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Most certainly has, both in telehealth and in-person. It has become more prevalent as treatment plans (esp in acute care) have become more and more algorithmic to help reinforce a midlevel run system. Problem is that when you have patients who dont fit the algorithm, like in this case where a 45yo with CKD is rare to see and you have to ask why he might have CKD. My guess is whatever algo they use said '45 yo with SOB/cough, try inhaler first' but didnt mention the CKD. Hemoptysis, is also a reason to send to the ED, but in fairness, can be seen in young chronic bronchitis patients.
But a 45yo with CKD is a red flag for likely other underlying issues going on (autoimmune like lupus, cystic disease, thrombosis etc) that makes them extremely high risk. Considering the speed at which the pt deteriorated, the blue feet a pulmonary embolism is high in the diff.
Telehealth is more dangerous than in-person as that perceptive discrepancy is exacerbated when you cant see the whole patient, and dont know what to ask 0 reply
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