Swaddled in an orange-and-black Giants blanket, 13-year-old Sergio Aaron Manriquez propped open his laptop and expertly signed into the video conference program WebEx, smiling to greet the face at the other end of the screen.
Kelsey Lythcott, a program analyst for the Integrated Pediatric Pain and Palliative Care unit (IP3) at UC San Francisco Benioff Children’s Hospital San Francisco, smiled back.
“I see you. Can you see me?” she asked. Aaron nodded.
“Looks like we’re ready for Dr. Kim,” Lythcott said. “I’ll go get her.”
Lythcott then handed her tablet to Dr. Cynthia Kim, an associate professor of pediatrics at UCSF specializing in pediatric pain management. She treats the pain Aaron suffers from metastatic osteosarcoma, also known as cancer of the bone.
“It’s nice to see you,” Kim said into the screen. “How are you feeling?” In response, Aaron lifted his hands to his cheeks and waved them back and forth, sucking in his cheeks to imitate a fish. His doctor laughed.
“That’s my favorite face. We always start with that face. That’s how I know that Aaron’s OK, when he makes his clown fish face,” said Kim. Such a conversation has become typical between Kim and her patients due to telehealth visits she conducts at UCSF. The program allows Kim’s patients, who primarily suffer chronic pain associated with cancer or other ailments, to continue their care from home via weekly consults on a computer.
As of this month, Kim has completed nearly 60 telehealth visits — more than any other provider at UCSF.
Aaron is the second patient of Kim and Lythcott’s to receive care using telehealth visits, which allowed him to live at his San Mateo home rather than a hospital from October through December, even enabling the self- proclaimed Giants fan to attend Game 5 of the World Series.
“I think this is going to be the way of the future,” Kim said. “It’s truly changed my practice. There’s just no way we could keep up with our clinic unless we did this.”
Each virtual visit lasts about 30 minutes and involves a conversation between Kim and her patient, and the patient’s caretaker. Through talking, Kim can gauge how a patient is feeling, such as when she speaks to Aaron via the computer and he makes a fish face, indicating he is feeling well enough to joke around.
After talking, Kim can alter a patient’s treatment plan, either prescribing more or less pain medication that a parent can fill at a local pharmacy. According to data collected by UCSF over the past six months, telehealth visits allow opiates to be weaned safer and faster.
“For the most part, you can do a lot on video,” Kim said. “I do 90 percent of my job on the phone or on video.”
By meeting virtually, patients on average save five hours and their caretakers save more than nine hours per appointment, according to UCSF data. Additionally, every patient surveyed by Lythcott following each telehealth appointment reported that it was easier to see the physician and that their medical needs were met.
Younger patients — often more tech-savvy — also enjoy using a laptop or tablet to conduct an appointment, Kim noted.
“Kids feel comfortable in that mode,” she said.
However, such visits can present challenges as well. Not all of Kim’s patients have Internet access at home. A patient who lives in Redding is driven by her mother 15 minutes to the community college, where the patient uses the school’s Wi-Fi to video conference with Kim from inside their car.
“It’s confidential, it’s in her car. I get to see her, I get to talk to her,” Kim explained.
Another family uses a private room at a nearby library to video conference with Kim.
“Families are really willing to figure out how to make it work, because they’re so grateful for not having to take off work, miss half a day or full day of school, or drive five hours,” Lythcott said.
Kim still sees her patients in person at least once a month. She administers acupuncture, which must be done in person as well. But the volume of visits with patients — both in her office and virtually — has tripled in just four months.
Kim predicts other doctors will soon latch on to telehealth medicine as well.
“I think the technology and the infrastructure is really there,” Kim said. “You now have to convince … the whole establishment that it’s worthwhile.”