This is the time of year when residents are interviewing for their chosen subspecialties. Sadly, endocrinology and pediatric endocrinology are not on the top of the list for lucrative salaries and an easy lifestyle. It clearly takes an interest in chronic care and a desire to care for patients in a longitudinal fashion to thrive in this specialty - thus developing relationships that can last for many years. Due to the dearth of endocrinologists and pediatric endocrinologists, there are many areas throughout the world that do not have enough necessary endocrinology care available, particularly for people who have insulin-dependent diabetes. As such, there must be a means to deliver care to those who live great distances from diabetes healthcare providers.
我们的儿童全国卫生系统华盛顿国民糖尿病护理复杂，包括远程医疗套件的建设后，我们就可以开始远程看诊。几年前，我写了一篇博客，宣布我们的新节目。在过去的一年半的时间里，我们一直与儿童和青少年工作从马里兰州东海岸，包括岛屿丹吉尔的，和特拉华州通过我们的远程医疗实践。在物理上，以达到东海岸，一个必须赶过来的切萨皮克湾大桥（一个非常大的和长期跨区桥 - 如同到奥克兰海湾大桥连接旧金山和奥克兰）。该驱动器是约两个来自华盛顿特区，一个半小时，使其很难对患者随访预约桥过来，甚至在附近的马里兰州安纳波利斯。通过我们的远程医疗方案，我一直在与这些孩子参观青少年每月，具有护士执业，提供了一个“动手”的方式给病人，进行体检共同努力。接下来我们来看看胰岛素治疗方案和剂量，下载血糖仪，讨论关心的事情，并制定治疗计划 - 所有在电视屏幕上。
Initially, I was worried that I could not develop a close, working relationship with my patients due to the distance between Children's National and Peninsula Regional Medical Center (PRMC) in Salisbury, Md., where many of my patients are seen. However, much to my relief, this has not been the case. We have been able to get to know each other, and with the help of my NP, Flora, these patients have been returning to see her between visits, enabling me to make treatment changes by communication with her at PRMC. In addition, as part of her thesis project, a pilot survey was conducted by a Nursing PhD student that demonstrated great satisfaction with the program.
As such, I was invited last Thursday evening to address the professional community residing on the Eastern Shore about our program and about "Innovations in Pediatric Diabetes." Much to my delight, many of my patients and families came to PRMC so that we could "meet and greet" prior to the discussion. Some of the families even attended the presentation. One family just came to quickly meet me in person and then immediately had to drive their child to participate in a sporting event. The fact that these families drove several hours to meet me in person meant so much to me personally and professionally and made the entire initiative worthwhile. It became very clear that we could, indeed, deliver quality careanddevelop a personal relationship without actually being physically present in the exam room.
As a result of our success with patients on the Eastern Shore, providing steady professional care and close follow-up in conjunction with the staff at PRMC, other specialties at Children's National are planning to provide telemedicine services. We also are looking to expand our coverage to other rural areas that lack pediatric endocrinology or diabetes specialists in Virginia, Delaware, and other remote counties of Maryland and beyond.
Evidence-based reports have demonstrated that telemedicine is a very effective means of delivering healthcare. Indeed, though we are not the first healthcare team to provide this service, we would encourage its application as much as possible throughout the country-and worldwide- as means of delivering care to those who cannot physically reach a needed specialized healthcare team.