Accept that there are challenges — First and foremost, it’s important to acknowledge that telemedicine will have limitations. Knowing this going into the visit allows the clinician to think of ways to overcome those limitations as they arise. This mindset is important for risk management and patient safety. Understanding limitations will ultimately lead to solutions, whether during the visit, or for the industry as a whole.
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. M. Samir Qamar.
Dr. M. Samir Qamar is the CEO of MedWand Solutions, Inc. and a practicing physican. In 2014, after working with Google on telemedicine projects, Samir found a team of medical engineers and invented the MedWand to provide what he thought was the missing link in telemedicine — physical exams. An award-winning family physician with an international upbringing, Samir envisioned MedWand technology being used to examine patients at any location around the world, whether down the street or in the next continent. Samir believes that advanced telemedicine will eventually replace much of what we see in the clinical world today.
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?
I was born in Lebanon and grew up around the world in a United Nations family, living in many continents and learning many languages. After college in the U.S., even my medical schooling was international, with studies in England, the Caribbean, and the U.S. Once I fulfilled my goal of becoming a doctor, I became obsessed with improving healthcare wherever I could, whether via new business models or new technology. I am constantly driven by a need to create something better for humanity. I believe my unique childhood has a lot to do with it.
Can you share the most interesting story that happened to you since you began your career?
As many doctors do, I often receive medical calls from friends and family. It was one such call that changed my life. My sister, at the time living in Chicago, called my cell and complained of a bad cough. “What can I do, I can’t even listen to your lungs!” I remember telling her, a frustration that carried over from my own telemedicine experiences where I couldn’t examine patients remotely. Then an idea dawned on me — what if we could use the phone’s mic to pick up breath sounds? I asked her to seal the bottom of her cell phone against her bare upper chest and take a few breaths — when she complied, I could hear her lung sounds! After reassuring her and hanging up, I immediately took apart my own iPhone to see how small the camera and mic were. Why not use similar miniaturized technology to form a multi-diagnostic device to examine patients during telemedicine appointments, sort of like a “medical computer mouse?” Patients could be examined through their computers or smartphones, and doctors would finally be able to examine patients remotely, something that was always missing in mainstream telemedicine. A week later I called Bob Rose, a master engineer, to ask him if he wanted to team up and create something extraordinary — and MedWand was born.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Whether you think you can, or you think you can’t, you’re right.” — Henry Ford
I came across this quote in high school and I never forgot it. I always liked cars, and Henry Ford was an icon I had always admired. He challenged the resistant status quo and emerged victorious. The quote is about whether your inner confidence and beliefs are strong enough to reach your chosen goals. It speaks to me of stubborn resilience and believing in your vision when others simply cannot see what you are seeing. I have made this quote a part of my life philosophy when embarking on any challenging venture, whether putting myself through medical school, or founding disruptive startups.
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?
I have been fortunate to have many mentors. In business, there was the late billionaire Richard Rainwater, who was also my patient. In medicine, there was the late Dr. John Judson, the famous cardiac surgeon I first met in Haiti on a medical mission. Throughout life, however, my mentor has been my own father, Dr. Kalim Qamar, a former United Nations diplomat.
In 2018, my healthy father suffered a horrific, surprise heart attack that nearly killed him. His body kept giving up, but his medical teams, which I coordinated, kept fighting for his life. For months he was trapped in a Las Vegas ICU where we battled a never-ending domino-effect of medical complications. After a coma, he lost both his legs, nearly all his fingers, and was so weak he could not even sit. Determined to live, however, he fought. He became a champion in rehab, exercising however he could, never missing a day for two years. Today, using advanced prosthetics that I helped design, he has taught himself how to walk and drive again. He just finished his first novel and will soon return to painting. It is the ultimate come-back story, and he did it while smiling and laughing. The impact on me has been profound. It reinforced in me that nothing is impossible, and the importance of never giving up no matter how dire the situation.
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?
Seeing patients in person is currently the gold standard, something telehealth and related technology is trying to emulate. Advantages of having a patient in front of you mainly revolve around stronger communication, testing capabilities, and physical examination.
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 main challenges with virtual care are essentially tied to the benefits of seeing a patient in person — communication, testing, and physical examination.
Communication in virtual care is an issue on several levels. First, body language is difficult to ascertain, as many times only the patient’s head and shoulders are viewed. A nervous patient’s toe-tapping, or pathologic tremor elsewhere on the body can easily be missed. Second, interruption with communication bandwidth, software, or hardware can be a critical issue. Even now, there are many areas of the world that don’t have Internet or broadband connectivity necessary to conduct telehealth visits. Finally, human contact, psychologically an important ingredient in patient care, is missed entirely.
Gathering patient data via testing and studies is still a challenge in telehealth, whether it’s a patient’s vitals, desired imaging, or necessary blood work.
Finally, physically examining a patient is very difficult in today’s video-centric virtual care ecosystem. Clinicians cannot graduate from their professional schooling until they master physical examination methods, yet mainstream telemedicine has ignored this important area of patient assessment. This, however, is beginning to change.
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.)
- Accept that there are challenges — First and foremost, it’s important to acknowledge that telemedicine will have limitations. Knowing this going into the visit allows the clinician to think of ways to overcome those limitations as they arise. This mindset is important for risk management and patient safety. Understanding limitations will ultimately lead to solutions, whether during the visit, or for the industry as a whole.
- Ensure optimal communication — On a micro level, patients should make sure there is good connectivity. Clinicians should make efforts to see more than the patient’s head. Asking a patient to sit a little farther back can make a big difference, as can changing the angle on the patient’s camera. Looking at the camera when speaking allows the patient to feel that the clinician is looking at him or her, important for rapport. Good lighting to illuminate facial expressions is also important. On a macro level, there should be strong online connectivity and communication equipment on both sides of the visit, clinician and patient. Improvements with satellite networks, faster connection speeds, and better cameras will make a big difference in the future.
- Incorporate remote testing — In the present, we should try implementing testing methods that already exist. Online, patients can take their temperature or blood pressure with their own equipment. For labs, they can ask for referrals to labs, or even order specific tests via commercially available home testing kits. In the future, I believe testing technology will improve dramatically, allowing patients to use integrated biosensors to collect and send data for medical analysis whenever needed.
- Incorporate trustworthy telemedicine diagnostic devices — Physical exams are a necessary component of standard medical practice, whether in person or via telemedicine, and methods should be sought out to do so. Currently, very few telemedicine examination devices exist, and the ones that do are either limited in functionality, or inaccurate. The patient’s own camera serves as a powerful visualization tool now, but more data is needed for medical visits. Telemedicine devices like MedWand are solving for this problem by combining highly-accurate multiple diagnostics into a singular handheld unit, incorporated with high-definition audio-video technology. With MedWand, physical exams can thus be conducted during telemedicine visits across any distance. This is the future of telemedicine.
- Care for patients as though they were in front of you — It may seem obvious, but remembering that patients on screen are real individuals with real medical needs is important. While every clinician’s style varies, all patients want to feel cared for and expect basic health services. Empathy, politeness, and competency can all be conveyed online. Telemedicine devices like MedWand, in fact, contribute to building rapport — patients feel connected to their doctor, for instance, when their heart is listened to or when their throat is examined. A patient will be more loyal to the clinician who cares and provides better medical service — whether via telemedicine, or in person.
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?
This is an interesting question, as telemedicine limitations are what are frequently discussed. In addition to the obvious advantages of access and convenience, there are numerous other benefits to telemedicine over in-person visits:
- Lower cost — Despite increasing insurance reimbursements for telemedicine visits, the overall cost of telemedicine visits is still lower. Many telemedicine services charge lower rates than in-person visits. In addition, there is decreased cost to the patient via travel elimination in addition to taking less time off work for medical appointments. Future advances with prescription delivery, remote testing, and remote diagnostics will lower the cost further, especially in primary care.
- Decreased microbial transmission — The recent pandemic gave the world a rapid education on microbiology and germ transmission. It may sound simple, but the importance of decreased microbial transmission with telemedicine cannot be stated enough. After the pandemic, many will find telemedicine comforting for this reason alone.
- Virtual house calls –- As a former house calls doctor, I can attest to the many advantages of seeing patients in their home setting. Telemedicine carries similar advantages. When discussing diet, for example, the patient can be asked to open their fridge. If there is a question regarding medication, the patient can readily access the medicine cabinet and offer instant clarification. A virtual home tour can help assess fall risk. These perspectives cannot be replicated when a patient is in the doctor’s office.
- Decreased anxiety — It is quite common for patients to feel anxious coming into a doctor’s office. Many experience trepidations with the journey itself, especially if there are problems with ambulation or transportation. For reasons to do with mental health, some aren’t comfortable in waiting rooms or other public places. Artificially elevated blood pressure from anxiety, or white coat pseudo-hypertension, can cause challenges with blood pressure management. Much of this is eliminated with telemedicine visits.
- Access to best care anywhere — Distance becomes irrelevant in telemedicine, and a patient no longer has to choose from local providers. As interstate medical practice becomes the new normal, patients will seek care beyond their home area if needed. Renowned specialists can be accessed more easily, as can better clinicians, no matter the distance. From a medical economics perspective, this will lead to more competition among clinicians to provide better service, ultimately a win for the patient.
- Better collaboration with family and medical teams — With in-person visits, it is a challenge to have necessary family or medical team members present for a medical visit, especially if they are in separate locations. Telemedicine can solve for this easily, especially with telehealth platforms that allow multiple people to join.
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?
To best replicate the in-person medical experience, I have found video to be very effective when it comes to communication choice, better than audio or text, where much can be lost in translation. For examination, it’s best to use clinically accurate telemedicine diagnostics that are intuitive to use, both for the patient and the clinician. Unfortunately, not many exist, but companies like ours are actively creating solutions.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
At the very least, the perfect telehealth system must replicate the four components of the doctor’s visit — communication, examination, testing, and treatment delivery. Communication is when the patient relays relevant history to the doctor. Examination is next, where the doctor physically examines the patient using a stethoscope, otoscope, or other diagnostic tool. Obtaining vital signs such as temperature, heart rate, and oxygen levels are part of this examination process. Testing includes assessments such as EKGs, spirometry, and blood analysis. Finally, treatment delivery is the prescribing of medication, therapy, or referrals to other clinicians. The telemedicine industry, still in its infancy, has been predominantly stuck in the “communication” phase. Very little has been done in other areas, and if so, there is almost no coordination of the other elements to create an all-in-one experience. The perfect telehealth system would be able to offer all the aforementioned elements under one roof as a basic first step.
Taking it further, this perfect telehealth system would be able to integrate its software with any EMR system, currently a source of frustration for many in the telemedicine industry. Additional barriers to be overcome would be easing interstate medical practice, allowing insurance reimbursement, and including accurate telemedicine diagnostics.
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?
Communication is everything, so patients should ensure their connection is good. Taking the call where bandwidth is poor can cause communication problems where details matter. Taking the time to learn basic technology tasks, such as downloading apps, checking Wi-Fi and connection speed, and texting help tremendously. Additional items that patients should think about include call location safety and privacy, familiarity with any telemedicine diagnostics, and taking their vitals with home equipment prior to starting appointments.
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?
I know of a company that captures a person’s speech and spoken thoughts, combines it with artificial intelligence (AI), and creates interactive VR avatars of that individual, essentially replicating that person in VR. If combined with medical data, I can see the emergence of “virtual clinicians” as a technology to enhance access to those who require basic medical care. Combined with telemedicine diagnostics and testing, this can become immensely powerful.
Is there a part of this future vision that concerns you? Can you explain?
Artificial intelligence is only as intelligent as we make it. It is not just about capturing enormous amounts of data and creating algorithms to retrieve relevant data. Human thinking requires logic and reasoning, ethical insight, and judgement based on varying circumstances. Even if we create “perfect” AI incorporating all the aforementioned elements, I worry about the ethical implications of such technology as it relates to patient care. Our obsession with technology can sometimes have negative consequences. Sometimes, all the patient wants is someone real to touch, something technology can never replicate.
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. 🙂
It’s been theorized that we produce enough food to feed everyone on the planet. However, excessive waste, bureaucracy, and poor logistics get in the way and people starve every day. What if we could find a way to redirect resources to help feed everyone on this planet? It’s not that we don’t have enough food, we do. We simply need to channel it properly. Wouldn’t that be something?
How can our readers further follow your work online?
Twitter is @medwand
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.