Telehealth Best Practices: Dr. Erkeda DeRouen On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Telehealth is not suitable for every problem: This may not be surprising to some, but telehealth has limitations. Not only do obvious visits, such as pap smears require in-person care. Other not-so-obvious things may need a higher level of evaluation. A doctor using a telehealth system takes your concern, asks appropriate questions, and triages the next steps using evidence-based medicine. When a doctor tells you no or states that they need more info with an examination, it means that they are giving you thorough and comprehensive care.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. Erkeda DeRouen.

Erkeda DeRouen is a Board-Certified Family and Lifestyle Medicine physician that serves in healthcare innovation in the telehealth space. Passionate about merging the human aspect of medicine with the new field of emerging technology, she has been able to utilize her gift of listening, communicating, and connecting the missing pieces through her speaking engagements. Dr. DeRouen also hosts a weekly podcast called “The Prospective Doctor,” focusing on hot topics in medicine for pre-meds and medical students. She can be contacted on her website www.drerkeda.com.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Thank you for interviewing me! I am originally from the DC Metropolitan Area. I have always had a love for science and people, so I chose to channel those passions into a desire to pursue medicine early on. I went to College at Hampton University. I then progressed to Boston University School of Medicine for medical school followed by the University of Maryland for residency. I chose Family Medicine as a specialty because I was drawn to helping care for families from the cradle to the grave in its most intimate moments. After a while of working in underserved communities, I decided to transition to digital health in order to work to figure out ways to expand quality access to care in a manner to impact more people.

Can you share the most interesting story that happened to you since you began your career?

That’s a tough question, as medicine is full of captivating stories that are impacted by the bonds that individuals form with their doctors. I will share a fun one. When I was caring for patients in an LGBT community center, I bonded with one of my patients who had a life full of great highs and deep lows. She was a transgendered individual that had to make a living in the business of sex. We spent over a year working to keep her safe and to treat her HIV. There were times when she would go missing for months, and then return with colorful stories of a life of adventure, but underneath it all she really wanted a stable life. She was so proud to tell me on one visit that she had switched careers from providing in person services to solo online entertainment. Boy, did we dance in celebration in the exam room for her victory. I will keep that memory with me always.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

My favorite life quote is “Figure out what kind of life you really want. Then, say no to everything that is not that.” Learning about what I really want has been an evolution, as so many paths are predetermined in medicine. Now that I am more comfortable with saying no to things that don’t support where I am headed, I have more space for exploring new possibilities.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

It definitely takes a village to support a person. I owe mostly everything to my strong mother, Pamela DeRouen, but there are other people that touched me throughout my journey. I would like to highlight one of my mentors, Ms. Janella Moore. She was my high school administrator who pushed me to choose the college that I did, as well as develop leadership skills, while acting as a confidant and personal cheerleader. She taught me to “Plan to work and work your plan,” which has led me to strategically approach different situations. She, unfortunately, passed away on the day of my high school graduation. I will remember her forever.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

As human beings, there is a lot of lost connection when someone is not in the same room. After a year of virtual meetings, I’m sure that the readers would agree that a virtual interaction is not as personable as an in person one. There is so much exchanged through body language and eye contact. If someone becomes tearful after a new diagnosis, it is much easier to console them by passing a piece of tissue paper or giving a hug, as opposed to using merely gentle words and awkward silence virtually.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

The variance in the availability of vital signs is a challenge. These measurements determine a lot of decisions about certain diagnoses and plans. Even with some home devices, such as thermometers or blood pressure cuffs, there may be less reliability depending on the patient’s comfort with using the device.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)

Mastering how to approach a telehealth visit is an acquired skill. Here are 5 things that you should keep in mind.

1. Medical Problem History: No one knows your medical history better than you. There is no universal medical record system, so many of the things that are documented by one doctor may not be available to the current doctor that is treating you. If you are utilizing a telehealth company that is not affiliated with your primary care office, let them know all of the things that you have been diagnosed with, as it could come into play with your diagnosis and treatment.
2. Medications: Similarly to the above, medication lists are important. Letting a healthcare provider know what you are taking is important, as some medications may be contributing to your symptoms and some medications may interact with potential medications that the provider is planning to prescribe.
3. Allergies: Always disclose your allergies in order to avoid allergic reactions.
4. Vital Signs: Vital signs are vital! They can give signals as to how your body is responding to stress or infection. Do not guess about certain numbers, like fevers, as it can determine a course of management of a condition. Lots of people state that they have a fever without measuring with a thermometer. It is impossible to tell if one has a fever without a thermometer, as the numbers are very specific. A temperature of 100.3 versus 100.4 designates an afebrile state versus a fever.
5. Telehealth is not suitable for every problem: This may not be surprising to some, but telehealth has limitations. Not only do obvious visits, such as pap smears require in-person care. Other not-so-obvious things may need a higher level of evaluation. A doctor using a telehealth system takes your concern, asks appropriate questions, and triages the next steps using evidence-based medicine. When a doctor tells you no or states that they need more info with an examination, it means that they are giving you thorough and comprehensive care.

Here is a link to an accompanying video.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Telehealth provides a great opportunity to expand access to care. Not only can it help in more rural areas where 9% of physicians care for 20% of the US population, but it can also provide opportunities for people to engage with medical care in a way that fits into their life structure. For example, a person may not need to take off of work in order to check on their rash since telehealth hours can be more flexible. Parents don’t need to find a babysitter or pack up their children to attend a visit to follow up on their hypothyroidism. The accessibility allows more people to seek care that may have avoided it.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

The access to tools varies greatly depending on what system you are using to see patients. Some systems are fully integrated with all of the bells and whistles, while other systems are literally a Zoom call. I would say in my personal experience, video and connected devices are great, i.e. a virtual otoscope that could provide images similarly to if I were looking at a painful ear in an exam room have been very helpful.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

Gosh, there are so many features that would take telehealth to the next level. I would love to be able to send a virtual drone to a patient’s home to complete a robotic examination, similar to how surgeons use robots.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Firstly, I wish that patients knew their medical history and medications. It is important to keep a copy of this in your smartphone or in your wallet, as you never know when you will need to tell this to a physician or provider in an urgent care, emergency department, or telemedicine company that is not affiliated with your primary care office. Many patients are surprised that information is not shared in some sort of universal electronic medical record. So am I. Having accurate data about yourself will help doctors connect the dots to rule in and rule out causes of symptoms, order the right tests, as well as safely prescribe medication.

Another thing that patients should do is try to provide as much information as possible. Some patients are a little vague with the history of their illness, which may make it a little more difficult to swiftly and correctly diagnose and treat. Pretend like you’re talking to your best friend and tell us everything. We would like to know at the very minimum: what concerns you, when it started, is it constant or intermittent, what makes it better/worse, how bad is it, and what have you tried to make it better.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

Wearable technology gives me goosebumps. It will allow patients to share more data for more personalized recommendations.

Is there a part of this future vision that concerns you? Can you explain?

Absolutely. While it’s fascinating to observe the growth and adoption of technology, it is also something that could make one concerned about job security in the future. Hence, all physicians need to join the club of technologically-integrated care.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

That is a great question! If I could inspire a movement, it would be for people to work on advocating for a more equitable health ecosystem. The pandemic has pulled the curtain back on so many health disparities. Working together to encourage access and equitable care to everyone will benefit the nation. Vote and chat with your elected officials to continue to push the needle for equity forward.

How can our readers further follow your work online?

I’d love to hear from the readers!

Instagram www.instagram.com/doctordgram

my website www.drerkeda.com

My LinkedIn www.linkedin.com/in/erkedaderouenmd

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.