The Telehealth Volunteer Doctor Experience
Picture yourself sitting in your most comfortable desk chair – perhaps the one you’re in now as you read this.
You’re sipping tea or coffee and reading information on your computer monitor about the patient you’re going to see next.
A few minutes ago, your smartphone, tablet and laptop computer all went off to tell you that there is a situation somewhere in the world that meets all of the criteria that you’ve established for people and places where you would be willing and able to help.
A physician in need of a specialty consultation – or a nurse or other health worker located in a place where there are no doctors at all – has accessed the Global Telehealth Network (GTN) website to obtain help for a patient whose needs exceed the capabilities of anyone at that site.
If you’re a primary care physician, it’s most likely a nurse or other health worker who has no nearby physician backup but who has been specially trained to facilitate telehealth services, and who has determined the need for intervention by a physician.
The health worker has used a smartphone, tablet or laptop to enter the appropriate data into the patient’s online health record, including the history of present illness, past medical history, family history, vital signs, physical exam findings – and sometimes even test results.
If you’re a medical or surgical specialist, the request is probably from a physician whose patient has a condition with a degree of complexity that exceeds his or her expertise and who is practicing in a location where there are no nearby specialists in your field.
If you’re a medical or surgical specialist, the request is probably from a physician whose patient has a condition with a degree of complexity that exceeds his or her expertise and who is practicing in a location where there are no nearby specialists in your field.
If so, the physician has entered all of the available patient data into a well-organized and standardized electronic health record.
Now the Network’s matching algorithm has determined that, of all the physician volunteers who are currently available, you are the most appropriate to help this patient and health worker based on their circumstances and your own physician profile.
The algorithm looked first for a physician located in the same country as the patient, but none was available. The next priorities were physicians from that country who are now in its diaspora, followed by physicians who have experience in that country and understand the culture and health care system, and again, none were available.
The Physician Profile that you created told the Network about your training, experience, special skills and interests.
You specified the underserved populations that you are willing to help, and perhaps you checked most of the boxes except the ones indicating fluency in languages other than English. As a result, you may receive requests from Africa, the Middle East, Asia & the Pacific Basin or Latin America & the Caribbean – or from a free medical clinic in the U.S. You also said that you’re available to help patients in disaster areas, refugee camps or centers for victims of human trafficking.
In all cases, you will be connected not directly with a patient, but with a physician or other health worker who has been trained in use of the Network, who speaks English or another language in which you are proficient, and who can translate for the patient, if necessary.
If language turns out to present a challenge, professionals are available through the network to provide translation in over 200 languages and dialects, either through an audio connection or with a video connection that allows the interpreter to evaluate expressions and body language, as well.
Along with the newly-entered patient data, the Network also has provided you with information related to the training and capabilities of the health worker, the organization for which he or she works and the resources available at that site, including point-of-care testing, medications, bandages, splints and other supplies.
An interactive online map displays distances and travel times to the nearest pharmacy and to other health resources such as a larger nurse-operated clinic, a doctor, a hospital and a major medical center. It also shows availability of ambulance service or other transportation.
After reviewing the patient’s information, you decide that you’re comfortable with the situation and accept the request.
If you weren’t comfortable, you would have sent the request back to the Network with an explanation to help connect the health worker and patient with a physician volunteer who is more appropriate than you – e.g., if you’re in primary care but after initial review you believe that a specialist is needed.
Even if you accept a request but then find that a specialist is needed, a consultation can quickly be arranged through the Network, and you can either establish a 3-way connection or simply hand off the situation to the other physician.
On accepting the request, you’re connected through high-quality video and audio. If you’re a specialist consulting for a physician, you share expertise much as you would with a colleague closer to home.
If you’re connecting with a non-physician, you verify pertinent aspects of the history and physical findings with the health worker and the patient, elicit additional history and guide the health worker in performing additional exam or testing as needed. Then you determine the diagnosis and specify a treatment plan.
Throughout the encounter, you can use integrated speech-recognition software to transcribe your words into text that is entered in the Electronic Health Record. If desired, you can also save a video recording of the entire encounter.
If medications are available in a formulary, you can watch the health worker hand them to the patient and save a photo or video clip of the package labels for the record. If medications need to come from a pharmacy, a few keystrokes will transmit prescriptions to the nearest one. Finally, you order any needed follow-up.
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