3 Important Things Patients Need to Know About Telemedicine

Technology is improving and advancing fast. What was impossible just a few years ago, is becoming possible now. Nowadays, a physician can see a patient, interview him or her, auscultate, examine the skin, prescribe medications and document in an electronic medical record, without being physically by the patient’s side. 

The first issue that needs to be brought up is the location of the medical act. It has been defined that the medical act occurs where the patient is located. This has consequences regarding licensing and regulations. As it is well known, in the United States, licensing goes state by state, so the physician has to be licensed in the state where the patient is located. This means that, so as the doctor is licensed in the state where the patient is located (and the state medical board is OK with it) the physician can be located anywhere in the world and see, listen and treat a patient.

A second issue is the question of insurance reimbursement. As of today, not all insurance plans reimburse for telemedicine services, although this is increasing by the day. The patients have to be aware if a service rendered by telemedicine will be reimbursed by a particular insurance plan if not paying out of pocket.

The third issue is that there are some specialties that are more ready for telemedicine, than others. For example, Neurology and Psychiatry have been using this services for some years. The surgical specialties (due to the nature of their service) have not quite embraced it yet. It is not impossible to think that in the future, a surgeon might operate remotely, using devices similar to joysticks.

Marco A. Ramos MD

3 Common Ways Kidneys Get Damaged Acutely

The kidneys are very delicate organs. As it can be seen in a previous post, they are in charge of many different functions and need to have a good supply of blood at all times in order to perform appropriately. 

1. The most common reason the kidneys get damaged is when the blood supply decreases. This happens when an individual loses fluids through diarrhea, vomiting and does not replenish its fluids with salt-containing fluids. 

2. Certain pain medications, can affect the internal blood flow of the kidneys. If these medications are taken and the body is not adequately hydrated the blood flow to the kidney cells can severely decrease and cause kidney damage. The type of pain medications belong to a category called non-steroidal anti-inflammatory drugs. Common examples of them are ibuprofen, naproxen and ketorolac. Other medications, taken when the body is not well hydrated can also damage the kidneys these include diuretics and blood pressure medications called ACE-inhibitors (examples: captopril, lisinopril, enalapril) and angiotensin receptor blockers (examples losartan, valsartan, irbesartan).

3. Finally, the kidneys can get damaged by a substance that is necessary for certain diagnostic procedures. The use of radiocontrast for coronary angiograpahies or CT scans can damage the kidneys if they are already chronically damaged or if the patient is not adequately hydrated.

There are other causes for acute kidney damage. The post concentrates in the common ones.

All these causes are usually temporary and the faster they are corrected, the better the chances of avoiding longer damage. Whenever there is a change in the level of fluids a body, the balance has to be restored. Do not hesitate to talk to your doctor or go the the closest Emergency Department if you feel at risk.

Marco A. Ramos MD

3 Pieces of Advise if You or Your Relative are Hospitalized

Hospitalization is a reality. It will happen to most of us, for one reason or another. It gets more common as age increases. The hospitalization process can be risky. There are specialized medications being given and invasive procedures performed. Regardless of the training and capabilities of the physicians and the watchful eyes and caring hands of nurses there will be side effects that might threaten the life or well being of a patient.

The first piece of advise is never to be confrontational with the hospital staff. In many occasions healthcare workers are working at the limit of their capabilities. Adding more stress to an already stressful situation by nature (which the hospitalization is) will only create negative feelings towards the patients and families. Healthcare workers are human beings and although they have been trained to be non-judgmental and to treat everyone equally, they are also human beings and have emotions of their own.

A second piece of advise is to make sure that all information about the hospitalization process is understood and that decisions are made together with the doctor. Patients and families sometimes fail to answer the questions because “the doctor already rounded and we missed him or her”.  It is the physician’s duty as the one ordering the treatments to inform the progress to the patient’s and/or families. Nurses know how to locate physicians and they will do it upon patient’s or family’s request.

Last, but not least, what do you do in case, in spite of multiple efforts to comprehend what is going on in the hospitalization process, things are not understood? At this point, what is needed is the intervention of the primary care provider (or even a third party physician patient advocate). Nowadays, there are more and more hospitalist services and the primary providers are staying away from the hospital scene. The primary provider or a private physician patient advocate would be able to interact with the hospital personnel and explain the issues to the patient and family afterwards.

The hospitalization process is complicated, but communication is key to a successful outcome. Barriers to effective communication can convert an already difficult situation into a worse one.

Marco A. Ramos MD