Healthcare and Travel
A recent trip to the Emerald Isles to visit family and friends found us in another country and short on medication. The discovery came late on Saturday evening which could have meant another 36 hours before we could speak to a clinician during normal working hours, obtain a replacement prescription and fill it.
The issue was not urgent enough to head to the nearest Emergency Room but waiting an extended period of time seemed unwise. We had a reservation a local restaurant with the family complicating the challenge. As a participant in social media and constant advocate of the power of social media this seemed like an ideal opportunity.
Connected World
I am lucky to have a big international network and have been used it on several occasions for other requests while traveling and away from home resources. Did I know any Irish Doctors that might be able to help or point me in the right direction? There was the #IrishMed group hosted by Dr Liam Farrell every Tuesday night. I had “met” Liam online some time back in another tweetchat and gotten to know a little of his background and participation through his chat and interactions. He has a private reminder list that he posts the details of his chat every week. If you are available and have the time I would encourage you to participate – you will find a wonderful community from all walks of life and contributors/participants to healthcare and can find all the details here: https://irishmed.wordpress.com/
I sent a note to Dr Farrell – remembering that he was retired but hopeful he might have some ideas. In the meantime, I looked at the list of participants for any clinicians who were based in Ireland. There were a few and sent a request to connect privately
A quick side note here: Depending on your settings in twitter you cannot send a private (in twitter terminology – Direct Message) note to people who do not follow you. This is a setting and some people allow for it – most do not to prevent spam.
I also posted a general post on my twitter feed asking if anyone had any suggestions for my predicament
Any of my tweeps licensed docs in Ireland that can help a traveller in need of a Rx #ireland #pharma #help
— Nick van Terheyden (@drnic1) July 8, 2017
In fairly short order I got a response from Dr Nick Flynn – a General Practioner at the Union Key Medical Center, from Waterford and living in Cork – not close (we were in County Kildare)
Map of Ireland
Aside from having a very cool name he was online was online and attending a Hurling Match – what’s “Hurling” you ask….
A 3000 year old incredibly tough game played by 15 players on a grass field mostly in Ireland with big wooden sticks that are used to beat each other up and occasionally hit a ball towards a net – highly recommended!
He connected with me and I was able to send him a private (Direct Message) explain the request and background. He replied immediately with a response:
I am at a match but will do a telephone consult in an hour and probably be able to ring it in then
(Translation “Ring it in” – call in a prescription to a local pharmacy)
So in the space of 30 minutes or so I had found a local family practitioner, established a connection and arranged for a teleconsult. We worked out the details of how to connect with several options available from POTS (Plain Old Telephone System) to a Skype connection or a similar alternative.
Meanwhile, our local relatives were able to point us to a local pharmacy that stayed open after hours and with the help of google we were able to confirm the hours and details for picking up the prescription.
Application in Healthcare
While this process is not for everyone and there were alternatives including a local urgent care clinic – Vista Clinics (Minute clinic) that could be used for the same purpose the potential for this new age of connectivity and access was exciting. Well exciting for me at least to get access out of hours.
Some might suggest that Dr Flynn might not be so excited to be disturbed after hours by some random stranger for a prescription they had failed to bring with them on a trip away from home and that’s a fair point. But Dr Flynn had a choice – he did not have to respond and the more sophisticated version of this would be having coverage scheduled by providers. Much in the way when you tweet a support request or problem to many of the large corporations they have people on staff monitoring and responding to help guide and support you.
You could say that social media is not appropriate for this kind of interaction – again its not for everyone but given the large swathes of the population that are online and use this medium I believe you ignore the channel at your peril. We do not compare service from a company or individual based on other companies or people in that industry. We compare service based on our experience of service everyone in our own world. FedEx has created a culture where everyone expects to be able to follow and tracking our packages every step of the way to our homes.
Trust and Security
There remain some security and privacy considerations that cannot and should not be ignored. How did Dr. Flynn know I was who I said I was. How did I know he was who he said he was. Currently, those questions remain open and answered only based on personal experience and relationship. My validation of him boiled down to trusting his profile and participation online and the material he posted and ultimately was confirmed by the Irish Medical Licensing authorities who have an existing system in place to validate his license when he prescribes medication at a pharmacy.
Dr Flynn had to make his own assessment of me and the validity of my claims – for sure, if I had been looking for a controlled drug (opioid pain killers for example) the interaction would have been very different and probably completely different outcome. Not to diminish the issue of security and privacy but these are solvable problems and we have seen similar issues addressed in the world of CraigsList exchanges (Safe Deal Zone and Safe Trade Stations)
Current Trust and Security in Healthcare
It’s worth noting that our existing system of validation is based on reputation and even on physical aspects of credentials – everything from certificates on a wall and a physical office and formal business presence. But that system has been found lacking in the past Fake Doctor: Oregon Man Charged With Performing Surgery Without a License and even as recently as last year (Florida Teen Performing Exam as Fake Doctor)
But the lesson here is we can find ways of improving access and service and do so safely and securely. Getting to this wide access and availability will require a different thinking. The way we have delivered care and provided access in the past may not apply in the new age of technology and connectivity.
Incremental Steps to Socially Enabled Healthcare
So how do we get to this new world of easy access that balances the need for security and not overwhelming the clinical resources with 24/7/365 access? Here are my thoughts on some incremental steps you could take to move towards this goal of increased access
- Open the door to new channels – this could start with listening on a social media channel
- Look at Other Industries and Experiences as possible models/alternatives for Healthcare
- Try a TeleHealth Consult from a Participating Provider or Service
- For Clinicians – Sign up to Deliver a Telehealth Service
I will leave it to Dr. Flynn to close this with his response when I asked him if I could post details of our interaction
As medical care becomes increasingly sophisticated and our patients (and ourselves hopefully) live longer into old age with multi-morbidity and polypharmacy we need to find new ways of delivering care effectively and of course safely.
I’m a strong advocate for our allied Health Care Professionals (HCP) role evolving to include where appropriate prescribing rights. The remote assessment of the patient is also evolving. Shortly there should be no reason for a doctor to drive 30 km to a nursing home when he could assess the pt remotely with the help of a trained nurse or physician assistant and a secure Skype type connection
Do you have any better suggestions? What small change have you seen that makes a difference to help jump start Telehealth services? What one thing could we do that would have a big impact in this area?
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