COVID-19 essentially shut down my in-person primary care practice, and we immediately turned to telemedicine (“seeing” a patient virtually either through a phone or video-based visit).
My primary care group did this out of necessity, but nobody predicted how much we would like it, or how effective it can be for patient care.
The most obvious benefit is time savings. There is no travel time – for me or the patient. No time lost in the waiting room or checking in with the staff or filling out forms, so the patient and I both feel more relaxed, rather than being tired and annoyed from a long wait.
But the biggest benefit I’ve noticed is that a telemedicine visit lessens the professional power barriers of me “being the doctor.” Instead, the patient and I are on more even footing: both of us at home on screen staring at our do-it-yourself haircuts. And nothing states real life more than a kid suddenly yelling in the background or a cat walking in front of the camera. There is no need to apologize because we are both in it together. We have a new connection through our shared experiences during this pandemic.
I have often felt that a professional office building visit creates a feeling of unreality for a patient – they plan for the visit, often dress up, and come in ready to commit to lead a healthier life. When they leave my office, however, real-life crashes back in, and the motivational sparks for positive lifestyle changes never light a fire, so to speak. Now we are discussing their health and brainstorming solutions together in the space where they need to plan to do the work. It’s much easier for them to contribute to the plan and commit to changes that are rational and attainable from their own reality.
And there are deeper benefits. A home visit, even if a virtual one, can profoundly affect how you connect to a patient and how you understand their customs. It’s easier to identify any barriers to leading a healthy life. There is no more “I left my glucometer at home.” Instead, we can talk about the reality of how expensive those glucometer strips are and how difficult it is to use one. No more, “I left my medications or med list at home.” We can walk over to the medicine cabinet and look at their pills bottles together to discover any missing prescriptions. We can then talk about why they are taking each medication, how expensive each one is, whether all are truly needed, and whether there are less expensive ones we can substitute. The kid yelling in the background just brings out the vivid point of how difficult it is to find time to exercise while homeschooling. I can share the YouTube video I used that morning to get a little exercise at home or suggest a meditation app.
The most important benefit to me? I am free to be a primary care doctor again. Over the years, many well-meaning initiatives had eroded my visit time with my patients (long in-depth medical symptom checklists, stress/mood surveys, social situation and goals of care surveys, and more). All of these conversations are very important, but they had, in the past, been squeezed into my already short visit times with patients. These questionnaires are still available, but they can be sent to my patients outside the telemedicine visit. I am able to simply talk to my patients again and really spend the time focusing on their concerns and medical needs, which means we can form an even stronger partnership in the face of a pandemic. We are focused on making sure we aren’t just thinking about the virus, but working to keep them healthy for the time in the future when we beat that virus back.
Of course, I can’t treat every condition remotely. Some things need an in-person examination, and we are still doing that in my practice. But quite a lot of “regular” medical care (diabetic sugar control, hypertension, sleep issues, mood problems, and more) can be done through video or phone visits. This return to regular care, even if done virtually, is much needed right now. As deaths from the COVID pandemic climb, patients have been scared to leave their homes; they’ve put usual medical care on hold. Our patients over time may be as much at risk from this pause in preventive care as from the coronavirus – the data will show us in a few months. Telemedicine will allow us to lessen this secondary impact of the virus.
Some physicians may be reluctant to take their first steps into telemedicine. It isn’t too difficult to get started. The federal government’s emergency declaration on March 13, 2020, allowed the Centers for Medicare & Medicaid Services to expand telehealth benefits under the Coronavirus Preparedness and Response Supplemental Appropriations Act, and many private insurance companies have followed suit. There are a variety of apps and platforms – some are free and some have a usually minimal cost per month. HIPAA regulations have been relaxed during the coronavirus outbreak, making it easier for physicians to choose a platform for them and their patients.
For doctors still on the fence, let me encourage you: documentation can be your usual electronic medical record note or written note of the visit; billing is the usual E&M (evaluation and management) levels. A link to the Medicare Telemedicine Fact Sheet can be found here. Many insurance companies now have information on telemedicine directly on their websites for providers or billing professionals to access. Please don’t wait any longer — our patients need us! Virtual visits are actually a powerful addition to the toolbox of effective patient care.
Try it — you just might like it.
Amy Wheeler is an internal medicine physician and public voices fellow, The OpEd Project.
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