In my prior role as the director of a 10-bed neuroscience ICU in a tertiary care medical center, I spent most of my workday coordinating the care of fewer than a dozen patients at a time. These patients often had multiple subspecialty teams assisting with their care, leaving me with only a few critical decisions to make. The amount of resources put into treating these patients far exceeded what was available to most critically ill patients in the United States.
Today, that scenario is still playing out in large academic medical centers. But for most hospitals and systems, resources are much more limited. As healthcare confronts multiple challenges of costs, rising patient acuity and the exodus of burned-out physicians and other clinical staff, this disparity is only getting worse. Gaps in care that impact quality, safety, patient satisfaction and outcomes are widening.
This is why after decades of bedside care I joined a small but growing cadre of highly trained medical subspecialists who fulfill most of their clinical and educational duties virtually. This move has greatly expanded my ability to make positive contributions to both clinical care and teaching.
Via a variety of telehealth technologies, I am able to apply my years of training and experience in critical care medicine, infectious diseases and neurocritical care to the bedside of patients in some of the most remote and resource-limited hospitals in the country. Not only am I able to see many more patients in a single day, but the amount of benefit derived by my personal involvement in the care of each of these patients is much greater. This has been extremely fulfilling.
Similarly, telemedicine has greatly expanded my ability to teach other medical professionals. In my past position as the director of a large critical care medicine fellowship, I would spend most of my time teaching one or two doctors who were toward the end of their five to eight years of clinical training. These fellows were selected as part of a highly competitive process and had already received much more time in training than your average physician. Although these rounds made for highly interesting and sometimes fruitful discussions, the amount of new knowledge that I felt was acquired by my fellows each day was limited.
Now that I round at multiple hospitals daily, I am able to teach many more providers. They range from medical residents to general practitioners, nurses, nurse practitioners and physician assistants. At some of the more remote community hospitals where I do virtual rounds, they may be the only clinicians providing care at the bedside. The amount of up-to-date knowledge that I can convey to them is immense. Overall, they have been very appreciative of my assistance.
In order to prevent burnout and achieve healthy work-life balance, many younger physicians are now joining companies such as mine. I am excited to be working with them via our in-house provider education program. I have always been interested in using technology to foster new and innovative approaches to medical education. At my current company, there is such a natural fit between the continuing educational needs of providers and the ways I like to teach.
When I chose telemedicine over a primary bedside practice, I was concerned about its limitations. Happily, I have found that it has only expanded my ability to contribute to improving healthcare.
Adam Keene, MD, MS
Dr. Keene serves as an Attending Physician as well as the Director of Provider Education at Equum Medical. Keene is a Board-Certified physician having certifications in Critical and Neurocritical Care, Infectious Disease, Internal Medicine, as well as Hospice and Palliative Medicine. Dr. Keene completed his primary studies at Columbia University and Medical School at UCLA with post graduate training at New York University, Columbia and St. Vincent’s Medical Center. As the Director of Provider Education, Dr. Keene focuses on physician on-boarding and continuing education at Equum Medical and also practices as a telehealth intensivist.