Even if you’re a huge fan of your primary care provider, there are probably times when you’re pretty sure you know what’s going on (that burning sensation when you pee has to be a UTI), or you simply want some reassurance (is this a garden-variety cold or a sinus infection?), and would rather not take time off work to schlep into the doctor’s office. That’s when telehealth comes in handy.
“In the past, patients would call and leave messages about symptoms on [the] phone. The provider would return their call and ask a few more questions so they could make a diagnosis and recommend treatment,” says Tearsanee Davis, director of clinical and advanced practice operations for the Center for Telehealth at the University of Mississippi Medical Center in Jackson, Mississippi. “Telehealth is the same but better, because you can see the patient.”
Before the coronavirus hit, many doctor’s offices and clinics offered some form of remote care. But the number providing telehealth has grown exponentially since most facilities shut down in response to COVID-19. According to a 2018 paper published in JAMA, primary care televisits grew 36 percent annually between 2005 and 2016. Then in March 2020 alone, visits jumped 50 percent.
There’s a reason to get onboard: Research suggests these virtual appointments can be equivalent to in-person care. In a survey of 1,274 patients published last year in Annals of Internal Medicine, 93 percent who used telemedicine with their primary care provider reported that the video visit adequately addressed their concerns.
Despite these reports, many patients are unclear about what their doctor can and can’t do over a video visit. The short answer: almost anything that’s not an emergency. “If it’s something where the average person would still go to work, that most likely can be assessed via telehealth,” Davis says.
That includes follow-up visits, as well as appointments to monitor ongoing conditions such as diabetes and hypertension. Since people living with these diseases are likely checking their blood sugar or blood pressure at home, “we can get a lot of information from the patient that they used to have to come into an office to get,” says Dr. Vanessa Diaz, a professor of family medicine at the Medical University of South Carolina.
The added benefit is that you can check in sooner. In the past, doctors may have prescribed medication and then had the patient come six weeks (or more) later. During this time, the patient may have stopped taking the medication due to a side effect or because they didn’t think it was working. That’s lost time, Diaz says. With telehealth, a doctor can check back in a week or so to see if the patient is taking the medication and having any adverse reactions. “Telehealth gives us more touches with patients, and we can react better as clinicians,” she adds.
“Although they are good to have, the reality is you don’t always need a lab or X-rays,” Davis adds. “You need a really good history, to pay attention to the patient and to do some basic assessment techniques.”
For acute problems, telehealth is particularly effective if you have an existing relationship with your doctor. “We have a saying in primary care: Eighty to 90 percent of the time, you know what’s happening with a patient based on their history,” Diaz says. “So I tell my patients, let’s do a virtual visit first and then I’ll decide if you need to come in. Often they don’t need a physical exam.”
That means telehealth can be the first step to diagnosing everything from colds and UTIs to earaches and even strep throat. Doctors use a method called differential diagnosis to go through a patient’s symptoms and narrow down the list of potential diagnoses. If a patient meets a certain number of criteria, then the doctor can determine if they have the flu, a UTI or strep — without any tests.
In fact, a review of 1,565 e-visits by MUSC researchers found that if patients had an in-person follow-up consultation, 82 percent of the time the original diagnosis didn’t change. While some research suggests that telehealth can make doctors more likely to prescribe antibiotics to children, another study found this doesn’t appear to be the case for adults.
In the case of stomach pain, Davis says your doctor can adapt tests to see if you have appendicitis over a video call. “One test is to jump up and down,” she says. “If they can do that without grimacing, more than likely it’s not appendicitis, but that would at least allow the clinician to assess the level of pain.” Or for some dermatological concerns, the doctor may have a patient blanch their skin, which means applying pressure to an area until it turns white to see how long the skin takes to return to its normal color. “Although they are good to have, the reality is you don’t always need a lab or X-rays,” Davis adds. “You need a really good history, to pay attention to the patient and to do some basic assessment techniques.”
However, there are some limitations to telehealth for primary care. If you have a first-degree burn (where the outer skin is red and painful but not blistering) or a minor cut, the doctor can advise how to treat it. But in the case of a more severe burn, a deeper cut that may need sutures or a possible broken bone, trust your gut. “The general public does a great job of triaging themselves,” Davis says. If you think you need immediate in-person care, get it. The same goes for severe shortness of breath and chest pain that you believe could be a cardiac issue.
All that said, if telehealth will do the job, show up (on screen) prepared. When you arrange the appointment, most providers ask why you’re requesting the appointment. Be as detailed as you can; your doctor will use that information to determine if your case seems appropriate for telehealth. Then, during the video visit, be ready to describe your symptoms in great detail: When did they start? Are they worse when you do certain activities or at certain times of the day? Are there any odors, colors or other distinguishing features? Don’t forget to tell the doctor what medications you’re taking.
Choose a spot that’s as free of noise and distractions as possible, has a strong Wi-Fi connection and is well-lit so your doctor can see something like a rash. You may also want to consider if a phone or laptop will be easier to show any parts of your body that you may need to.
Lastly, check with your insurance. During the coronavirus outbreak, most providers will cover telehealth visits. However, before the pandemic, telehealth regulations varied from state to state and provider to provider. Be sure you and the insurer are clear on what applies to your plan and its policies, when and for how long.
Interest in telehealth, however, is likely here to stay. “I think primary care physicians see the benefits of reaching patients where they are, and I think the general public who may have been apprehensive about telehealth will begin to ask for it and expect it,” Davis says.
Diaz agrees: “I hope we end up in a place where we are thoughtful in how to use telehealth, to increase convenience to patients and make it easier for doctors to provide care,” she says. “Telehealth can’t take the place of having strong relationships and continuity with patients, but it can enhance that.”