Summer 2021 (Volume 31, Number 2)
A Great (Virtual) Debate:
Be It Resolved that Telemedicine Allows Rheumatologists to Provide Excellent Care to Patients with Autoimmune Rheumatic Diseases
By Alexandra Saltman, MD, FRCPC, on behalf of Volodko Bakowsky, MD, FRCPC; Tommy Gerschman, MD, MSc, FRCPC; Jocelyne Murdoch, OT Reg. (Ont.), ACPAC; and Brent Ohata, MD, CM, FRCPC
This year’s CRA meeting was one of many firsts, as
rheumatologists from across the country embraced
technology to participate in the annual meeting virtually,
keeping everyone safe amidst a global pandemic.
The annual tradition of the Great Debate was no exception,
wrapping up this year’s meeting with a fact-and-fun filled
hour of oral arguments and good old-fashioned jousting!
This year, the resolution was a timely one: "Be it Resolved
that Telemedicine Allows Rheumatologists to Provide Excellent
Care to Patients with Autoimmune Rheumatic Diseases.”
Arguing in favour of the resolution were Drs. Tommy
Gerschman and Alexandra Saltman, who proposed that,
“Telemedicine is excellent patient care in brand new packaging…
patient-centred packaging.” They reminded the
audience that telemedicine can encompass many domains,
including virtual visits by video or telephone, the use of an
online portal to share information, record measurements
or coordinate care, and the use of email or text reminders.
They argued that tele-rheumatology is a means by which
rheumatologists can provide care that is patient-centered
and accessible, allowing patients to access care from remote
or rural areas, as well as improving access to care for homebound
patients. They presented data on patient satisfaction
with virtual models of care, predating the pandemic and
during its course, as well as early data suggesting that the
quality is not diminished for patients with inflammatory
arthritis who receive care virtually versus in person.
They also proposed that tele-rheumatology is cost-effective—
saving patients, providers and the healthcare system
the costs of travel, parking, lost time and income due
to high no-show rates, and time off work for patients and
family members to attend in-person appointments.
They further contended that tele-rheumatology afforded
opportunities for collaborative and innovative models
of care, working with other disciplines and within the
patient’s home environment to meet patients where they
are at, and deliver high-value care.
Arguing against the resolution were Dr. Brent Ohata
and Advanced Practice occupational therapist (OT) Jocelyne
Murdoch, who maintained that rheumatologists are
not ready to embrace 21st century technology, and that
tele-rheumatology has been fraught with gaffes and blunders
by patients and providers alike. They claimed that
providing virtual care properly requires training, specialized
knowledge, specific equipment and preparation on
the part of the patient as well as the rheumatologist—none
of which is sufficiently available or accessible in today’s environment,
despite the pivot to many virtual visits during
the COVID-19 pandemic.
They went on to cite data showing poor uptake of virtual
care amongst rheumatology colleagues across the country,
a preference for telephone (47%) over video (19%) visits,
and a lack of technical support for those who do engage in
this type of care.
Furthermore, they argued that tele-rheumatology
exacerbates inequities in care between the technological
haves and have-nots, and they raised the frightening
spectre of missed or delayed diagnoses due to the limitations
of a virtual physical examination.
The rebuttals and summaries were filled with strong
counter-arguments, with each debate team using their
opponents’ personal and professional experiences against
them (though all in good fun!).
The outcome was “virtually” a tie, however the pro side did
end up squeaking out a slim victory (aided, perhaps, by the absence
of technological glitches mid-debate!), with the audience
voting 53% in favour and 47% against the resolution. Perhaps
these results show that, while there is certainly enthusiasm for
virtual care amongst our colleagues, we still have work to do in
optimizing tele-rheumatology for patients and providers alike—
and the time to do so is now, since virtual care is here to stay.
The Canadian Rheumatology Association has recently
put out a position statement related to virtual care
(tele-rheumatology). It recognizes that as a profession we
are at a unique time when we can responsibly seek to expand
and better understand the role that tele-rheumatology
may play in the future care of our patients.
Alexandra Saltman, B.A. (Hons), MD, FRCPC
Rheumatologist, Mount Sinai Hospital
Palliative Care Physician, Princess Margaret Hospital
University Health Network, Toronto, Ontario