The ED isn't for everyone.

As an emergency physician, I am often asked about the most challenging cases I see in the emergency department. There are several types of patients who present to the ED.

First, there are diagnostic dilemmas that challenge my clinical and physical diagnostic skills. These patients often require sophisticated diagnostic tests and subsequent admission to the hospital. When an elusive diagnosis is correctly identified in the ED, it’s especially rewarding because the care team can immediately embark on treatment to improve patient outcome. Patients are also relieved to have an explanation for their symptoms.

A second type of difficult patient is one with an acute exacerbation of a chronic condition, where the goal is to alleviate suffering and bridge a gap so that care can be resumed by the primary care provider as an outpatient.

Lastly, perhaps the most discouraging cases I see in the emergency department are those patients who don’t need to be in the ED at all. Increasingly, I find myself wading through an ED waiting room overflowing with patients, many of whom do not need to be seen in an acute setting but have no other choice. They’ve tried to contact their primary care provider, but are unable to be seen in a timely fashion, or illness occurs after the clinic has closed in the evening. Many of these patients will wait between 2 to 6 hours to be evaluated for a problem that could be handled in 15 minutes in an outpatient setting. Patients are understandably frustrated by the long wait, short evaluation time, and hefty bill from the ED after such a visit.

At CirrusMD, we provide all patients access to timely care by a local physician who knows their primary doctor’s practice. Patients are evaluated on average within minutes of texting the on-call provider. Patients accessing our service range from pediatric to geriatric with complaints that run the gamut from strep throat to cellulitis to abdominal pain. The majority of cases can be handled with asynchronous communication through text messaging with an ability to send pictures or use video as needed.

This rich dialogue between patient and physician is a game changer in telemedicine. In many cases, patients can be appropriately advised and treated in the outpatient setting. They can also be correctly identified as needing acute care and directed to go to the emergency department. Patients calling in can be followed and reevaluated by the same on call provider over many hours, and changes can be made to the patient’s treatment plan as needed. The responding physician also has access to the patient’s medical record to optimally direct follow up care.

CirrusMD provides a platform that is a win-win for patients and physicians. Patients have access from home to board-certified physicians in a timely fashion when they need it. The result is more convenient cost effective care in the appropriate setting, leaving me more time to see those difficult diagnostic patients. Telemedicine by CirrusMD is all about delivering the best care to more patients throughout the community.

John Dutton, M.D.

I'm the Medical Director for CirrusMD

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