Given the choice, I think most of us would like to die at home surrounded by our loved ones. A century ago, that was more likely than it is today when the end of life is more often spent in a hospital, often kept alive by machines to help us breath and drugs to ease our physical pain, while we become spiritually and emotionally detached. I was quite moved recently by a segment on the PBS News Hour about a palliative care physician, Michael Fratkin, whose patients live in a vast rural area of northern California. He travels a great many miles by small plane, but once a solid relationship in an environment of trust has been established, he is able to visit his patients and monitor their physical and spiritual health more frequently with videoconferencing.
One of his patients is a 73-year-old woman with an aggressive form of pancreatic cancer that would require surgery and chemotherapy. She prefers to stay home and live a normal life with her family no matter how long or short her remaining time may be. She said her husband was in a hospital for a very long time before he died there. She does not want that experience and prefers to live out the rest of her life at home. Videoconferencing is a way to provide high quality care to this woman and other patients who would not be able to get frequent care because of their distance from brick and mortar health care facilities. Traveling long distances for care and treatment incurs physical, psychological, and financial stress to patients as well as their caregivers. How much more comfortable would it be to get help and care without leaving home.
While this seems a positive way to care for such patients, the problem of paying for it remains to be addressed. Medicare does cover some areas of telehealth, even videoconferencing. However, the conference must take place at a medical facility, not the patient's home.
There is no standard for private insurers yet, but they, too, seem to be considering this direction. Beginning in 2016 a new law goes into effect in Oregon that covers videoconferencing no matter where the patient is located. Until now Oregon, like Medicare, offered video conferencing only between two medical facilities.
In Connecticut, Anthem Blue Cross and Blue Shield recently offered a Live Health Online to customers in group plans and Medicare plans, allowing a patient to use a tablet or computer to talk with a doctor. Hopefully, others will follow this trend.
Palliative care via videoconferencing has been studied for some time in Canada. In 2007 the provincial Ministry of Health provided a grant to Canadian palliative care providers to study cancer patients in rural northern Alberta. They learned that delivery of specialist multidisciplinary palliative care consultation by videoconferencing may actually improve symptoms, result in cost savings to patients and families and is satisfactory to users. The medical director of a hospice care group in Canada used Ontario Telemedicine Network, to begin a project of seeing patients near the end of their lives through videoconferencing, including a pilot project that loans computer tablets to such patients.
In the PBS program, the woman with terminal cancer carried on her life as normally as possible. She was not isolated in a hospital room with nothing to look at but the television. She was moving around her kitchen with her family as they got dinner on the table. There was camaraderie and laughter. And while the woman acknowledged to Dr. Fratkin that her emotions had been painful at first, and she sometimes experienced severe back pain from her condition, she was able to cope with it because she was in a loving environment; not in an impersonal building with strangers and many other sick people.
When Dr. Fratkin made one of his less frequent in-person home visits and asked her how she was feeling inside herself, she was able to smile as she sat back on her own comfortable couch in front of a window that looked out on the rural mountain landscape she so loved.
A century or two ago, spiritual care for people in remote areas, was provided by the circuit rider, often a Methodist minister, who traveled by horseback to rural villages to dispense care. I know of a healthcare chaplain in rural Wyoming who still does that, albeit with a car instead of a horse. But like Dr. Fratkin in a small plane, he can only cover so much territory at a time and with video conferencing he would be able to spend more quality time with his patients.