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11 Articles in Volume 21, Issue #1
Advanced Practice Matters with Theresa & Jeremy: Mentorship
Ask the PharmD: What is a true opioid allergy?
Behavioral Medicine: How Clinicians Can Reduce the Stigma Attached to Chronic Pain
Chronic Headache: How to Conduct a Virtual Neurological Examination
COVID-19 Long Haulers: A Look at Cardiovascular Risk
How COVID Has Changed Pain Practice and Policies
How to Conduct a Pain Evaluation Using Telemedicine
Inside the Potential of Biologics for the Treatment of Rheumatoid Arthritis
Managing Pain in Parkinson’s Disease
Spinal Cord Stimulation Shown to Improve Pain and Movement in Parkinson’s Disease
TeleRheumatology Before and During the COVID-19 Pandemic

How to Conduct a Pain Evaluation Using Telemedicine

What you can – and cannot – assess in a virtual visit, and how to compensate. Plus, what to document.

What you can – and cannot – assess in a virtual visit, and how to compensate. Plus, what to document.

 

Background

The COVID-19 pandemic has disrupted the usual workflow of clinical medicine and the delivery of patient care. Public policies aimed at reducing the spread of the virus have created conditions that challenge the traditional doctor-patient encounter.

Fortunately, advances in device and communication technology have facilitated the rapid development and expansion and of telemedicine platforms that has helped drive improved access to medical care (and probably changed physician–patient interaction forever). With this dramatic increase in telemedicine, HCPs have been forced to get creative in their approach not only to history taking but also to the performance and documentation of a patient’s physical exam. These are uncharted waters for most of us with little or no precedent to rely on.

Although there is a wide variability in visit structure that is dictated by the patient’s technological capabilities, most clinicians prefer a platform that allows for two-way audio and video. If the patient encounter occurs by an audio-only (telecommunication), it is clearly impossible to observe facial expressions, physical maneuvers, and visually apparent deficits. Even with video chat, there are limitations to what can be accomplished during a “physical” examination. As a result, many clinicians have constructed problem-focused exams that can be performed by the patient and observed by the clinician via mobile or desktop screen.

At the end of the day, our goal is to provide comprehensive yet accessible and safe care to our patients. By adjusting our history and physical (H&P) examination protocols, and utilizing the results of diagnostic imaging and laboratory testing, it is possible to continue providing the best possible care. In fact, if there is a silver lining to the past year’s events, it may be the increased openness of patients, HCPs, and payors to explore new avenues of quality healthcare delivery.

The infographic below, created by Jeff Gudin, MD, and Jeremiah Jeffers, MD, demonstrates common physical examination maneuvers that can be performed with patient assistance during a telemedicine visit. These observations and tests may be used as part of an initial or follow-up assessment, with tweaks made accordingly. Additional testing may be possible with the assistance of accompanying family members or caregivers.

The Telemedicine Physical Exam

Download a PDF

 

Clinical Pharmacy and Telehealth

Jeffrey Fudin, PharmD, has also put together a quick guide for conducting a medication and risk assessment with patients or referring providers:

Download a PDF

 

What to Document

Additional Clinical Examples

Also in this special telemedicine issue of PPM:

Last updated on: January 6, 2021
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How COVID Has Changed Pain Practice and Policies
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