What to Expect from Telemedicine: Get the Most Out of Your Virtual Doctor Visit
Wouldn't you rather avoid doctors' offices right about now? Here's how to make telemedicine work for you.
What is telemedicine?
In the age of coronavirus, telehealth is being utilized in lieu of in-person doctor visits more than ever before. But I actually made my first video visit pre-pandemic, back in October 2019: I had a mole that had changed, and my doctor was able to examine it online. It went so well that when another scheduled in-person appointment was canceled due to Covid-19 facility changes, I decided to do telehealth appointment again.
More people are going digital for healthcare these days: Marisa Lavine, a spokesperson for Kaiser Permanente, says, “Prior to the Covid-19 pandemic, Kaiser Permanente averaged 85 percent office visits to 15 percent telehealth appointments.” Now the numbers are almost reversed. Now, about 80 percent of Kaiser visits are virtual.
Johns Hopkins Telemedicine reported 203,926 visits cumulative for 2020 and a whopping 29,225 telemedicine visits in the first week of March 2020 alone. Patients would rather not have to leave the house in a pandemic to get quality healthcare—and they’ve mostly been able to. A 2019 study published in The American Journal of Managed Care on virtual doctor visits found that 62.6 percent of the 426 reported no difference in “the overall quality of the visit.” (Here are three telemedicine apps everyone should know.)
Preparation for your visit will contribute to your satisfaction with the outcome: To be equipped for a potential telehealth appointment, I’m sharing what I learned from my experience, plus I’ve included tips from doctors to help make future visits a better experience for patients. (Here’s how to get online therapy if you can’t leave your home.)
Prepare your telemedicine examination room
Once my appointment was scheduled, I received specific instructions to download an app for my smartphone. Whether you’re using a smartphone, laptop, or another device, make sure it is fully charged for your appointment. Like an in-person doctor visit, you still might have to wait to see your doctor while they finish up with the patient before you. I had to wait for around 15 minutes past my scheduled appointment for both telehealth appointments. It wasn’t a big deal because I was in the comfort of my home office and could keep working. But it’s something to keep in mind if you’re scheduling your day around the appointment.
Matthew Faiman, MD, medical director at Cleveland Clinic Express Care Online, says their providers allow patients to check-in 15 to 30 minutes before the visit and arrive up to 15 to 20 after the scheduled visit was supposed to start. When you’re picking a room in your house to have the visit—avoid high-traffic areas like the kitchen or living room; you want a quiet area that has plenty of light if you’re doing a video visit. One more thing—your caller ID may not specifically say it’s your doctor’s office, so be sure to answer the phone at the appointed time even if you don’t recognize the phone number, or it says “no caller ID.”
Be ready for your telehealth doctor’s queries
Prior doctor visits have taught me that when I’m knowledgeable about matters surrounding my health issue, the appointment is more productive in finding a solution. The same holds for virtual visits. With my mole and menopause concerns, I kept a diary to record things like symptoms, activities that made the problem worse, or medications I tried.
Dennis Truong, MD, regional director of Telemedicine for Kaiser Permanente in the mid-Atlantic region, says I’m onto something. He recommends using the “PPQRST” approach to prep for the questions your doctor will ask:
Provoke: What makes you feel worse?
Palliative: What makes you feel better?
Quality: What does the pain (or symptoms) feel like?
Radiation: Does the pain (or symptoms) radiate anywhere?
Severity: How severe is the pain? What would you rate it on a scale of one to ten, with zero being no pain and ten being the worst? How does it hinder your normal activities?
Time: How long have the symptoms been going on? Are they constant or do they come and go?
“We learn this frame of questioning in medical school, so patients that keep track of their symptoms in this format are able to provide a more complete picture to help their doctor understand what’s been going on,” says Dr. Truong. Be sure to tell your doctor if you have these new Covid-19 symptoms.
Have your questions ready
I didn’t have any questions regarding the mole on my face because I knew I needed my general practitioner’s assessment to get a referral to see a dermatologist. I sat in front of the window and held my phone closer to my face so my doctor could get a closer look. Since the mole had changed in appearance and was itchy, she made an appointment on-the-spot to see a dermatologist. (Turns out it was nothing serious.) Here are some questions to ask your dermatologist on your next visit.
By contrast, I had a lot of questions and concerns regarding menopause for the telehealth visit with my gynecologist. Historically, I tend to get so engrossed in what the doctor is saying that when it comes time to ask questions, I draw a blank. This time I wrote down my questions ahead of time—which is a good idea for in-person visits as well. For a successful virtual visit, Dr. Faiman says that’s a good plan. “Often, just navigating the technology can create stress for both the patient and the provider,” Dr. Faiman says. “Having an agenda can help. If, for example, I am seeing my patient for diabetes followup (and they have obtained their lab work prior to the visit), it still will help to have some questions prepared. That way, if there is a novel therapy, or if there is another issue that needs to be discussed, they will not be forgotten.” Don’t miss these tips on how to really communicate with your doctor.
Gather your medications
The physicians I see for in-person visits are the same ones I see in virtual visits thanks to my integrated health management system. This means my doctor has access to all my records, so I didn’t need to have them handy. But I made sure to bring up the supplements and over-the-counter remedies I recently began taking.
Dr. Faiman says in most cases, electronic medical records allow doctors to exchange and share medical history (with your consent). Even if you’re seeing a new doctor, they should be able to access your medical information. Still, Dr. Faiman says it’s a good idea to have a list of medications handy, or just grab them out of the medicine cabinet so you can show your doctor the label. With my integrated insurance system, my doctor was able to prescribe and order medications. I had the option of picking them up at my healthcare system pharmacy or have them shipped directly to me. Given the pandemic, I had them shipped. Some telemedicine doctors work with a general service—not a specific office or hospital—so getting tests and imaging can be tricky. However, these vendor-based telemedicine doctors can call in a prescription to a retail pharmacy. Be sure to ask your doctor these important questions before you start taking prescription medications.
When telemedicine is a good option
“There are almost no visits that would not be appropriate,” says Dr. Faiman. Obviously, hands-on procedures like surgeries, imaging, and blood work aren’t possible, yet that still leaves a myriad of health concerns well suited for telemedicine. “In the range of low-acuity conditions, upper respiratory symptoms, painful urination, skin conditions, minor injuries, seasonal allergies, pinkeye, insect bites, etc. are usually resolvable over a virtual visit,” says Dr. Truong. Plus, consultations, follow-up care, chronic illness management, behavioral health, and even dermatology.
Adam Friedman, MD, FAAD, professor and interim chair of dermatology at The George Washington University School of Medicine & Health Sciences says telemedicine has been a part of dermatology for close to a decade. “There is a lot we can do during a synchronous televisit utilizing audio and visual given the quality of cameras these days. It would be easier to say what we can’t do or what is limited,” Dr. Friedman says.
When telemedicine isn’t a good option
Telemedicine isn’t effective for a full-body skin scan, for doing skin surveillance for skin cancer, or diagnosing a unique skin rash that may require a biopsy. For the most part, virtual doctor visits are very effective in managing common skin diseases such as acne, rosacea, eczema, and psoriasis. “Sometimes these conditions require blood tests to follow the medications which can be done safely with proper guidance,” adds Dr. Friedman. You may be interested in how to identify non-Covid-19 rash symptoms.
Emergencies that require immediate attention—crushing chest pain, uncontrolled bleeding, unable to breathe, stroke symptoms like partial paralysis—warrant a 911 call, Dr. Faiman says. But if it doesn’t feel like an emergency, you could try telemedicine: “I would rather someone call and have a virtual visit, and I assess and triage their symptoms,” he says. “I can assess their body language, their symptoms, and their ability to access care. If they need a higher level of care, I can arrange this with a warm hand-off or call the emergency room if needed, or wait with the patient and their family if they need to call 911.” Watch for these seven signs you might need to go to the emergency room after a head injury.
Telemedicine for Covid-19 symptoms
If I develop Covid-19 symptoms, would a telehealth appointment be able to evaluate me like an in-person appointment? Dr. Faiman and Dr. Truong agree telehealth appointments would keep me safe and support social distancing. “These appointments also allow us to effectively triage patients for testing and follow-up care based on CDC guidelines. With Covid-19, virtual visits also allow us to appropriately allocate local health care resources to care for those that need it most. At Kaiser Permanente, virtual visits also allow us a safe pathway to check-in on our patients daily to make sure we’re reevaluating and meeting their health care needs,” says Dr. Truong. Here are nine coronavirus symptoms everyone should watch for.
Telehealth tools for patients
Thanks to new technology, patients have the option to use the grown-up version of medical exam tools in telemedicine visits. TytoCare is an exam kit (with a $299.00 price tag) that includes an otoscope (to examine ears), a tongue depressor (to examine the throat), a stethoscope (to listen to heart, lung, and abdomen), a thermometer (to take a temperature), and a digital camera to get a closer look at the skin and throat. The devices upload the data during your virtual appointment and to your medical chart.
“This will be where things move in the future,” says Dr. Faiman. “In addition to school-based health, for home care and for certain employers, devices like Tyto can be useful to enhance the examination. They are highly effective at recording heart and lung sounds,” he says.
Currently, the exam tools work with Lifehealth Online, a nationwide on-demand medical care app, and with Sanford Health customers, which serves Minnesota, South Dakota, and North Dakota. Learn about the best at-home thermometers to monitor for Covid-19.
- Lightico: "Digital and Remote Health During COVID-19"
- Marisa Lavine, spokeswoman for Kaiser Permanente's mid-Atlantic region, which includes D.C., Maryland, and Virginia
- The American Journal of Managed Care: "Patient and Clinician Experiences With Telehealth for Patient Follow-up Care"
- Matthew Faiman, MD, medical director at Cleveland Clinic Express Care Online, Independence Family Health Center, Independence, Ohio
- Dennis Truong, MD, Regional Director of Telemedicine for Kaiser Permanente in the mid-Atlantic region. Tysons Corner, Mclean, Virginia
- Adam Friedman, MD, FAAD, Professor and Interim Chair of Dermatology at The George Washington University School of Medicine & Health Sciences, Bethesda, Maryland and Washington, D.C.