwelder, Great story! As a leader in the field of eHealth and virtual, collaborative care, I must interject that there are better and more secure ways of mobile, asynchronous communications than simply SMS messaging (texting). Messaging over a secure platform such as the one my practice uses allows me to perform this identical task, but in a HIPAA compliant mechanism. I use The Apractis Clinic as a means to communicate securely with my patients and colleagues online wherever I am: in the clinic, hospital, conference, or even on vacation. Technology no longer poses obstacles for communication, rather, our own thoughts about our availability when we are not in traditional patient care environments is what we have to grapple with now! Sincerely, Robert L. Smith, MD, FAAFP Canandaigua, NY

Posted by Robert L. Smith, MD, FAAFP on January 06, 2013 at 12:32 PM CST #

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.