A Recent Televisit
I will write something about the whole idea and concept of televisits at a later time however in this post I would like to describe a recent case as an example. Televisits are the future of clinical visits and I suspect that in the next 4-5 years the majority of visits will be done through some sort of electronic device and not face to face with a clinician. Many companies are gearing up for this and advances in tech are impressive in this field. I didn’t say whether I’m for/against it, it’s just my observation.
This patient is a 68 yo male with no past medical history. I spoke to him over the phone and he reports left 3rd toe sudden redness and pain along with swelling. It started 5 days ago and when he first noticed it he had moderate left foot swelling as well. No fevers or chills and with some icing swelling of the foot came down the first day. Today there is only redness of the distal portion of the 3rd toe. He mentioned that he had taken a picture of the feet on the 1st day which his wife could email me. So we exchanged emails and while on the phone I got the picture in my email.Left 4th toe swelling, redness and pain along with foot swelling.
From the picture (which is very well taken by the way) you can see swelling of the left foot. The skill to learn for this change in medical examination is to REALLY pay attention to details of an image. Notice the disappearance of the veins on the left foot. Notice the tension in the skin folds between the 1st and 2nd digit, notice there is good signs of circulation. There is slight redness over the proximal dorsal midfoot but it doesn’t appear indurated and there is no redness in the rest of the foot except the toe. So this is likely not an infection that’s spreading proximally. There is isolated redness over the entire top portion of the left 3rd digit. The skin is more pinkish with some slight breakdown with no signs of skin induration.
After our discussion I reassured him. I told him I see no signs of cellulitis. Patient didn’t need a xray since no trauma occurred. It’s possible he had a gout attack (no hx of this in the past), it’s possible he had an acute non-gout arthritic flare but less likely for that to cause extensive foot swelling as well. An irritated blister is possible as well but due to improvement I wouldn’t manage differently.
Patient was reassured. I had him look on the bottom of the foot. He had no other symptoms that were concerning. I posted this case because it’s such a convenience for patients who just need reassurance. Being able to get an image to complete the clinical picture was very helpful. Thankfully this wasn’t a genital issue because I’m still trying to figure out how I’m going to deal with that. Oh and I gave him thorough return precautions so he is tucked in nice and neatly.
Are you doing televisits?
What are your thoughts on televisits as a clinical took for assessing patients?