Everyone’s buzzing about telehealth, but is virtual healthcare for you? Two telemedicine experts/MDs reveal how to get the most out of online visits
Also, be sure to check out our microcast with the CEO of the American Telemedicine Association, Anne Mond-Johnson, including how telemedicine can specifically impact dermatology and skin health.
According to a recent ambulatory-care study in the Journal of American Medicine Association, access to common healthcare services—from ER and urgent care visits, to check-ups and routine screenings—were declining throughout the pandemic for many, particularly the socioeconomically disadvantaged. Enter telemedicine, which has not only provided a more convenient option to a traditional in-person doctor’s visit, but has also helped many get the care they need in these challenging times.
We spoke with the study’s authors, Dr. John Mafi, a primary care physician and associate professor of medicine at UCLA School of Medicine, and Dr. Melody Craff, Vice President of Strategic Analytics and Education at Milliman MedInsight (a well-regarded platform for healthcare analytics), to learn how telemedicine has transformed the way we interact with doctors—and how to make the most out of phone or virtual visits.
How would you define telemedicine?
Dr. Mafi: Broadly, telemedicine is a medical encounter done electronically. There are variations of this: e-messaging, e-visits, real-time video visits, audio-only, telephonic visits. Most U.S. physician offices offer telemedicine visits as an alternative to in-person visits. For an audio-only visit, all you need is a telephone. For a video visit, you need internet access or a smart phone. If you don’t have a smart phone, then a computer or tablet with internet. (Editor’s note: There’s also the term “telehealth,” which refers to a broader scope of remote services, compared to “telemedicine,” which is specific to remote clinical services.)
How has telemedicine impacted access to healthcare over the course of the pandemic?
Dr. Craff: Telemedicine partially off-set the reductions in care, but not completely. The use of telemedicine has increased dramatically. Audio-only services represented more than half of all the telemedicine cases through Medicare. This is particularly important for those with limited internet access, particularly rural residents, but also individuals who lack video-enabled devices or are uncomfortable with technology.
What are the benefits of telemedicine?
Dr. Craff: Surveys done by the Department of Health and Human Services report a quicker responsiveness with telemedicine. Patients have had more frequent support and encouragement through check-ins and experienced less time away from work and less time looking for childcare. There were patients who said they like reviewing information on their own time. A few of them perceived increased confidentiality and privacy.
What are the limitations or challenges?
Dr. Craff: It sounds so basic, but there are definitely problems with internet connectivity and a lack of broadband. If you’ve worked from home during the pandemic with Zoom call after Zoom call, you know that there’s just no way to prevent technical difficulties sometimes. And some people lack privacy in their home or they share devices with others, which a few have reported as quite a concern for confidentiality.
Dr. Mafi: Telemedicine is great and convenient. A lot of barriers are removed, but at the same time, my diagnostic skills are limited. We really need to get smarter about how we triage different types of visits and what needs to be in-person appointments, vs. what can be managed easily over the phone.
What types of conditions are more challenging to evaluate on a telemedicine appointment? Are there certain conditions or medical specialties that are more suited for telemedicine than others?
Dr. Mafi: Mental health and behavioral health are perhaps the best use of telehealth. If you have shortness of breath or chest pain, it’s very hard as a physician to assess whether this is something that is life threatening or not. You really need a physical exam. That’s really not something telemedicine can do for you, other than saying, you need to go to the emergency room. For muscular skeletal complaints, you can do a little bit with a video visit. You can watch [a patient] move their shoulder to see what makes the pain worse, but it really is harder to evaluate the cause of a muscular skeletal complaint on a telemedicine visit. Similarly, for dermatology, video visits can suffice for most concerns, but it’s sometimes for less-obvious cases, in-person visits are needed.
With what we know now, how can patients make the most out of a telemedicine appointment?
Dr. Mafi: Patients can make sure they are in a place where they have good internet connectivity in a quiet place where they can easily converse and not have a lot of background noise. They should try to make themselves available on the phone in the hours leading up to the visit to help with preparation. If they have high blood pressure, checking their blood pressure at home and have their logs ready to give to the nurse. If they have diabetes, what’s the recent logs of blood sugars? Going through all these before the visit would really streamline the visits.
Telemedicine can be a godsend for patients with chronic conditions, especially those with comorbidities because for those patients, you really need frequent monitoring to make sure their conditions aren’t going awry. The problem is how do you design policies that maximize those high value visits but don’t encourage overuse. We’re all still learning—the patients are learning and the providers are also learning.
References for this information:
Jama Network, January 18, 2022
The views expressed in this article do not necessarily represent the views of Murad, and are for informational purposes only, even if the advice of physicians and medical practitioners are included. This article is not a substitute for professional medical advice, diagnosis or treatment, and should not looked be considered specific medical advice.