Daniel Albert, MD: Telemedicine Challenges for Rheumatologists During COVID-19


Three key issues with using the technology over in-person visits.

The use of telemedicine during coronavirus disease 2019 (COVID-19) has allowed rheumatologists to continue caring for patients virtually. But the technology comes with many challenges.

The primary concern is a lack of a physical exam, Daniel Albert, MD, of Dartmouth-Hitchcock, said in a recent interview with HCPLive®. Rheumatologists often rely on a physical examination to get a better look at the whole patient.

“It’s a very difficult transition for providers to care for patients without a physical exam,” he said.

There are workarounds, however, but they require ingenuity. For example, patients often show Albert how they walk, how they use their upper extremities for activities, and physical exam maneuvers can be done similarly to how they would be done in person, but they have to use a visual rather than sensory input. Sometimes rheumatologists can elicit tender points on an individual if they are asked to put pressure on certain areas.

Other concerns exist, such as patients who are simply not suited for a virtual appointment, whether it be because they have a visual impairment or less cognitive ability than is required to conduct such an interview virtually. Sometimes diseases are just too complex and there are too many comorbidities, or the patient has too severe of a disease.

Lastly, it’s important for patients to buy into the idea of virtual encounters. If patients are uncomfortable, you have to give them the opportunity to be seen in the clinic.

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