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FMC tapping distant healers via teleconference

Nurses tending to Karen Vickery while she recovered from a hip surgery walked into her room at The Peaks last winter to find her acting and speaking abnormally.

One side of her face was drooping, indicating a probable stroke, so Vickery was sent to Flagstaff Medical Center for a CT scan.

This scenario leads to a tough call for doctors.

A patient suffering a stroke due to a bleed in the brain needs one kind of treatment; a patient suffering a stroke due to a blood clot can greatly be helped by a clot-busting medication.

But if a doctor gives the clot-busting medication to a stroke patient suffering from uncontrolled bleeding, the patient dies.

So physicians here are very hesitant to give the drug without a recommendation from a neurologist -- and only one neurologist takes calls at Flagstaff's hospital.

"It is very challenging to direct care for patients when you do not have specialty services readily available," said Dr. Jennifer Conn, physician and medical director of the emergency department at FMC.

Vickery, 69, had a blood clot and got a drug that previously might have been withheld -- all due to help from faraway specialists able to examine her remotely with help from teleconferencing equipment.

Furthermore, 83 other people believed to have stroke symptoms have been examined remotely at FMC in the past year, with five others receiving the blood-clot-busting drug, and 71 admitted to the hospital.

These remote consultations could be happening more here, and that has time-saving implications for people living in areas far from Flagstaff, such as those with chronic health problems and those kept home due to bad weather.

Vickery got the clot-busting drug because another physician from Mayo Clinic Hospital in the Valley teleconferenced with her to check out her symptoms and make the determination about what was wrong.

"They brought this television in, and there was this doctor from Phoenix talking to me," Vickery remembered.

A doctor using this teleconferencing equipment can sometimes see the patient's heart rate, blood pressure and oxygen levels, for example. But the doctor can also ask the patient to do relevant tasks, like holding his or her arms out to look for a tendency to drift in cases of stroke.

The patient and physician view each other on computer monitors.

These kinds of consultations are also more accurate than one physician phoning another and describing the symptoms, one study found.

Vickery next received an injection and some intravenous medication.

"Within a couple hours, I was almost back to normal. The next day a doctor examined me and said it was like I never had a stroke," she said.

She's now in a different recovery unit in Show Low, following knee surgery.

REMOTE DIAGNOSES

This distance medicine could be useful in remote tribal villages, for example, where nurses could have the capacity to tap into software measuring weight, blood pressure or other indicators in patients, said Gigi Sorenson, head of FMC's telemedicine program.

"It's keeping the patients in their closest home environment, in contact with the best specialist they can get," Sorenson said.

This could save some trauma patients $25,000 helicopter flights to FMC if they actually need to be transported to a different hospital, for example.

It has possible uses for mental health counseling via home computer, and for keeping patients with treatable physical conditions on their regimens.

CONSULTATION PAYMENTS LOW

FMC is largely a recipient of advice from medical specialists elsewhere, but that could change, too.

It's possible Flagstaff's physicians could someday be providers of medical advice on faraway children needing pediatric specialists, for example.

There remain a lot of "ifs" for one main reason: Although so-called "telemedicine" is happening across North America and Europe, Medicare and insurers aren't yet willing to pay much or sometimes at all for telemedicine here.

Medicare is paying just $24 for the average physician consultation at FMC, for example, and insurers are denying claims on some of these consults.

Sorenson is seeking out grants to fund FMC's programs now.

A study on the matter out of Mayo Clinic said the field lacks systematic cost-benefit studies that weigh outcomes for patients and possible cost savings.

Published by the Arizona Daily Sun and written by Cyndy Cole, Sun Staff Reporter.



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