A guide to getting the most out of virtual care
One expert answers your most pressing questions about digital health appointments.
In the blink of an eye, the coronavirus pandemic has changed how doctors in America treat everyday illnesses and handle routine checkups. Video visits and phone consultations are suddenly a very accepted normal practice.
Virtual care’s big moment to shine has arrived, according to Ryan Spaulding, Ph.D., acting director of the University of Kansas Center for Telemedicine and Telehealth.
Sparked by the onslaught of COVID-19, the respiratory illness caused by the new coronavirus, health care providers have quickly turned on their virtual open-for-business signs.
At the same time, Medicare, private health insurers, and state and federal regulatory agencies have all relaxed their rules surrounding virtual care tools so that people can limit their trips outside the home and cut exposure to the highly contagious virus.
“We are rapidly deploying telehealth technology at scale during this public health emergency,” says Steven E. Waldren, M.D., vice president and chief medical informatics officer for the American Academy of Family Physicians.
But just because the roll out has happened at an impressively fast pace, that doesn’t mean you’re entering unknown territory. “Some patients think, ‘Are we going to be doing this thing that’s experimental or not really proven yet?’ and that’s not the case,” says Spaulding.
“Telemedicine has been around since at least the 1960s,” he continues, “and in some health fields it’s become commonplace. So, it’s not experimental. It’s documented. It’s secure. It’s private. Virtual care is a good way for providers to connect with patients.”
Before you and your doctor make your first online connection, here are answers to your most pressing questions about virtual care in the age of COVID-19.
What, exactly, is virtual care?
Simply put, it’s the care you receive from your doctor or other health care provider when you can’t be in the same room together. It can be a video chat, or you can use an app or online portal. In some cases, even a phone call with your doctor can count as an exam. (More on that later.)
As Spaulding noted, virtual care dates back as far as 1959, when the Nebraska Psychiatric Institute started using video conferencing to provide therapy to hospitalized patients.
You may also hear the terms telemedicine and telehealth; both are umbrella terms for the many interactive technologies that doctors use to provide care from a distance. Think of virtual care as the toolbox that holds all these methods of connecting online or on the phone.
If virtual care is not new, why am I only now hearing about it?
One word: coronavirus. To prevent the further spread of the virus, doctors need to meet people in the safest place possible, which right now many times happens to be your own home, says Dr. Waldren.
“Telemedicine isn’t best for every type of medical situation,” explains Dr. Waldren. “If you feel the need to see your doctor about something that’s going on with your health, we encourage you to call your doctor, explain what your issues are, and consider a telemedicine appointment.”
He notes that doctors across the country—even in communities that aren’t so-called “hot spots” for the coronavirus—are doing risk assessments: Is the risk to my patient greater if I see them in the office, or greater if I see them during a video visit?
“In the current environment, and especially if the patient has underlying lung or heart problems, or is of an advanced age, the risk may be worse to actually have them come to the practice,” says Dr. Waldren.
Does this mean being seen in person is out of the question?
Not at all. Obviously, chest pain, breathing problems, broken bones, and severe wounds require emergency care. But if you have a sore throat, a mysterious rash or if you are due for a routine checkup for an ongoing health issue, a virtual care call is the best first step.
Can a doctor provide good care and give an accurate diagnosis this way?
While the hands-on aspects of a doctor visit can’t be met if you’re at home, virtual visits are surprisingly wide-reaching and thorough. “Many routine appointments, across all conditions, can be transferred to telemedicine,” says Spaulding.
Post-surgical follow-up? Check. Dementia care? Check. Diabetes and cardiology appointments? Check and check.
“We even do a block of telemedicine appointments for ALS patients,” he says, referring to amyotrophic lateral sclerosis (aka Lou Gehrig’s disease).
Behavioral health has a long track record with virtual care, especially in the treatment of post-traumatic stress disorder, depression, anxiety disorders, and ADHD, according to the American Psychiatric Association.
A doctor’s first preference is always going to be to see their patients in person, admits Dr. Waldren. But a lot can be accomplished even through a simple video call.
“A doctor can ask you to get close to the camera,” he explains, “and they’ll be able to see if your lips are not pursed and if your color is good. They can also ask to see the area underneath your collarbone and check to see that it’s not sinking in, so you’re not having labored breathing.
“There are a lot of things physicians can see straight away,” Dr. Waldren continues, “and know that you’re generally okay, you’re not likely in respiratory distress, and be less concerned that you’re in an emergency situation.”
Two examples that may warrant an in-person visit include keeping your infant and toddler up-to-date on their vaccinations and having a new or changing lump checked out.
“Nineteen years ago, when I started in telehealth, people were really surprised that a doctor visit could be done this way,” says Spaulding. “Today, what surprises people the most is how routine a video visit can be.”
Will I be able to get prescription refills or new medicine if I have a virtual care appointment?
Yes. Even if you’re not seeing your regular doctor, a provider in the practice will be able to access your electronic records and prescribe necessary medicines.
In fact, the Drug Enforcement Agency, or DEA, has loosened some of its rules surrounding the prescribing of certain medications
Normally, some medications couldn’t be prescribed without an in-person visit (and in some cases testing), Dr. Waldren explains. Now, however, a virtual care appointment with a video component will satisfy that face-to-face requirement. (Different state regulations may still apply.)
He adds that there are some opioids and medicines used to treat ADHD (attention deficit hyperactivity disorder) that still require testing and an in-person visit.
How should I prepare for my telemedicine visit?
Turning your home into an exam room requires a little prep. Start here:
1. Make the call. Schedule your visit as you normally would, either by calling your doctor’s office or going to your online patient portal. Pay attention to any instructions you’re given regarding steps to take prior to the video visit.
2. Gather your background material. Jot down your symptoms, including details such as when they started, how often they occur, and so on.
3. Draft an agenda. “Know what questions and concerns you want to cover with the doctor—anything you think is important,” says Dr. Waldren. “Make sure you have these thoughts written down and in front of you before the visit begins.”
4. Set the stage. While a smartphone may suffice, Spaulding recommends using a computer, laptop, or tablet. “The bigger screen will be a plus,” he says.
Set yourself up in a quiet room with good lighting. Ideally, the light source should be behind the camera, so you’re illuminated.
5. Be comfortable with your equipment. Some doctors and clinics will have specially designed virtual care software built into their patient portals, making video visits as easy as clicking on a button once you’ve logged in. For others, you may need to download an app, while still others will simply need you to have access to video chat services such as FaceTime, Skype, Google Duo, or Zoom. Whatever the tool, make sure you know how to operate the camera feature on your phone, tablet, or computer. During the appointment, your doctor may ask you to pull the camera closer, or zoom in on a body part—say, to look at a rash or an injury.
If you’re not comfortable with technology, you can ask a trusted family member or caregiver to help you during the appointment—just be sure to let the doctor know that they’re there.
6. Have self-monitoring numbers available. If you think you have a fever, record your temperature a few minutes before the visit begins.
If you are monitoring your blood pressure, blood sugars, or weight at home have those numbers available for your visit. Dr. Waldren and Spaulding both emphasize that owning these items isn’t necessary for a virtual care appointment though.
7. Be on time. When your appointment time arrives, follow the instructions you were given to connect with your doctor. In some cases, the doctor may call you, or you may be given a phone number or web link to join a video conference line.
“Have patience,” says Dr. Waldren. “Doctors may be running late, so have a spare thing to do while you’re virtually waiting.”