With COVID-19 diverting medical resources and making in-person doctor visits a risk for patients and physicians alike, many healthcare providers are turning to telemedicine.
Medical practices, urgent care centers, and hospitals are overwhelmed and will only be more so in the coming weeks. Telemedicine lets doctors evaluate, diagnose, and treat patients through a visit conducted via video or on the phone, whether it’s for a well visit, a follow-up, or even an evaluation for COVID-19. This form of care could be new to both you and your physician and knowing what to expect and what to have on hand could make the transition smoother and help you get the most out of your visit.
How to Schedule
Telemedicine visits can be conducted over video or on the phone. To schedule a visit, call your physician’s office and see what options are available. Small offices and large health systems alike are rapidly moving to telemedicine right now.
For those who do not have a health care provider or have one who is not available for telemedicine, Doctor on Demand is another way to have a physician visit without going into a healthcare facility. The online service is available 24 hours a day, seven days a week. Visits are conducted using video through a browser or an app (iOS, Android) on phones and tablets.
Types of Visits
If you have a smartphone or computer on which you can have a video visit, you and your physician will get more out of it. “It’s more of an interaction,” says Dr. Daniel Kellner, a Yale Medicine urologist. “You can see the person. It’s actually like they’re coming to the office.”
That said, it is still possible to meet with a doctor by phone. “There are physicians who are just doing telephone visits so if patients don't have the capability for video they shouldn't worry,” says Dr. Julie Yip, rheumatologist at New Haven Rheumatology and clinical instructor at Yale School of Medicine.
Payment and Insurance
Insurance coverage for telemedicine varies by state but with the current pandemic, many providers have amended their policies and in some cases have even waived co-pays. It is advisable to call your provider before your visit to see what will be covered.
Doctor on Demand accepts insurance; without insurance, a medical visit is $75.
What to Have With You
During the visit, the physician will ask you to describe symptoms, tell them about any allergies, and ask about medications and dosages, so be sure to have all of that information at the ready as well as the contact information for your pharmacy. Dr. Kellner advises that if there is any relevant information or data that exists outside the purview of the provider, it should be shared with them. If you don’t have access to it, communicate that to your physician so they can assist in tracking it down.
When speaking to a physician who you regularly see or who is part of the same health system, they will have your chart with them for the visit. “During their encounter, we have access to all their records—we can look at their labs and their imaging and the notes from other providers in the system,” Dr. Kellner says.
If you have home medical equipment, it is useful to have it accessible during the visit. “Depending on what their visit is for, they can have a blood-pressure cuff handy, a pulse oximeter to check heart rate or their oxygen saturation level, and a thermometer” Dr. Yip says. For a more thorough exam, you may also want to purchase a remote exam kit that has a stethoscope, otoscope, and basal thermometer that can send information to your physician. If cardiac issues are a concern, EKGs can be done through a small personal monitor or an Apple Watch (Series 4 or 5).
Dr. Yip also recommends earbuds or headphones for a clear audio connection and to try to be as close as possible to the source of your Wi-Fi.
What You Can Expect During Your Visit
Before the visit, make sure you’re in a relatively quiet, private, and well-lit location so you can freely speak to the doctor and are prepared for any possible physical examination they might perform by video.
Usually a video visit is initiated by a text message with a link asking you to join the physician in a secure conference call. You will then either be directly connected to the physician or to a nurse or medical assistant who will ask some basic questions before you are joined by the physician. If your physician is part of a large health system, the visit might be conducted through a secure patient portal that you will log into. For phone visits, you or the physician will initiate the call at the appointment time.
The exam itself does not differ too much from one that takes place in an office setting. Dr. Yip says she conducts her telemedicine visits the same as she does her in-person visits with the exception of physical touch.
“The doctor will listen to their issue or concern, ask questions, and examine them to the extent possible,” says Dr. Sara Perkins, a dermatologist at Yale Medicine. “They will make recommendations and a plan for follow-up, if needed.”
Many medical conditions can be handled with telemedicine but of course there are constraints. Dr. Perkins notes that dermatology relies heavily on visual recognition, making it in some ways ideal for telemedicine. Dr. Kellner says that many urologic complaints and even complex conditions can be managed in part with telemedicine—though not all.
“We are in the digital age, but we haven’t figured out how to do a digital rectal exam through a telemedicine visit,” he says.
After the Visit
At the conclusion of the telemedicine visit, you can expect the same as you would from any other one. Dr. Kellner says patients will be set up for either further testing, lab testing, imaging, further telemedicine or office visits, if necessary. Any prescriptions will be sent to a pharmacy or mail-order prescription service. Should you have any questions, you can call the office as you normally would.
“We’re relying heavily on telemedicine visits while we have the epidemic,” Dr. Kellner says. “I think these are here to stay. Having this epidemic has really accelerated our use of telemed visits and I anticipate this will forever change medicine moving forward.”
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