Philadelphia Medicine Summer 2020 - 17

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patient is obtained through the history and a big part of the physical
exam is done by visual inspection, we realize that telemedicine gets
us almost all the way there."
Some patients cannot navigate the telemedicine system, especially
the elderly. Those patients are getting telephone visits - a less than
ideal situation, but better than not having any type of visit.
"We've been losing track of blood pressures, labs and cancer screenings. We're starting to do routine mammograms and colonoscopies
again. In the beginning of the pandemic, we were holding off on
labs but now people are more willing to go to the lab while others
are able to get blood drawn at home."

bills that have created some protections for physicians.
The need for remote visits has led Medicare and supplemental
insurers to make them reimbursable. It has also loosened former
requirements that the patient and provider must be in the same
state. Now, specialists in New York, for example, can examine a
patient in Philadelphia via telemedicine.
"I don't see why that can't be a permanent change. What does it
matter if a competent licensed physician is across town or across
the state line?"

Last month, Jefferson administrators asked physicians to return
to the office, with the goal of having about half of the visits in
Cardiology is also doing some telemedicine, but at some point person and the other half video hookups. "We started out by only
the patient still needs to get the EKG or the echocardiogram.
having two face-to-face visits an hour, and only three of the four
doctors
in the office at one time because we're trying to minimize
"I had a guy today who is an alcoholic" Dr. Graziani said. "He
the
number
of people in the waiting room. Right now we are up
had a pulmonary embolism, and he suffers from anxiety and deto
three
patients
per hour in the office and one on telemedicine.
pression. He was just released from the hospital and needed post
The
ratio
is
likely
to
change again as the number of Covid-19 cases
hospital follow up. I was able to take care of everything he needed
either
increases
or
decreases."
on telemedicine.
For personal reasons, Dr. Graziani misses working from home.
"On the other hand, I had a lady who was complaining of low
"I
was
hoping we were going to continue working from home at
blood pressure at home. Unfortunately, the accuracy of a home
blood pressure monitor is variable. Most of the time it's fine, but least a couple of days a week. It was an antidote to burnout. I was
sometimes it's way off. I was hesitant to trust completely, her meter getting all the work hours in but didn't have the hour and 20-minute
commute, roundtrip. I could spend that time with my family. Make
at home, but I had no choice. She's 76 years old.
dinner. Do other things. It created a much better balance for me
"She has a lot of medical problems. And she's not coming into the and my family. For me, it was one really good thing to come out
office although that would have been my preference. So, I had to of the pandemic." *
act on the available data and decrease her medicine. I will want to
actually see her in the office as soon as she is comfortable with that."
Dr. Graziani said she's concerned that telemedicine will produce
a flurry of lawsuits, although Pennsylvania lawmakers have passed
Summer 2020 : Philadelphia Medicine 17

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Philadelphia Medicine Summer 2020

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