Healio: Surgeon considers patient perspective to establish telehealth protocols for TJA

Prior to the COVID-19 pandemic, Richard A. Berger, MD, established a telehealth protocol to accommodate patients both outside of and within the city limits of Chicago who needed a total joint replacement.

“I always try to put myself in my patient’s perspective. If I needed a joint replacement, I would find the best specialist who used a minimally invasive procedure that allowed for a quicker recovery. If that means traveling to find that specialist, I would do so. The beauty of our telehealth consultation is the patient can meet the medical team virtually and only has to travel to Chicago for the surgery,” Berger, assistant professor of orthopedic surgery at Rush University Medical Center, told Healio Orthopedics.

Berger started performing telehealth visits on a limited basis, with the hope of adding more telehealth visits to his schedule as it became more integrated into his practice.

“Then COVID happened, which rapidly changed everything,” Berger said. “There are a lot of horrible things about COVID, of course, but there are some silver linings. One of them is that we embraced new platforms to care for our patients. Suddenly my staff, as well as a lot of other people, were forced into implementing new strategies to care for our patients. These strategies included telehealth visits, which, ultimately, are more convenient for some of our patients.”

Similar virtual, in-office care

When creating telehealth protocols, Berger said his staff wanted to provide the same care patients would receive if they were to come into the office.

“We want to always provide a first-class experience for our patients,” Berger said. “Whether in the clinic or via telehealth, we offer a concierge level service to everyone.”

Berger noted the telehealth protocols established in his practice involve speaking with patients to identify the source of their pain and collecting their medical history. He also reviews X-rays when available.

Once the patient’s history is reviewed, Berger performs a virtual exam, which involves having the patient walk toward and away from the camera. Patients are also asked to perform various range of motion and functional tasks.

“Occasionally, it is a little more complicated with telehealth consultations, so we may enlist a family member to help us examine the patient,” Berger said.

However, he said, there are some exams performed in the office that cannot be performed virtually for more complex cases. Although rare, Berger said, in those cases, patients will either have to set up an in-person office visit or go for additional testing.

“But that is a rare thing. Usually, the telehealth visit is essentially the same [exam],” Berger said. “We get the same history, a similar physical, and we review the X-rays just as if the patient were in this office. This creates a standardized medical visit for our patients – whether they are in person or on the computer.”

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