Telemedicine in Otolaryngology
By Gregory Osetinsky, MD FACS
Telemedicine has flourished recently out of necessity with the COVID-19 pandemic. To lower the risk of dissemination of the SARS- CoV2 virus medical visits have been restricted to urgent and emergent problems.
Distant medicine’s origin reaches back to 1879 in a Lancet article addressing use of the telephone to reduce unnecessary office visits. Telemedicine’s origins (with the addition of video) date back to the 1950s in the practice of Psychiatry.Teleradiography soon followed.
The problems of telemedicine as a complete substitute for office visit include lack of a complete physician examination, legal barriers regarding licensure, HIPPA privacy issues, and limitations of billable services. There has also been need for a distant telemedicine studio with both an Audiovisual staff and a trained clinical staff. The technology of smart phones has erased this last hurdle, but it was the CMS decision to loosen the HIPPA enforcement and to reimburse physicians that has dramatically changed the frequency of Telemedicine in clinical medicine today. Again, the complete physical examination is not available in telemedicine, but the quality of smart phone cameras today combined with the extraordinary talent some patients (and their teen children assistants) have for Selfies is remarkably helpful.
Even in my Otolaryngology specialty with its necessary microscopes, otoscopes, rhinoscopes, and laryngoscopes to augment the physical examination, there is a role for telemedicine.
In my practice, follow- up of established patients is the best role after a complete examination has previously been performed. A telemedicine visit to discuss a benign biopsy, a visit to discuss allergy immunotherapy progress, a visit to discuss response to migraine management, a visit reviewing vestibular physical therapy in a vertigo patient, and a visit to discuss post- thyroidectomy labs all can be appropriate.
While fewer new-patient consultations than follow-up visits are performed via telehealth, they still can be useful to schedule required diagnostic tests prior to our office meeting. If it becomes obvious that more of an examination is needed, an office visit appointment is scheduled.
Is Telemedicine as comprehensive as a full examination office visit? No, but it may be more appreciated by patients and more appropriate in certain circumstances. The busy Mom whose fifth child is robust, active, and gained 3 pounds after missing a week of school recuperating from a tonsillectomy is reluctant to drive 2 hours for a well post-operative visit. After a taste of telemedicine, she is not returning for her sixth child’s well post op visit.
Dr. Osetinsky is an Otolaryngologist and a member of Kentucky Ear, Nose, & Throat, a part of Lexington Clinic.