In RI, now you can talk to a local ER doctor without leaving home

Over a weekend in the summer — maybe it was late July, maybe early August, he can’t remember exactly — Warren resident Andrew Galligan started to feel quite tired and weak. He passed out on the couch on that Saturday afternoon and his wife, Kim, couldn’t rouse him. 

On Sunday, he developed a fever. He’d also been dealing with gas. He was going to wait until Monday to go to the doctor, but Kim, who works at Brown University, told her husband about a new service that Brown Emergency Medicine had launched recently through which people could call up an emergency doctor on a laptop or cellphone for a video visit.

So, despite his desire to just go to sleep, he decided to give it a go. Or as Kim, who serves as an unpaid member of the Brown Emergency Medicine board of directors, describes it with a laugh: “I shoved the computer in front of his face. He was not willing.” 

The face that came up on the other side of his computer screen wasn’t some intern or med student, not some newbie wet behind the ears. 

"Holy cow," Andrew thought, "I know this lady."

“I knew her face from TV,” said Galligan, who still has an Irish accent from his native Dublin. “She was right there, lookin’ at me.” 

“It was an absolute delight,” the emergency doctor on the other end of the laptop, Megan Ranney, said in an interview.

Ranney is better known nationally these days for appearing on TV screens: She’s become a go-to voice for CNN and other media outlets to discuss COVID.

But she is still a practicing emergency physician, too, and Galligan was her first telemedicine patient. 

“I felt really lucky to be able to take care of him,” Ranney said. “I’m really glad he called instead of just suffering.” 

So, what was ailing Galligan? Ranney, Galligan said, instructed Kim to poke him in the stomach a bit.

Sharp pain. Appendicitis. He’d need surgery.

Ranney looked up a hospital he could go to. The Miriam wasn’t too busy. She told the Miriam he was on his way.

By 1 a.m., just a few hours after his telemedicine visit, Galligan, 54, was under the knife, having his appendix, which might not have stayed intact until Monday, surgically removed. 

“I think it was fantastic,” Galligan said of his telehealth experience. “Say I just had gas and you go to the hospital and spend six hours in a waiting room, and you’re told you have gas — that’s one way to feel silly.

"I think a lot of guys like me, you really have to be dead before you go and see the doctor, you know what I mean?” 

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Yes, and especially during the COVID pandemic, that reluctance has become even more acute.

That’s where Brown Emergency Medicine’s new telehealth service comes in. From anywhere in the state with an internet connection and a smartphone, tablet or laptop, people can get care for urgent — but not life-threatening — problems via video chat. 

Telemedicine has been growing for years. And thanks to COVID, it probably will only increase. One of Gov. Gina Raimondo’s first executive orders regarding the virus back in March was expanding access to, and insurance reimbursement of, telemedicine. 

The initiative by Brown Emergency Medicine, an independent physicians group, started in July. Now that COVID is surging again, stretching hospitals and emergency departments, its practitioners are pitching it as one option to take care of acute medical needs.

So far, the virtual patient queue has been a “steady trickle,” the people running it say, and they’d be happier if they were busier. 

“The word needs to get out,” said Dr. Susan Duffy, a pediatric emergency physician who is codirecting the program for Brown Emergency Medicine. 

The physician group works in Lifespan hospitals, which include the only Level 1 trauma center in the area, at Rhode Island Hospital. But Lifespan itself is not involved in this telemedicine initiative. 

The Brown Emergency Medicine telehealth program is looking to fill a niche in Rhode Island — acute, but not life-threatening, medical needs. Though the platform is staffed by emergency physicians, if you’re suffering from a true emergency, like a gunshot or chest pain, call 911 or go to the emergency room. 

But if you think you might have COVID or the flu, or have a sports injury and aren’t sure whether it needs stitches, or if your kid has a worrying rash, sore throat, minor falls or a sprain? That’s when it might just be easier to do telemedicine. The website is https://www.brownemtelecare.org. It's available from noon to midnight, seven days a week. 

Of course, there are national players in the telemedicine game. So, what’s the value proposition of doing it with the folks at the local physicians group?

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“We practice at a level that’s a step higher than you would get in an urgent care,” Duffy said. “And we’re local experts. We run the emergency departments of this state. We know the health-care providers.” 

There are, of course, limitations to telemedicine. Doctors cannot put their hands on a patient through the phone. Not everyone has a pulse oximeter or blood-pressure monitor at home. There’s also the question of access. Not everyone has an internet connection, much less a smartphone or laptop with a camera. 

“We’re going to have to be very careful to make sure people can access it,” Duffy said in a phone interview. 

Mindful of a journalistic lesson about reporting on soup kitchens — you have to try the soup — The Providence Journal did a simulated visit with this telemedicine initiative. The patient, 32, was negative for COVID but reported a recent flareup of asthma. 

You have to fill out a few forms — they take insurance — and then you’ll get a text that states, if your name is Brian, “Brian: The doctor from Brown EM Telecare is ready to see you.”

In all, it took about 10 minutes from filling out an online form to seeing the doctor.  

Program codirector Dr. Gary Bubly, from his book-lined office at home in Somerset, appeared on the other end of the camera phone. He quickly determined the patient looked OK right now — wasn’t using any accessory muscles to breathe.

He had the patient take his own pulse, counting off heartbeats, and that was OK, too — 68 beats per minute. The patient walked around a bit, then showed a few of his inhalers as they chatted about asthma. 

“The patients love this,” Bubly said in an interview over the telehealth platform, a Zoom-ish provider called Healow that’s fully HIPAA compliant. “Every single patient loves this.” 

Bubly likes it, too. It's a different atmosphere in his home office than in a busy emergency department.

And one of the benefits of telemedicine is actually COVID protection itself: When he's in a hospital, Bubly is wearing an N95 mask, which can get uncomfortable after a few hours. At 60, he worries about exposure, but with telehealth, a patient can stick the phone camera right in their mouth to check on abscesses without any problem for either of them. 

Meanwhile, just like he could in person, Bubly can prescribe medicine, order up tests or, if things are bad enough, tell the patient to go to a hospital.  

“The genie is out of the bottle with telemedicine,” Bubly said. “It is just so convenient.”

bamaral@providencejournal.com

(401) 277-7615

On Twitter: @bamaral44