Telemedicine enables me to accept patients who are located over an hour away from my general practice. I’m able to follow their cases personally instead of delegating follow-up care to another physician, and that leads to better care and a higher degree of patient satisfaction.
- With telemedicine I can easily visit a patient three times in the same day. It enables me to provide a very high standard of care.
- Robotic telemedicine makes patient care more personal, not less personal. It delivers face-to-face interaction and the sound of my voice provides comfort. The family can provide support because they are there with the patient.
- Patients and their families want the highest-quality consultative care, and they have little or no resistance to establishing the doctor-patient relationship via telemedicine.
Interview with Peter N. Bretan, Jr., MD, FACS
An accomplished surgeon, Dr. Peter Bretan is a urological specialist in private practice in Novato, CA. Founder and Chair of RotoPlant/Life Plant, Dr. Bretan is known for his humanitarian work performing kidney transplants in the Philippines. In addition to his work as a leading urological surgeon, Dr. Bretan currently serves as Adjunct Associate Clinical Professor of Urology at Touro University, CA, and is a past president of the Marin Medical Society. He also served as Associate Professor of Surgery and Urology at UCSF, where he graduated from medical school and performed his residency. Dr. Bretan has additional expertise in pancreatic and renal transplantation, radiology, physiology, and molecular biology.
Within the first year since you were first introduced to telemedicine, how has your practice changed?
Telemedicine enables me to accept patients who are located over an hour away from my general practice. The powerful time efficiencies have enabled me to become the urologist for the town of Sebastopol, CA. I perform surgeries with full support from the local hospital’s physicians and nurses, and then follow my patients via telemedicine. My practice has expanded to include general patients in Sebastopol, as well as the elective surgeries I’ve added to my case load. What I like is that I’m able to follow their cases personally instead of delegating follow-up care to another physician, and that leads to better care and a higher degree of patient satisfaction.
From the perspective of a urologist, what is the difference between a virtual consultation and a direct examination?
From my perspective, there’s really no difference in the vast majority of cases. In hospitals where there is no urologist available, telemedicine reduces or eliminates the need to transport patients via ambulance. Patients are grateful to see a specialist that can care for them, and by working with the clinical support staff I can review x-rays, CT scans, and lab records from any remote location. Telemedicine makes it more convenient to have a conversation with patients and their families, and everyone is more confident because they know the patient is safely under my care.
Urology is well-suited for telemedicine because there are only two urologic emergencies. If the patient is stable, I can schedule them for elective surgery, which is beneficial to the economics of the hospital. Surgery can usually wait 72 hours, which gives me a chance to put my patients on antibiotics and do a cardiac workup. Patients can be safely evaluated via telemedicine, and then I can schedule surgery if I determine it’s necessary.
Are you able to follow your telemedicine patients as closely as your local patients?
Absolutely. Sometimes I’m even more comprehensive, because with telemedicine I can easily visit a patient three times in the same day. I can order a sonogram or a blood test, get the results, and then come back in a couple of hours and see the patient again. I want to be sure that the patient is super-stable, and if necessary, I can easily see a patient three or four times in a single day. The evaluations only take a few minutes, and I can conveniently work them into my office schedule. It’s much quicker than seeing patients at a local hospital, and it enables me to provide a very high standard of care.
Critics sometimes feel that telemedicine is an impersonal method of communication. Would you please comment on that?
My experience is that robotic telemedicine makes patient care more personal, not less personal. Telemedicine delivers face-to-face interaction, which lets my patients to see my concern for their health. This facilitates the doctor-patient relationship – there’s almost no difference in our interaction whether I’m with them in person or in my robotic persona.
How does telemedicine affect your relationship with the hospital support staff?
The telemedicine solution fosters a different relationship between physicians and the support staff in a remote hospital. The nurses understand that I’m working remotely, and they’re willing to work with me to support my efforts on the patient’s behalf. As a specialist, I have found that by working closely with my nurse practitioners that there is absolutely no loss in assessment – they perform the physical exams onsite, and I am able to evaluate the results via telemedicine. Once the relationship has been established, it is both workable and effective.
How does telemedicine affect your relationship with the patient and their family?
There’s a real advantage in treating patients by telemedicine, because it keeps them close to their family and close to their primary-care physicians. Patients and their families want the highest-quality consultative care, and they have little or no resistance to establishing the doctor-patient relationship via telemedicine. When I meet them in person, it’s a seamless continuation of our relationship – in fact, they often say “You look just like you do in the robot!” Frequent contact via telemedicine provides a strong foundation to the relationship. The sound of my voice provides comfort as I discuss their case, and the family can provide support because they are right with the patient.