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 the criteria that you’ve established for people and places where you would be willing and able to help.
A Local Provider – either 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 location.
If you’re a primary care physician, the Local Provider is 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 Local Provider has entered the appropriate data into the patient’s 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 Local Provider is probably 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 the available patient data into the health record.
Now the GTN 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.
GTN looked first for a physician with the necessary skills who is located in the same country as the patient. If none was available, the next priority was 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.
The Physician Profile that you created told GTN 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 Local Provider – a physician or other health worker who has already performed an initial workup, 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.
In some cases, Local Providers who need help are employees of a Ministry of Health. However, in most cases they are employees of NGOs who either are primary care physicians or are nurses, Medical Assistants, paramedics or other health workers who generally must function with little or no physician support.
After reviewing the patient’s information, you decide that you’re comfortable with the situation, so you accept the request, and you’re connected with the Local Provider through high-quality video and audio over “Zoom for Healthcare.”
If you weren’t comfortable, you would have declined the request and provided an explanation to help GTN 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 different Consulting Physician is needed, GTN can arrange it, and you can either establish a 3-way connection or simply hand off the situation to the other physician.
If you’re a specialist consulting for a Local Provider who is 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 Local Provider and the patient, elicit additional history and guide the Local Provider in performing additional exam or testing as needed. Then you determine the diagnosis and specify a treatment plan that involves either treating locally or transferring to another facility.
If medications are available in a formulary, you can watch the Local Provider 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, the Local Provider can arrange that.
Finally, you and the Local Provider determine any needed follow-up.
See Typical Telehealth Encounter: Perspective of the Local Provider
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