You might wonder if telehealth really is a valid option for seeking healthcare and the opinion of a professional if they are unable to see you in person. Here are some guidelines we use when considering if telehealth makes sense for our patients.
Constitutional: e.g. well-nourished, well-developed, well-appearing, Vitals
Ears, nose, mouth, throat: e.g. normocephalic, atraumatic, external ears normal
Eyes: proptosis, extra-ocular eye movement intact, nl sclerae, conjunctivae not
Neck: visible goiter, range of motion of neck
Respiratory: comment on increased respiratory effort
Cardiovascular: patient can palpate PMI
Chest/Breast: e.g. gynecomastia, symmetry
Gastrointestinal: e.g. no caput medusae, no tenderness with self-palpation in
Genitourinary: visual exam of external genitalia
Musculoskeletal: ROM (active & passive), nails/digits
Lymphatic: Large lymph nodes can be visible
Skin: rashes, ulcers, varicose veins
Psychiatric: anxiety level, affect, memory, tangential conversation
Neurologic: motor deficits, select cranial nerves (e.g. sticking out tongue)
Systems that allow us to gather crucial data, like vitals, facilitate the option for telehealth. Elite Home Health & Hospice pursues telehealth by issuing a system which can support weight tracking, blood pressure recording, pulse oximetry, and heart rate. Telehealth requires patients to participate in their health care assessment, sometimes by being hands on, such as depressing the skin in the shin to show edema.
Using the camera on a phone can facilitate assessment of foot ulcers: Have the patient put the camera on the floor and show you
the bottom of their feet, top of scalp, nape of neck (acanthosis), close-ups of body areas that trouble them, neurologic and musculoskeletal exams: Have the patients move their extremities for passive and active ROM etc, and even GI: self-palpation under supervision may help document rebound, guarding etc, and using a coin/ruler can help create context of the size of a lesion.
Telehealth is a brand new world in healthcare. We are excited to participate in the first steps and bring care to our communities in new ways.