Practicing Telemedicine as a Family Physician in a Pandemic

Session 174

Dr. Olatokunbo Kolawole is a telemedicine family physician. She joins me today to talk about her path to medicine and discuss what telehealth is like during a pandemic.

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Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:28] Interest in Family Medicine

Prior to medical school, Dr. Kolawole had always wanted to become a doctor and she was interested in either family medicine or OB/GYN. After doing some clinical rotations and as time went on, she became fascinated with family medicine just because she was seeing a wide variety of medical conditions.

Being the type of person who likes excitement in her day, she thought such a specialty kept her going. And why she chose family medicine over OB/GYN was because of the types of cases she was seeing on a daily basis.

[03:26] Traits That Make a Good Family Medicine Physician.

As a physician, you have to care about your patient. You have to understand Family Medicine in terms of having full knowledge of a vast array of different medical conditions.

'As a family doctor, you are essentially a gatekeeper in healthcare.'Click To Tweet

As a family doctor, you’re the person that the patient sees first so there has to be a trusting relationship between you and your patient.

A lot of patients come to a family doctor wanting answers of what they should do or what next steps they should take or if they should see a special specialist. Ultimately, you need to strongly care about every facet of patient care.

So, not only do you have to have that strong knowledge base of virtually every other specialty but then if it’s beyond your knowledge base, you can always refer a patient.

[05:39] Biggest Myths or Misconceptions Around Family Medicine

Dr. Kolawole feels that if there are no family doctors out there, then it makes the job of a specialist harder. A lot of times when they see patients, they’ve already done a lot of the initial evaluation and workup before they send them to a special specialist. So she believes every patient needs to have a family doctor.

In other specialties, specialists are trained for that specific specialty. A family doctor has a vast array of knowledge of different conditions.

Medical students may also feel that a family medicine doctor doesn’t measure up to any other specialty.

'If you really are interested in the field, and if you have a good foundation and knowledge of the field, it's as good as any other specialty.'Click To Tweet

[07:52] Types of Patients

Family medicine doctors take care of preventative medicine. This includes sports physicals and acute cases. For example, patients come in with infections like urinary tract infections, sinus infections, colds, coughs, chronic cases, such as diabetes, hypertension, COPD, or asthma. Some patients come in with heart disease, congestive heart failure, or coronary artery disease.

So they are trained to see a vast array of patients and conditions from acute to chronic cases. They see from newborns, all the way up to geriatric patients, and everything in between. And at times, they will do some minor procedures in their practices as well.

“It's very robust and there's no dull moment in family medicine.”Click To Tweet

[09:29] Typical Day

In an office setting, Dr. Kolawole starts off at about eight in the morning, and she would be done by about 4 pm or 5 pm. She sees about 18 t0 24 patients a day. It’s fast-paced, very interesting, and exciting.

Sometimes, they might see a lot more chronic cases where she’d have to spend a lot more time with patients. If she’s seeing a diabetic patient, for instance, she has to educate them, understand their eating habits, order blood work, review any testing she had ordered prior to the appointment. So it can take quite some time.

But then, the next patient could just be a UTI, where they’re doing a urine dip. And before they even get a positive indication that the patient has a urinary tract infection, they’ve already treated the patient on the way. Again, she sees a vast array of patients every day.

[11:57] The Future of Virtual Medicine

Dr. Kolawole believes virtual medicine is here to stay 100%. Virtual medicine companies have sprung up since COVID. On a typical day, Dr. Kolawole would see close to 30 or more patients virtually. It’s faster-paced than a family practice as they’re seeing mostly urgent care and acute cases. They’re spending 10 to 15 minutes just talking to a patient and finding out what their concern is.

'Virtual medicine was here prior to COVID and it definitely is here to stay.'Click To Tweet

Although they do order lab testing, there are some conditions that don’t require that. And a lot of patients are still grateful to have a doctor to talk to online because.

So many patients are fearful of going to a doctor’s office. They’re fearful of going to urgent care and going to the ER. That being said, she still sends some cases into the emergency room when she feels they need more evaluation. But definitely, virtual medicine is here to stay and on a larger or wider scale.

[14:17] Going Into a Career in Virtual Medicine

For students who are thinking of a virtual telemedicine physician as their main career, Dr. Kolawole recommends that students still need to go into whatever specialty. They still need to have a mindset of seeing patients in a hospital or community setting or clinic because those are the kinds of settings where you will get training from. But just have that understanding that you can work virtually down the line if that’s something you’re interested in.

“Students still need the foundations of medicine and still need to practice in either a hospital or clinic setting.” Click To Tweet

Additionally, not all patients who come in should be virtual patients because some of them need that hands-on, face to face visit. And even in some cases, they need to be seen in an emergency room setting.

Dr. Kolawole admits she misses having that physical contact, of being able to touch, feel, and examine patients. Even with telemedicine, she’s looking at her patient through video where she’s able to guide them, it’s not the same as that hands-on care that she provides in a clinic setting. The fact that she’s doing this now doesn’t mean she would never go back to practice. It’s just what’s working for her at this time. And she’s grateful to have this option because not every specialty has the option of going completely virtual.

Put simply, this is just one of the benefits of urgent care, primary care they’re able to do to provide patient care.

[17:17] Training Path

After medical school, you get into three years of residency. And as a resident, you’ll get to go through core rotations in pediatrics, obstetrics and gynecology, internal medicine, psychiatry, surgery, neurology, and community medicine. You may also complete some other subspecialty rotations. Some doctors would do an extra year or two, say, in Sports Medicine or Reproductive Medicine. Some other doctors go into Emergency Medicine. But these are fellowships that you complete after your three years of residency.

Dr. Kolawole thinks that although the field is easy to get into, you still have to work hard, get good grades, and get high scores on Steps. So as a specialty, it will be one of the least competitive ones. Family doctors have a lot of work to do and it takes a great knowledge base to work and collaborate with other specialties.

[20:23] Message to Future Specialists

What Dr. Kolawole wishes future specialists to know about family medicine is that sometimes, when they refer patients to specialists,

Just know that they are working together as a team for patient care. Their goal is to get the best care for their patients. And they would appreciate it if they know they’ve done their due diligence.

They’re not just sending them off to be evaluated from scratch. They’ve done as much as they could do. And when they get to a point where we feel okay, it’s time for them to see someone who specializes in that area and can address the problem more effectively. So, I would like

'We're all working together towards a common goal. We get the patients ready and as far as we can before they're referred to them.'Click To Tweet

[22:51] Taking Calls

As a telemedicine Family Medicine doctor, call is not there for you Dr. Kolawole. However, when she was still in her practice, her call wasn’t as intense as some other family doctors and as it was when she was a resident.

She would typically be on a call about four or five times a year, which is every six to eight weeks and they would receive calls from nursing homes and the ER.

In her practice, she wasn’t required to go to the hospital because she worked outpatient in an outpatient setting. But there are doctors that still combine outpatient and inpatient medicine. So whenever they’re on a call, they may have to go to the hospital and they’ll see a patient.

Now, most of the patients that were admitted to the hospital were seen by hospitalists. This is the difference from when she was in residency. Back then, they were still seeing patients, both inpatient and outpatient.

It was a traditional family practice where we saw patients in both settings. So if she was on call and she had a patient that was admitted to the hospital, she will be that doctor that would have to go to the hospital. She would have to see the patient, evaluate the patient, and have to see the patient on a daily basis. And on top of that, she will have to combine that with her outpatient. So she would have clinic days, while also seeing patients.

However, after she had graduated from residency, she decided she wanted to focus solely on just outpatient only. And so, that’s what she has been doing all these years.

[26:08] The Most and Least Liked Things About Family Medicine

Dr. Kolawole primarily loves the variety of cases that I see. She likes that she can treat patients across genders, or ages, from newborns to geriatric patients, and she gets to treat families as well.

'I have that trust and relationship with my patients. They know that they have a doctor that they can go and talk to, and we can address whatever the problem is.'Click To Tweet

Knowing generations of families trust her as their family doctor is something really special. Just having that rapport with patients and being able to care for them on different levels is very rewarding.

What she likes the least about the specialty, on the flip side, is the challenge of balancing career and family. As a family doctor, you’re trained to do virtually almost everything. When she was still a resident, she not only saw patients in the ER, she also delivered babies, scrubbed in for surgeries, and virtually everything else. She thought to herself that if she really wanted to have just that balance of her career with the family, she knew she had to find a way to make this work for her.

And so, that’s when she decided to just focus on one area and decided not to go down the traditional route of both inpatient and outpatient. It just wasn’t for her as an individual.

[31:11] Final Words of Wisdom

“Go into medicine for the right reasons.'Click To Tweet

At whatever point when you decide what specialty you want to ultimately pursue, have an open mind. Because as you continue to rotate through different specialties, you would find that, all of a sudden, you’ll fall in love with another one. So just have an open mind.

Most doctors never really end up in the specialty they originally wanted to go into. And that’s because when you’re starting out in medical school, you don’t really have a full understanding until you actually start to rotate through those specialties.

Dr. Kolawole also encourages students to be strong-minded and work smart. Persevere because the road is not an easy one. There’ll be obstacles in the way. But other people who went through those challenges have overcome them and are doctors now.

Finally, it’s important for students to have a mentor that is bold. But if you can find a mentor that you can rub minds with and discuss your goals and what you desire, ultimately, that will really help you and guide you along the way. This will also help you avoid making mistakes that others have made.

Again, just work hard, stay focused, stay strong, and stay determined. There is a great deal of mental toughness involved in medicine. And once you’ve made up your mind that this is the path you want to take, you will definitely be able to achieve it with the right people, the right resources, and the right mentors around you.