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Pre-COVID Telemedicine was anathema for many ODs. The current situation seems to have increased its credibility for many. I’m even hearing from people who believe the crisis we are witnessing is the beginning of a new era where exam lanes morph into a chimera of telemedical and traditional care. Will we see a post COVID paradigm shift in the way we practice where telemedicine and traditional medicine are used together in the exam lane? Is telemedicine here to stay?

Why is telemedicine suddenly OK to use for certain problem-specific issues but not comprehensive care? A look at care provided in the military can help us gain insight. A soldier at a modern military hospital has access to standard of care medical treatment. When they deploy the best care available is provided by field hospitals or medics with medical kits, both lower standard of care than a hospital, yet available and better than no care, thus acceptable. When the soldier returns to the military base they receive the hospital standard of care once more. Nobody wants our soldiers to be treated by a medic with a medical field kit where there’s a modern hospital available. The problem-specific telemedicine we can use during this crisis provides a level of care analogous to the care a soldier receives in the field if the only care available. It has suddenly become acceptable to provide telemedical sub-standard care during this pandemic also because it’s what is available. Pre-pandemic, visionary’s touted telemedicine that would cover comprehensive care. While current telemedicine tech can handle urgent and problem-specific issues to a limited degree, we are far from having the ability to provide comprehensive care. There will come a day where telemedicine provides the same standard of care as traditional medicine, and there will be a “med-moment” where the telemedicine standard of care will surpass the traditional medical standard of care. Until then the only fundamental change the telemedicine of today will result in is the way we practice during temporary crises; those where we aren’t able to see patients face-to-face.

Health care providers may not want telemedicine for one of many reasons, but whether they want it or not, technology to deliver telemedical solutions marches on regardless; there is no way to avoid it. Someone wise once said, “the market gets what the market wants”. The market demands telemedicine options and demand will only grow. When will we be ready for comprehensive, main-stream telemedicine? Only when technology utilized for telemedicine does not in any way decrease standards of care. Clearly we are not there yet. Fear, hysteria and those with a commercial interest in the success of telemedicine are driving the message that in the post-COVID world telemedicine and traditional medicine will suddenly converge and change how we practice in the exam lane.

Regardless, Optometry must embrace a future where telemedicine plays a significant role. We need to be included as providers in telemedicine and we need to ensure we are the professionals who define what is acceptable and position ourselves to be the profession chosen to regulate it. Inclusion is critical to the future of the profession. It ensures we don’t end up in a situation where the telemedicine practice of Optometry is subject to regulation by insurers, corporations or worse, rules laid down by other eye care professions. We must be sure we are on par with other eye care professions when it comes to reimbursement as well.

Don’t mistake the fact that telemedicine is suddenly gaining acceptance as an indication things are changing in the exam lane when we get back to work. From a public health perspective, it’s fortunate we have the tools that have been developed so far and kudos to the brilliant minds and entrepreneurs that are pushing boundaries in this area. You are on the front lines of transforming health care and we salute you. For the average, everyday grunt clinician it’s our responsibility to limit telemedicine visits to remote urgent care. Not only do we need to ensure we are invited to the party, we need to be the ones throwing it. We turn into a pumpkin at midnight if we don’t ultimately embrace telemedicine. If we run away from the party no one is going to chase us down and to give us our glass slipper back. At that point, it’s game over for the profession.

Alan Glazier
Proud founder of a private practice in the Maryland suburbs of Washington DC. and I founded this small online community called "ODs on Facebook". I like to connect people.

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