Telemedicine: A Doctor’s Perspective
By Dr. Mia Finkelston, Medical Director of American Well
I would never have believed it, if when I first began my career as a doctor, someone looked into a crystal ball and said to me, “Mia, you will be practicing Telemedicine. And not only that, you will be an early adopter”.
For me, it began in 2012. I had heard of the use of Telemedicine to reach patients who did not have the ability to get to the doctor’s office, did not have insurance, or could not get an appointment when they wanted one. I work in rural Maryland. There are a host of reasons why getting an appointment can be difficult – everything from the chronic shortage of physicians in rural areas to weather-related challenges, like rising flood waters that close practices.
That summer American Well had a nationwide search for interested, experienced physicians. I called and a few hours later The Chief Medical Officer called back. I remember his energy, how he articulated the mission of the company. I was impressed by their future-forward thinking. Here was a group that understood what I was living: My patients were often not able to see me when they wanted or needed. They were getting sent, unnecessarily, to the ER. Or to other doctors! It was maddening.
I decided to incorporate American Well into my own practice. The Medical Director at my regular clinical practice though was NOT interested. In fact, I was chastised for looking into it.
3 months later I realized, I had a passion for Telemedicine and wanted to be all in. I left the “brick and mortar” practice later that year.
I still live in a rural area and often see my patients around the community. Most of them are intrigued about this notion of caring for them, medically, over a video chat (not simply a phone call). My colleagues, however, were not very supportive then – and to this day still do not use Telemedicine. Few have tried to connect with me simply to see how it works. It is an attitude I want to help change!
Within Amwell, the medical practice part of American Well, I participated as much as I was allowed. I was on the panel that helped form guidelines – which are updated yearly – for the most common diagnoses seen on the online platform. I am also a member of both the credentialing committee and the quality committee. In 2015, I was asked to become the Medical Director. I was honored and have enjoyed this position and its responsibilities. This is all in addition to seeing patients full-time.
What does it all look like? I work in my basement, flanked by 2 senior dogs. If I travel, I take my computer with me, as needed. As long as I have a private location to work in, a cable outlet or good Wi-Fi, I can work. I have seen 3 children through high school and college. I have been available for them in ways that traditional office-based medicine could not. American Wells’ service is 24/7, so that allows me to adjust my schedule as personally needed.
I think that ALL primary care practices should adopt a Telemedicine system, so they can reach patients with lower acuity problems and keep the more complicated cases and new patient assessments coming physically into their offices. I occasionally moonlight for a family practice in my area. After a day of seeing patients, I usually believe that close to 50% could have been seen through a Telemedicine visit.
Healthcare is evolving. And I am thrilled to be at the forefront – an environment that will help deliver quality medicine, more effectively and at less cost!