Jaspal Singh, MD, MHA, MHS, on How I Practice Now: The Pros and Cons of Telemedicine

Many of you have utilized telemedicine these past several months. In this video, Jaspal Singh, MD, MHA, MHS, talks about the advantages and disadvantages of telemedicine that you may have experienced and that need to be considered going forward.

Jaspal Singh, MD, MHA, MHS, is medical director of both pulmonary oncology and critical care education, as well as a professor, at Atrium Health in Charlotte, North Carolina.


Jaspal Singh: Hi, I’m Jaspal Singh. I’m at Atrium Health. I’m the medical director of both pulmonary oncology as well as critical care education for the Pulmonary and Critical Care Network, and I’m talking about telemedicine today.

So a couple things since we last talked about telemedicine back in March of this year when COVID-19 started happening, a couple of things have happened. I think our practices, number one, have gotten used to it a little bit. And I think there are some advantages now that telemedicine is becoming ubiquitous. A lot of my patients tell me that, you know, their dermatologists, their cancer specialist, their primary care doctor are doing a lot of virtual visits. And it has some advantages, disadvantages, and everybody seems to be kind of feeling that out a little bit more. 

I think the advantages are that, one is, you get to see the patient in their home, and I think that’s very helpful. Particularly helpful from that perspective has been, we’ve limited—with the resurgence of COVID in our area—that we’ve been very cautious about still allowing visitors to come back in. Some of my patients with advanced cardiopulmonary diseases or oncologic diseases, they still come alone, and their loved one is somewhere nearby to pick them up later or in the parking lot, and so they’re left isolated. Whereas, if I do a virtual visit, whether it be phone or through telemedicine portal, then at least I can get a family member right there. They can take their notes, they can see what’s happening. If it’s a virtual platform that can share my screen, I can show them a CT scan, or a diagnostic study, or laboratory results; I can share that screen with them. So from that perspective, it is very helpful having a virtual option.

Now that being said, virtual care, we’re still learning. You know, you don’t have the physical exam features for specialized things like particular airway examination, or lesion examination, or lymph node evaluation or listen oscillation of breath sounds. It’s clearly suboptimal, so you have to kind of figure out adjuncts, like should you go have that patient go get a chest X-ray before or after. Then managing the before and after can be a little bit tricky. 

Having your staff kind of facilitate some of those logistic can be also challenging on the staff members. The staff members may be working remotely also, so they may not be right outside your room, ready to sort of help you out and jump in when needed. So they may be also kind of helping to sort of manipulate the diagnostics scheduling and such. And that can be a little bit challenging for a lot of us no matter where you are.

On the plus side, I can tell you that, for example, tomorrow, I have a half day morning at the bedside and the afternoon is all virtual; I’ll do the virtual from home. And I can kind of finagle around, you know, various schedules. My kids are young, and so starting school up again, so depending on what happens with schooling, I may need to be home for often, depending on how things go in this fall. So it’s nice to be able to allow that flexibility to do that. From that perspective, I think telemedicine is hopefully here to stay.

I think the main thing is that physicians and others health care providers need to just reach out and make sure that this is not just a, you know, you’ve done virtual once and now you learn it. We’re all on this journey, and we’re all trying to learn how to do this better, how our patients can benefit from it. But I've actually been doing virtual for a long time, virtual care for a while, and even I’m learning now. The whole population wants to see this happen and stick for some time. Many of my patients actually who used to love seeing me really prefer the virtual visit. And they’re actually very savvy; they’re more involved in their medical records, they look to access to medical records remotely. We’ve seen a massive increase in the number of patients that are actually engaging with the online portal now. And so the times are changing, and I think patients are demanding it.