7.09.2017

in which telehealth sends me to the emergency room and i wonder why. or, what's the deal with telehealth?

I used Telehealth for the first time this past week, Ontario's call centre for health questions. I thought it was a great service, but now that I've spoken to others about my experience, I'm confused. Is it true Telehealth sends everyone to Urgent Care or the Emergency Room?

USians, you may marvel at the beauty of universal public health care.

* * * *

It was the Monday after Canada Day, and I had been sick all weekend. My family doctor's office always has an on-call doctor or nurse-practitioner, but the office was closed. I had a feeling I should see a doctor, in case I needed antibiotics.

I Googled to find the number, and read this on the Telehealth website.
Call Telehealth for medical advice
Telehealth Ontario is a free, confidential service you can call to get health advice or information. A Registered Nurse will take your call 24 hours a day, seven days a week. 
  • Toll-free: 1-866-797-0000
  • Toll-free TTY: 1-866-797-0007
Telehealth Ontario is only offered over the phone. Email advice is not available. 
How it works
When you call, a Registered Nurse will ask you to answer questions so they can assess your health problem and give you advice.
Telehealth Ontario nurses will not diagnose your illness or give you medicine. They will direct you to the most appropriate level of care or may put you in contact with a health professional who can advise you on your next steps.
The nurse will help you decide whether to: 
  • handle a problem yourself
  • visit your doctor or nurse practitioner
  • go to a clinic
  • contact a community service
  • go to a hospital emergency room
Who can call
Anyone can call Telehealth Ontario to ask a health-related question. This service is: 
  • confidential –  you may be asked to provide your health card number, but it is not required
  • provided in both English and French, with translation support for some other languages
  • free for all users
What you can ask
You can contact Telehealth Ontario when you have health-related questions or concerns about: 
  • illness or injury that may need medical care
  • illnesses that don’t go away or keep coming back
  • food and healthy living
  • teen health and issues
  • depression, suicide or other mental health concerns
  • medications and drug interactions
  • breastfeeding
First a recorded announcement told me what was going to happen, and how to access emergency care. This part was kind of long; I wondered if most people would listen to that much information.

Then an intake person came on the line. She asked me a series of questions, then said I would speak to the registered nurse on duty. The wait would be about 20 minutes, and I could either stay on hold or she could call me back.

Fifteen minutes later, the nurse called. I told her what I was experiencing, and she asked me a series of questions.

When she was finished, she said, "Right now, when this call is finished, you should go the emergency room." I was so surprised, and asked if that was really necessary. "Yes. You must go. If you have a respiratory infection, while you wait to see a doctor, it will get worse. You can end up with bronchitis or pneumonia, and both are serious, especially if you already have respiratory issues. Will you go to the emergency room right away?"

The nurse also said I could use my inhaler (puffer) more often. I'm new to puffers and didn't realize that. But she wanted me to assure her that I would go to the emergency room.

Me: "If a nurse is telling me I should go, I guess I should."

Nurse: "Not just a nurse -- a panel of 12 doctors. A panel of 12 doctors created these interview questions, and based on your answers, you need to go to the emergency room."

I was highly skeptical, because I suspected I didn't have bronchitis. I didn't have either of the two classic symptoms, shortness of breath and chest pain. But the nurse was so insistent... so, despite my skepticism, I woke up Allan, and off we went.

There is an Urgent Care clinic in my area, and I knew that was more appropriate than the actual Emergency Room.

We waited three hours in UC. A doctor listened to my breathing, told me to use my puffer, and sent me home. The interaction with the doctor took 2-3 minutes.

I was annoyed at myself for going.

Allan and I talked about how you can't base your decision on an unknown outcome. If it turns out something is wrong, you're glad you went. If it turns out that you didn't need antibiotics or anything else, you feel stupid, like you should have known to stay home. Obviously you can't know the outcome until you go, so you have to go.

Two days later, I was still sick, plus I thought I might need a doctor's note for work. I called our health centre, made an appointment for the on-call nurse-practitioner, and was seen immediately. She listened to my breathing much more carefully than the UC doctor, and asked me more questions. She concurred -- wait it out. If there's no fever, green phlegm, chest pains, or shortness of breath, just use the puffer and wait it out.

When I told her that Telehealth told me to go to the ER, she said, "They tell a lot of people that. I think it's a liability issue."

Later in the week, I mentioned to a friend that Telehealth sent me to UC, she said the same thing: "That's what they do." We were with a group of people, and everyone seemed to agree that Telehealth recommends the ER or UC to cover themselves. What if they tell you to wait, and your condition worsens? What if you have a respiratory crisis, and it comes out that they told you to stay home and not worry?

Is this true? If so, what's the point of Telehealth? Actual question, not sarcasm.

Also, why didn't the Telehealth nurse ask if there was an UC facility near me? She only said ER. If I hadn't known the difference between UC and ER, I would have diverted ER care -- plus probably waited much longer, since I would be lower down on the triage scale in ER.


2 comments:

Jonathon said...

It's pretty rare that they would be comfortable telling you to 'wait it out'. They don't have docs on site, and docs are the ones tasked with and responsible for, making diagnoses. So in many cases, they tell you to go see a doc (which on weekends and evenings, pretty much means ER).

I had an instance where they told me to manage it at home and watch for A, B, or C; if any of those showed up, go to ER. ER's are set up to deal with EVERYTHING, whereas UC are not. So, telehealth will often default to ER, as it removes their 'responsibility for the diagnosis' from the equation...

So, yeah. Your experience is pretty typical

laura k said...

Makes sense, in a circular kind of way. Thanks.