The Doctor Will See You—Online
The office visit used to be a mainstay of medicine. The patient would contact the office, schedule an appointment, come to the office, and see the clinician, in person, face-to-face.
Because of quarantine and social distancing, telemedicine has taken over as our means of seeing patients. It uses video conferencing via a computer, tablet, or smartphone for an online meeting between clinician and patient.
Over the last month, I have been using telemedicine appointments for routine and acute patient visits that would typically take place in the office.
When a patient schedules an appointment, they are told it will be a telehealth visit. Patients must “opt-out” if they don’t have video capabilities or access to a smartphone or computer.
Before the visit, a medical assistant will call the patient to do an initial health screening. They will conduct a technology screening as well. They will make sure that the required software has been downloaded, and that a camera is available and working.
Patients are then given a unique meeting ID, which they use to access the virtual waiting room. On the physician’s end, we can access the patient’s EHR and see that the patient is online and available. With a click, the visit begins. It’s very similar to an office visit.
This is not to say that there are no bumps along the road. If there are paper forms requiring a signature, this may not be possible via telemedicine, depending upon what other solutions are in place.
When a patient checks-in at the office, we have a process to verify a patient’s identity. During a telehealth visit, on the rare occasion I don’t recognize the patient, or if they are new to me, I will ask them to state their full name and date of birth to be sure I know who I’m talking with. It’s also good practice to ask if the patient is alone or if anyone else can hear the conversation.
I could perform the visit using just a telephone, but some insurance companies view such visits as less effective than those that include video. More importantly, I have discovered that as part of the visit, if the patient’s camera is on, there is added value in seeing their face as well as hearing their voice. I might notice if a patient is feverish or pale, or looking unusually disheveled. If the camera resolution allows it, I can take a look down their throat or see how well an incision is healing. I can even have the patient assist me in the visit by performing elements of the physical exam on themselves. I’ve demonstrated to patients how to see if their glands are swollen. It’s a team effort.
Telemedicine is not without its limitations. Most people have a thermometer and can take their temperature, but not everyone has a blood pressure monitor, accurate scale, or other necessary medical measurement devices.
And as mentioned, it’s preferable for patients to have video conference capabilities, which can be a barrier for patients who do not have access to a computer monitor. (“The better to see you with, my dear,” as the Big Bad Wolf would say.) A smartphone is a viable alternative, as is a tablet.
Naturally, some patients voice concerns about patient privacy and HIPAA laws. Patients may not be able to seclude themselves for in-home privacy during a telemedicine session, which could make it difficult to share sensitive information.
Patients may be concerned about their online privacy. However, this does not seem to be an issue, as medical professionals use third party services designed with ultimate privacy features. What’s more, these services are working to increase privacy every day.
Another barrier for some patients is a lack of understanding of technology. I see this most often in my elderly patients. In those cases, we try to have them recruit a son or daughter who can help. And once my patient figures it out, they sometimes go on to video chat with their families. What a beautiful side effect.
Despite the challenges, I’ve discovered several unexpected benefits using telemedicine. Previously, when I asked a patient about their medications, and they’ve forgotten their list or their bottles, I can now ask them to go to the medicine cabinet and retrieve them while I wait. I can take a look inside their pantry, cabinets, and refrigerators to see if they are eating properly and are not food insecure. I can see trip and fall hazards. Telemedicine has provided me a glimpse into my patients’ lifestyle that I would not have otherwise.
And my patients and I are finding unexpected humor. I’ve been photobombed by pets ranging from the usual dog and cat to the unusual, including a snake and a squirrel (not the same household, luckily for the squirrel). Toddlers wave and say hello, and well-meaning significant others chime in with their diagnosis. I’ve even been able to discern if my patient is an avid golfer or movie buff, judging by their décor.
But it’s equally important that my face be visible during these visits and that I look professional. It’s not enough that I turn my camera on; I need to look into the camera. Without the in-person proximity, patients must be able to see my face, look into my eyes, and feel that they are being listened to.
Fortunately, incorporating Augmedix during my telemedicine visits allows me to focus on my patient instead of looking down to write or type notes. If need be, I can pull up their EHR on my monitor to look at their records during the visit, or I can speak with the scribe who is also in the session. This quick and immediate access has been invaluable as we navigate these unknown waters.
Patients have also responded overwhelmingly positive to the convenience of having a doctor visit from their own home. They save a lot of time not having to commute to and from our office and if I am running late, they are not stuck in our waiting room but rather in the comfort of their own home. Some patients with difficulty leaving the house now have the opportunity to see me. I’ve had patients who are bedridden or who are in too much pain to leave their homes who are very grateful for the opportunity to see me now. Our obstetrician-gynecologists, or OB/GYNs, have shared how their newly postpartum patients are especially grateful to be at home.
Is telemedicine medicine here to stay? Given all of the positives for both patients and physicians, I have a hard time believing it’s not. And we have only covered a handful of the possible scenarios where a virtual visit may be superior to coming to the office.
I have a colleague who has said, “Make the right thing the easy thing.” Virtual care has always been the right thing. Telemedicine makes it the easy thing.