The Doctor in the Mouse: Why telemedicine is the one stunningly hopeful change COVID has created
As COVID infections spread in mid-2020, and as isolating was recognized as the path to prevention, patients were reluctant to show up for face-to-face doctor visits for most routine consultations and management of chronic illnesses such as diabetes, high blood pressure and heart disease. The stage was set for telemedicine.
In response, medical offices ramped up to accommodate patients remotely as routine elective surgeries were postponed or canceled, and even insurance companies got on board with the plan for reimbursement. The bureaucratic reimbursement and regulatory hurdles for telemedicine were largely eliminated last spring.
Which left the medical system—the Emergency Departments and ICUs—poised to receive and treat the COVID patients.
Yet in the midst of pandemic-driven healthcare, other preventive measures were put on hold such as cancer screenings using colonoscopies and mammograms (down 70%). The absence or delay of these tests will have dramatic long-term consequences for health and well-being.
Chemotherapy treatments fell, cataract surgeries were diminished, and MRIs typically done for serious problems were reduced by 45%. I know one patient whose knee replacement surgery has been postponed three times and is still pending. Overall, healthcare use by patients declined by 50% starting in April 2020.
But also that month, a stunning 48% of healthcare visits were delivered virtually. Telemedicine became much more than an interesting tool to reach rural patients. It was now prime time.
For decades, telemedicine was the method of delivery of care through computers with the patient who would be “visited” by a healthcare provider, and the patient could see the doctor, almost like a Facetime with a family member on an iPhone. Telemedicine was viewed as an interesting tool but until this year never really achieved universal acceptance by the medical community.
Rural patients who were miles from a doctor’s office, or nursing home patients with mental health issues who were too fragile to travel to a physician’s office (and few geriatric psychiatrists were available to visit in person) were the main recipients of this new technology in medical care. Check-ins for kids with ADHD were handled over computer links.
Even though a small group of physicians and health administrators saw the wider promise of this technology, telemedicine never really was embraced by the rank and file of healthcare providers. Patients wanted and expected that face-to-face encounter.
Today, a visit by the doctor in the mouse is almost routine.
For the tech savvy, for the tech-comfortable patient and family, telemedicine works well. In fact in some studies 90% of patients were very pleased with the technology. But for individuals among certain segments of baby boomers, technology was an endless source of frustration.
About 40% of elderly patients simply could not handle the technical details. So here we are again faced with a dilemma. It’s time to get Grandma up to speed on the technology. Here’s how best to navigate a telemedicine visit:
Practice with your provider’s patient portal. Staff can give you a user name and password and walk you through the online registration, by phone. Understand how to find appointments, where to see the results of consultations and tests, and especially understand how to order medications online. The VA has successfully been doing this type of electronic healthcare delivery for years. This is a time to be humble and respectful. Let a staffer explain how to sign into a telemedicine visit before your scheduled time. If you are patient and practice, you can get comfortable with this technology.
Prior to your virtual meeting with a healthcare provider, have no more than three main issues to discuss. Write them down before the consultation and be in a quiet environment without distractions.
Have pertinent information about medications (with the pill bottles in front of you) and the history of your concerns you are discussing with the doctor in the mouse: When did the cough start? What makes your pain better or worse? When did you start to lose weight? Be concise, be targeted. This is not a time to talk about your daughter’s wedding, the weather, or the football scores.
Have readily available within arm’s reach insurance cards, Medicare numbers, and other financial documents. Your time with the provider is limited so do not waste it fumbling in the bottom of your purse trying to find your inhaler. Think of the virtual consultation as a targeted, concise zoning in on a few key issues without a lot of trivial detail.
If you are visiting with the new provider, it is crucial that you confirm who the provider is (And you are Dr. —?), what their credentials are (You are the cardiologist my primary doctor said would contact me?), and you should clearly identify yourself. Confirm either with your date of birth or some other identifier that the right patient (you) are in touch with the right provider. In some circumstances that provider may be in another state, in another time zone, and you could be confused with some other patient. Yes, this does happen.
The virtual consultation does not lend itself to the usual give and take of a normal conversation between friends over a cup of coffee. Let the provider finish his or her commentary and then weigh in with your concerns. Take notes. Write down issues to be reviewed. Have a clear idea of a plan of management. Say this: Okay, we do tests X, Y, and Z, how do I get the results, how do I connect with you, and what are the next steps?
Decide up front if you want anyone else to be involved in the virtual consultation. If there is a delicate or sensitive concern, if there are mental health or behavioral issues, you might not want your spouse or daughter sitting in. Politely ask them to leave you in privacy.
A picture is worth a thousand words. Most telemedicine consultations have a function called “screen share” where the provider can easily toggle back and forth between their commentary and your images, scans, and X-rays. Ask to see these images if they are not offered to you.
You as a patient should expect the same level of professionalism and concern as if this were a face-to-face visit. If the provider seems distracted or preoccupied, your care may be compromised.
What does telemedicine look like from the physician’s perspective? The doctor or nurse is essentially sitting at a desk in the medical office, looking at a screen. Your electronic medical records may be in front of the doctor, possibly on a different screen. The provider in the real world makes eye contact with you as a patient and may glance away to look at records or images. When the doctor looks away in the virtual world, you may have the impression the doctor is being indifferent or distracted. Just remember that this is an artificial environment designed to provide information, and the subtleties and nuances of caring sometimes become distorted. The doctor may be scrolling on a different screen through your electronic medical record or searching using the keyboard for your lab results.
When a virtual consultation is over, the ending can usually be very abrupt. You may feel a sense of loss when the screen goes blank. Make sure your questions were answered or follow up with the physician’s office staff with further questions.
My prediction for the future: I don’t think medical care delivery will return to pre-COVID in-person visits. I just don’t. We have proven that healthcare can be accomplished for many patients with various conditions efficiently and safely. Certainly, initial diagnosis and workups require an office visit and hands-on medical examination, as do routine screenings, testing, imaging, and blood draws, and, of course, emergency conditions.
Get on board with the technology because the doctor in the mouse is here to stay.