What Exactly Is Telemedicine—and How Does It Work?
Everything you need to know about virtual doctor appointments, plus when you really should see an MD in person.
Nearly half of US doctors now report treating patients via telemedicine (also known as telehealth), according to a recent survey by Merritt Hawkins in collaboration with The Physicians Foundation. Telemedicine isn’t actually a new thing; doctors have been offering telephone consultations for decades. But the COVID-19 era has brought telemedicine to the forefront of health care. Until there’s a proven treatment or vaccine for the new coronavirus, getting medical advice, checking out symptoms, or going for a checkup remotely might be a reality for many of us. Here's what doctors who practice telehealth want you to know about it.
What is telemedicine?
Telehealth is simpler than it sounds. Basically, you get a consultation or an appointment with your doctor over the phone or via an online video platform like Skype, FaceTime, or Zoom. Think of it as a “virtual visit” with your health care provider.
Before COVID-19, New York City-based gynecologist Rebecca C. Brightman, MD, assistant clinical professor of obstetrics, gynecology and reproductive medicine at the Icahn School of Medicine at Mount Sinai, offered phone consults to patients. But since the outbreak, she’s offered both consultations and appointments via phone or webcam. “I offer both to my patients—it’s up to them whether they want the face-to-face interaction,” she tells Health.
Orthodontist Heather Kunen, DDS, co-founder of dental practice Beam Street, in New York City, is another doctor who has embraced telehealth. “Prior to the COVID-19 pandemic, my office had been considering incorporating virtual Invisalign consultations as part of our list of services," she tells Health. "The lockdown/stay-at-home orders motivated us to officially implement the virtual service using Zoom."
Most health care providers are pretty flexible when it comes to digital platforms. “Using FaceTime is a simple option for those with an iPhone, and Skype works great as well,” pediatric urologist Jay Levy, MD, who is a medical director at Aeroflow Healthcare, tells Health. “Many providers also offer an electronic medical record system, like Doxy.me, where patients can check in online and connect with their doctor.”
Various health care platforms are available to connect patients remotely with the right medical providers, such as Walgreens Find Care, which also offers a virtual pharmacy to those who need to have their prescriptions filled and delivered.
What do I need to do telemedicine appointments?
If you’re happy with a phone consultation, all you need is a phone. If you’d prefer a face-to-face consultation, you’ll need a smartphone, tablet, or a computer with a webcam. To ensure a positive, productive telemedicine experience, Dr. Levy says the most important thing is to check your WiFi is working properly. “One of the biggest issues is an appointment being sidetracked or ultimately cancelled due to poor WiFi connectivity,” he says.
Just as you have a private, quiet space when you meet with your health care provider in their office, it’s a good idea to do the same at home. Dr. Levy suggests a well-lit space where you’re not likely to be disturbed. On that note, it’s a good idea to let others in your home know ahead of time that you’ll be unavailable during your appointment time frame.
Any other preparation, such as checking your weight or your temperature, really depends on the specific health questions you have. To give your doctor an accurate health history, take note of any symptoms and their duration, Kevin Ban, MD, chief medical officer at Walgreens, tells Health.
Do all insurance companies cover it?
Not necessarily. “As telehealth has become even more critical to help address medical needs during the coronavirus outbreak, the government, health plans, and providers have begun instituting new policies and technological advances to make it more accessible to patients across the nation,” says Dr. Ban. For instance, the federal government recently passed legislation expanding the availability of services provided through telehealth under Medicare.
When you call the doctor’s office to make or confirm an appointment date and time, staff will verify your insurance, make any necessary updates and, if applicable, take payment for your co-pay over the phone, Dr. Levy says. Still, play it safe by asking your health care provider or their office staff about coverage before you schedule an appointment, or what the total cost will be.
What happens during a telemedicine appointment?
During a telehealth consultation, Dr. Brightman asks her patients questions about their medical history and current symptoms to decide the best course of treatment. She never asks a patient to disrobe, but they can send her a photo (without any identifiers) if they are concerned about a visible finding. “This can help me make a diagnosis and work out whether or not it can be treated remotely or requires an office visit. “Typically, nobody else is present when I host a telemedicine visit,” she adds.
If she decides that a patient needs an exam, she encourages them to come to the office, where all precautions have been taken regarding social distancing, hand hygiene, and personal protective equipment (PPE) where appropriate.
Dr. Kunen starts a Zoom consultation by asking her patient what their chief concern is. She then examines their teeth and analyzes their bite before providing a diagnosis. “I explain the Invisalign product and process to the patient and answer any questions they may have,” she says. After the consultation, the practice’s treatment coordinator contacts the patient to discuss financials and the next steps.
Can my partner or friend listen in for support?
It’s absolutely fine if you want your partner, family member, or roommate to be present during your telehealth appointment. “I have had several telemedicine appointments with young teens who have wanted their moms present during the visit,” says Dr. Brightman. “Having a family member present can also be helpful when it comes to obtaining a family history or reviewing a course of treatment.”
Dr. Kunen always encourages her patients to invite a friend or family member to be present. “I want consultations to be fun and comfortable, whether they’re done in person or virtually,” she says.
When should I stick with an IRL visit?
“Telemedicine can support many acute care needs and illnesses, but it’s not appropriate in some circumstances,” says Dr. Ban. “For example, patients can’t undergo procedures or receive imaging tests remotely.” And telemedicine is never a replacement for an in-person appointment for patients who are extremely ill and require urgent medical attention, or who have symptoms that could indicate a serious and urgent issue.
Dr. Brightman has performed consultations via telemedicine for the management of menopausal symptoms and painful periods and family planning, as well as to treat urinary tract and other infections. Some obstetrics visits can also be done virtually, with women checking their blood pressure and weight at home. But Dr. Brightman says there are times when an in-office visit is necessary, such as abnormally heavy bleeding and STI screening.
When it comes to dentistry, almost all procedures will require an in-person visit at some stage to let the dentist complete any physical work that needs to be done. While minor emergencies like a broken bracket or a popped-out wire can often be resolved temporarily at home via virtual guidance by an orthodontist, detailed clinical observation and specific diagnosis must be done in person, says Dr. Kunen.
What are the drawbacks?
While telemedicine offers face-to-face interaction with health care providers—which is crucial at a time like this, when needs are critically high due to the COVID-19 pandemic—it’s important to remember that it does have limitations.
“Physicians are able to rely on patients to take their temperature, however things such as blood pressure and lab work all rely on nursing staff,” says Dr. Levy. “It’s also impossible to recreate the hands-on element of a standard office visit. Without the ability for the doctor to touch or feel the patient, it is sometimes more difficult to determine what the actual issue is.”
Dr. Kunen agrees that telemedicine may be somewhat limited in terms of what can be accomplished, but she believes it’s “a wonderful adjunct to modern practice.” And during this unprecedented time, when many people may not be able to (or want to) go to an in-person visit, a virtual one is a great alternative in many cases. “Going forward, I think telehealth will remain an important component to all medical practices,” she says.
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