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Telemedicine offers speed, convenience, and efficiency but isn't right for every situation. Making the right call for cardiology consults should rests in the hands of primary care physicans making the referral together with the patient, says Jason Wasfy, MD.
In this exclusive video, Wasfy, director of quality and analytics at the Massachusetts General Hospital Heart Center in Boston, discusses how such an e-consult system has worked at his center.
So, there are some patients that need to come into the office. They're complicated, they need a physical examination, they may need to be followed with time, but there [are] other patients where their question for cardiologists is very discrete and limited, and what they really need is to know the answer as quickly as possible. There was probably a time in medicine where doctors would brag about how long their waiting list was, that the doctor that had the longest waiting list to get in to see them was the best physician, and I think that's the old days. We want to deliver care to patients as quickly as possible to relieve anxiety, to make sure that they have the input they need as quickly as possible.
So, e-consult allows us a mechanism to get discrete information about a clinical question, from the cardiologist to the primary care doctor, who can then share with the patient. But because we're accommodating some of the questions that way, we also have more bandwidth in our clinics to see the more complicated patients -- for example, people who need caths or people who need procedures. So, we find it a very effective mechanism of addressing patients' needs in the way that they perceive their own needs.
There are different ways to do e-consult. One is sort of an active referral mechanism, where all the referrals coming into our office, a cardiologist can triage them and say, "Oh, I'll see that one in the office, but this question I can answer without seeing the patient." We do not take that approach. We empower our primary care physicians, together with the patients in the office, to decide what they think is most appropriate for the clinical question. And we really think that's important. Because there are some times when I'm getting a referral that I think I can answer the question about the EKG, but I've never met the patient in person, and I don't understand that they're anxious and that their father had a heart attack at a young age, and these sorts of intangible points that are really hard to know until you meet the patient. That's why instead of going through an active referral process, where you go through the referrals and say I can answer this one via e-consult or I'll see this one in the office, we give that choice to the patient and to the primary care doctor. We allow them that choice.
We've done detailed surveys of our patients and our primary care providers just to make sure that they're happy with the mechanism, and we had have very high satisfaction rates, both among referring doctors and patients. And we think part of that is because we empower them to decide upfront, do they want an electronic consult where they get an answer in 48 hours or are they willing to wait a little longer for an in-person evaluation? We'd like to customize the care we deliver to the patients' preferences and the patients' needs.
Patient engagement is a major factor. Within the bounds of safety...what does your patient want?