Improving Rheumatology: Telemedicine and Patient Evaluation


Considerations for the role of telemedicine in caring for patients with SARDs, with deference to the challenges of an accurate patient evaluation.


W. Hayes Wilson, MD: We live in a COVID-19 world now. I’m sure you see people from a long way away, and people who don’t want to come into the office. Do you use much telemedicine?

Kostas N. Botsoglou, MD: Yes. Telemedicine is here to stay. We went from zero to 100% telemedicine, much faster than we expected. But it’s a great option for patients who are stable, and perhaps there’s a travel burden. Or in our region, snow, it can snow 12 months of the year. It might be difficult to get to an appointment. But rather than lose that spot, because as you know, there’s a demand for rheumatologists all over the country. And at least we can preserve those spots for our stable patients, or at least see someone who otherwise was unable to travel to see us. It’s part of our daily practice. At this time, it’s primarily face-to-face because things are better in our region. But it’s always going to be an option for our patients.

W. Hayes Wilson, MD: Yes, I completely agree. To be honest with you, we see people from a long way away. It makes it sort of challenging. I remember when I was in training, I used to have a dermatology professor, Marilynne McKay, [MD]. And she just thought it was funny as all get out, being on call for dermatology. Somebody would call her on the phone and say, “I have a rash,” and she’d say, “Hold it up to the phone.” That was 35, 40 years ago. Now, they can actually do that. They can FaceTime you and do that as well. Telemedicine is a great tool to be able to use for people. But there are some challenges too. What are some of the ways that you do muscle testing if you’ve got an inflammatory myopathy? For dermatomyositis or for lupus, you can see if they have a malar rash or if they have a shawl sign, but how do you do muscle testing?

Kostas N. Botsoglou, MD: Exactly. There are limitations, and we won’t see a new patient by telehealth. I want to examine them. There’s an element of a physical examination that’s important for us. But for our stable patients for whom we’ve made the diagnosis, who are on treatments, those would be better candidates.

W. Hayes Wilson, MD: Sometimes what we’ll do is, we’ll say, “This is going to be a really expensive test. Now, what we want you to do is, we want you to cross your arms and stand up,” and see if they can stand from a chair, that sort of thing. But as you mentioned earlier, a lot of our clues are from asking questions like, “Can you wash your hair? Can you put your hair up? Can you brush your teeth?” I’ve had patients who’ve had to lean against the ironing table while they’re ironing, or have to prop their elbow up to be able to put on their makeup. That’s more women than men. But as you said earlier, a lot of the clues can come orally. Then a lot of times, one of the things that we do now that we’re in a more general thing, and looking at lupus and rheumatoid arthritis [RA] and other autoimmune diseases, is looking back over the notes and saying, “Hey, have you been to see your nephrologist? What did your nephrologist say?” Or, you look over the old nephrologist notes, it says that they were concerned about this, that, or theother, and you can gofurther into that. One of the points to be made, and I’ll let you comment on this, is that it’s hard to do rheumatology visits quickly because you really have to touch on a lot of different things.

Kostas N. Botsoglou, MD: Absolutely. Just the documentation itself can take half the visit. The longest part and primary one is the education, helping them understand, especially for RA, differentiating with OA [osteoarthritis]. That’s a very common conversation. Or what are our shared goals? Why are you on this medicine? And why are we doing the blood work? To make sure you can preserve your functionality, preserve your quality of life, allow you to do your daily tasks. Yes, it involves a lot of effort in person as well.

W. Hayes Wilson, MD: I want to thank all those out there who are watching this HCPLive® Peers and Perspectives. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming programs and other great content right in your inbox.

Transcript edited for clarity.

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