Telemedicine as a Practice Model

A fundamental skill developed in medical training is triage - the ability to determine which patients go to the ICU vs. floor, which patients come to the office vs. ED, and which patients follow up in 1 week vs. 6 months. For many seasoned providers, thes e decisions are reflexive as they have become unconsciously competent in considering the necessary information (severity, prognosis, data needed, treatment planned etc.) that underpins them. The COVID-19 public health emergency forced us back to conscious incompetence as the options changed: In office follow up was discouraged as were ER visits for some conditions; Telemedicine emerged as a new option and was encouraged. The most common triage decision became deferred visit vs. video visit, with only emergencies meriting in person care. At the time of writing, in October 2020, this is no longer the most common triage decision. As practices have re-opened many providers have returned to life as it was in the before times including traditional triage decisions. However, telemedicine remains an important tool in our armamentarium for delivery of Neuro-ophthalmic care. It can be thoughtfully utilized to support high quality care that is satisfying to the patient, provider and staff. Failing to consider it as a triage option is a disservice to our patients.