In the mid-1980s, Richard Dean Anderson portrayed Angus ‘Mac” MacGyver, a protagonist who rebooted the fame of the Swiss Army knife, duct tape, and ID card with an incredible knack at unconventional problem solving of unforeseen problems.  A sensitive dude, MacGyver tended to blame himself for personal losses and tragedies including his guilt of missing his mother’s funeral and depression he ensued after his best friend tragically died from a climbing accident that they did together.

I was reminded by this as the roll-out of Telehealth and the irrational exuberance by many in our profession toward it. On the one hand, we have MacGyver PT’s, using what is necessary during unprecedented times and understanding that this new tool is like a Swiss Knife-able to get the job done and ok is not the enemy of good but understanding it is at best an adjunct and not a replacement or business model.

On the other hand, we have opportunists clearly bored with stay at home orders including:

An email from a “cash-based only” PT who already has converted his entire patient population to Telehealth and is actually now making more money than ever and is offering for a 50% discount for you to join his Mastermind group so you too can learn how to convert your patients and make more money

An advertisement for $750 on how to set up your own Telehealth platform

PT’s actually calling and promoting themselves as Telehealth experts

A healthy twitter conversation in which I participated where all kinds of thoughts were detailed including PT’s espousing Telehealth as a choice, the evidence is on the side of Telehealth and that Telehealth is just like education-can choose to do it online or in-person

PT’s being called out for not adopting Telehealth earlier and even more indicting essentially calling us Luddites

Other calling out how this opens access to more patients in more remote areas and that there is more to PT than just hands-on care

Other claiming this our future, get used to it (the proverbial “get on the train or get off” argument common in our past).

And yet others claiming it will lower cost (side note, clearly this was Medrisk’s position pre-pandemic but they really mean their cost and thus more profits)

Far more refreshing though PT’s who regularly treat patients are also weighing in, “It sucks”.   The limitations eliminate the essence of a physical exam and testing and what most describe as our critical differentiator- 100% inability of hands-on interventions including the most evidence-based.  This does not mean they won’t be using it post-pandemic, as an adjunct and platform for the right patient, at the right time of their treatment plan at the right dose.  Of course, the Telehealth PT experts and those who paid $750 will simply say the PT’s aren’t doing it right as though Telehealth were a Ouija board.

But, let’s also not forget our patients either since their values and preferences are critical parts of clinical decision making. Simply ask 10 patients if they prefer exclusive PT as Telehealth, blended, or in clinic. Without prompting or biasing, I talked to 15 this weekend and 2 said they would prefer blended and none exclusively. One patient said they preferred hybrid but only if it is after some visits to the clinic or if it was a recurrent problem where they needed reminders and explanation of exercises and self-management.  The other mentioned they would like it because of their travel schedule and they already have a trusting relationship with their PT-they want to keep that relationship exclusive!

Regardless of your position, we can all agree that during this pandemic, necessity is indeed the mother of invention and we can learn new skills and techniques without believing our entire profession is going to be spent finding creative virtual backgrounds on Zoom. We can take a measured approach that involves the use of professional judgment rather than an extreme take in which we try and convince payor or each other that Telehealth mode is interchangeable with clinical #physicaltherapy.

Personally, Telehealth is MacGyver time right now and although we might use this “Swiss Knife” when we return to normal times, we will do so judiciously. Unlike MacGyver though, let’s not feel guilty during losses that we are all invariably going through right now.

Stay safe.

Thoughts?

@physicaltherapy

Note: the opinions expressed here are my own and unaffiliated with and company or group