Telehealth Tips: How To Make The Most Of Video Visits With Your Doctor

Apr 15, 2020
Originally published on June 1, 2020 12:01 am

Updated on June 1 at 12:01 a.m. ET

I'm a primary care doctor, and in normal times, my favorite part of the job is getting to see my patients regularly. But because of the COVID-19 pandemic, I've had to substantially cut down on in-person visits to help put the brakes on the spread of the coronavirus.

In this time of high medical anxiety, the phones at my clinic have, understandably, been ringing off the hook.

Lots of patients have questions about symptoms that might signal COVID-19. (This coronavirus risk tracker from Emory University can help you there too.) But they still need to know whether the pain in their knee after a fall signals a broken bone that requires treatment, whether their child with a fever needs antibiotics or whether a family member's fatigue is a sign of a serious illness.

For many such cases, I once would have said, "Come on in, and let's get you checked out." But now, I'm increasingly turning to email, phone calls and video chats.

Here are some tips to help you know when to call your doctor and how to get the most out of your telemedicine visit:

If you don't have a doctor yet, get one. Because of the pandemic, many primary care providers are allowing new patients to establish care via a telemedicine appointment. (Previously, many practices would return only the calls of patients who had already been seen in person at some point.) Your new doctor will probably ask you to come in for an in-person visit when it becomes safe to do so.

Many urgent care centers and walk-in clinics are also offering telemedicine visits. You can call or check out their websites to set up an appointment.

Emergencies are still emergencies. Some of the same rules from pre-pandemic days apply: Sudden chest pain, weakness in one side of the face or body, or sudden difficulty breathing are all red-alert symptoms. Call 911 pronto in these cases.

Urgent, but not an emergency? Call your primary care provider's office. Ask yourself if, in pre-pandemic times, these symptoms would have led you to call your doctor in the middle of the night for advice. Common concerns in this category include high fevers, a new source of pain or a minor injury. If the answer is yes or if you aren't sure, please give your doctor a call right away.

"If you feel as though this is a ... situation that can't wait, that would make you pick up and go to the urgent care or the hospital, you need to be giving me a call," Dr. Gary LeRoy, an associate professor of family medicine at Wright State University and president of the American Academy of Family Physicians, tells his patients.

Note that you probably won't immediately reach your primary care provider. Most doctors and nurse practitioners work with a team of office staff, including nurses and other clinicians, who can quickly help you talk through your issue over the phone.

Help the triage nurse.

To get the most out of this triage call, try to summarize what's going on in one or two sentences. Start with your most urgent symptom first; note how long it has been going on and what has changed.

If the triage nurse determines your symptoms sound like an emergency, you might be advised to go to the emergency room right away. If that's what you're told, don't hesitate — do it. Even during the COVID-19 crisis, the hospital is still the safest place for true emergencies.

Otherwise, if your concern can best be treated via telemedicine, you'll be scheduled for a phone or video appointment. Whether you'll have a copay for that conversation depends on its length and your health insurance. (To avoid getting unexpected bills, make sure you ask the triage nurse or administrative staff if your call is considered an appointment.)

Prepare for the conversation

Make a list. Even for in-person visits, I always recommend that my patients write down a list of two or three issues they want to address, so they won't forget anything important. This is especially vital when the visit is via phone or video chat, where, I've noticed, my patients are more likely to lose their train of thought.

LeRoy recommends patients ask themselves: Why do you need to be seen today? What's the biggest priority? "I spend so much of my time," he says, "trying to figure out, 'What are you really here for?' "

Keep track of when your symptoms started and if they've changed. A symptom diary may reveal clues to what's causing your condition. Keep a brief record of when symptoms occur, what seems to trigger or aggravate them, and what alleviates them.

Take and send a photo of obvious symptoms. Some medical issues — bites, moles, rashes and other skin issues — are particularly well suited to telemedicine. To help a doctor know how quickly a rash or skin reaction is spreading, draw a circle around it with a pen and send a sequence of photos taken over a couple of hours, noting the time each was taken.

Address routine issues before the visit. Medication refills, notes from a doctor that are required by your employer or insurer, or other paperwork may not even require a telemedicine visit.

Sign up for your doctor's online patient portal if it's offered — that's the secure app that's connected to your medical record, where you can see your test results and request appointments. You can often ask for medication refills that way without needing to be seen.

You can also use that portal to submit any scanned forms you need completed; that way you can spend the virtual visit going over any questions or details with your doctor. If you need a note for work, make sure you have an email address or fax number where you'd like it sent.

Be ready to talk

Call from a quiet place. So many of the telemedicine appointments I've fielded during the coronavirus pandemic have been tough for a simple reason: It was hard to hear. Try to find a quiet place with good cellphone reception to receive your doctor's call. If you're using a video chat app, give it a try before the appointment, so you can troubleshoot any challenges.

Avoid phone tag. Be prepared to answer your phone at the appointed time, even if it comes from an unknown number. Make sure you've disabled any spam blockers or functions that reject calls from private numbers.

Use health tech and equipment to your advantage. Have on hand any medical devices your doctor has prescribed or recommended.

A thermometer will confirm whether you have a fever. If you're experiencing chills or body aches, check your temperature orally — or use a rectal thermometer for babies who can't hold the thermometer in their mouths. And avoid forehead or armpit readings, since they tend to be inaccurate. A fever is defined as 100.4 degrees Fahrenheit or above.

If a condition like heart failure is causing you to retain fluid, you'll be able to help a doctor detect that by measuring your weight at the same time every day on a home scale and keeping a record.

A blood pressure cuff can help you make sure any medicine you take for hypertension is working correctly. Your blood pressure goal depends on your age and underlying medical conditions, so make sure you ask your doctor what number you need to aim for. And a glucometer can help people with diabetes keep blood sugar levels under control. If you've been told to use one, track your values.

Sometimes an office visit is best. Know that for urgent issues, your doctor's office is still open for business. In my experience over the last few weeks, the telemedicine approach has worked really well for certain concerns — mental health care, medication refills or skin problems that can be easily examined with a photo.

But it doesn't work so well for more complex issues, like an elderly patient who can't walk after a fall or a child who has gotten dehydrated from vomiting. In those scenarios, I really need to examine my patients and check their vital signs. I'll still ask them to come into our clinic if I think a brief appointment with me may help them avoid a trip to the emergency department later.

Telemedicine also doesn't work for preventive procedures such as Pap smears, colonoscopies and mammograms. Many of these have been put on hold, but some hospitals are now adding back more in-person visits and elective procedures when they can do it safely.

I certainly miss seeing my patients in person. But I also hope that we doctors can learn from this experience and start using technology to offer our patients more convenient care.

Especially now, when so much of daily life has been upended, "it's gratifying to be able to offer this additional service to our patients," LeRoy says. "We can interact with them. They feel connected and not marginalized or forgotten."

Mara Gordon is a family physician in Camden, N.J., and a contributor to NPR. You can follow her on Twitter: @MaraGordonMD.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

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LIFE KIT wants to hear from you. If you've got a random tip, leave us a voicemail at 202-216-9823. Or email us at lifekit@npr.org.

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MARA GORDON: Prior to the COVID-19 pandemic, I was doing zero telehealth.

MERAJI: That's Dr. Mara Gordon. She's a primary care physician and fellow LIFE KIT host.

GORDON: I would call my patients, chat with them on the phone briefly about test results or medication renewals or specific questions that they had. But pretty much everything, I always asked my patients to come in. My whole schedule was packed with appointments, and so that was sort of the unit of time that we use in primary care. And it was really hard to squeeze anything else in.

MERAJI: The COVID pandemic has changed Dr. Gordon's routines, and telemedicine is now a big part of her day.

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GORDON: Hello? Hello, this is Dr. Gordon. OK they hung up. All right.

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MERAJI: Dr. Gordon's a lot more familiar with the ups and downs of phone and video visits with her patients. And she's here to share some tips on how to get the most out of your telehealth appointments. We're going to cover everything from how to prep for an appointment to what sort of equipment you might want to have at home.

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MERAJI: All right, Dr. Gordon, let's start with the basics. When we say telehealth, what exactly does that mean?

GORDON: So telehealth means having a doctor's appointment over the phone or over video chat. It's something that some doctors offered and some people were able to take advantage of prior to the coronavirus pandemic, but it was not really in widespread use prior to a month or two ago. So it is - it's pretty new.

MERAJI: What sorts of things can patients use telehealth for?

GORDON: Things that it's good for, things that telehealth is good for - something that's changed and you aren't too worried about it; you don't think it's an emergency, but something that ordinarily you might make a sort of semi-urgent appointment with your doctor within the next week or so. A lot of those work really, really well over telemedicine. Mental health concerns work great over telemedicine. I do a lot of mental health care in primary care, and those kind of visits are totally seamless over telemedicine. A lot of chronic disease management - so if you've been stable with high blood pressure for months and months and months and you just want to check in about it, that works great over telemedicine. So those are the main categories that I'd say work really well.

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MERAJI: We all know that healthcare workers, like you, are really overloaded right now. And I know for sure that there are folks out there who are delaying calling their doctor because they don't want to add more to your plates. So...

GORDON: Yeah (laughter).

MERAJI: ...When should people call you, and is it ever OK to wait?

GORDON: A month ago, I would have said wait. Now we are in the swing of things with telehealth. We have it up and running. We have adapted really, really quickly. And I don't think you have to wait. I think it's totally fine to try to address routine issues now, and I think it's totally fine to establish care with a new doctor. You can always, always call, and you should never feel like you can't talk through what's going on with your doctor.

I think the question, rather, should be not, you know - should you call? But the question should be - should you choose one of three options, which is do a telehealth appointment, should you do an in-person appointment, or should you schedule an in-person appointment for a couple months in advance?

MERAJI: So how do you decide which one's best?

GORDON: So a good rule of thumb is that if you have a problem that's been going on for years and you have a good treatment plan for it, those kinds of visits can generally be delayed. So for example, if you have high blood pressure but it's really well-controlled on medicines, you just need a renewal on those medicines - that's the kind of thing you can delay. Your doctor is going to want to see you and talk about it, but that could probably wait a couple months. Check in with your doctor just to make sure that it truly is as stable as you think it is, but many of those can safely be delayed for a couple months.

The other thing that can wait a few months is preventative care. So when I say preventative care, I mean things like pap smears for cervical cancer screening, mammograms, colon cancer screening. That kind of stuff, I'd say it can wait a couple months but not too long. You should always call your doctor if you have questions about it, but I would say a lot of those types of preventative procedures can safely be delayed.

For acute concerns - acute concerns mean things that are new, unexpected. Those, we can break up into two categories - things that need to be addressed in person and things that can be addressed via telemedicine. You know, emergencies are still emergencies. Right? So if it's the kind of thing that you would go to the emergency room for, you should definitely still go. I have a lot of patients who are calling me who feel afraid to go into the ER, and there's some new data coming out about people who are dying of heart attacks because they're afraid to go into the ER during the coronavirus pandemic. There's a lot of emerging research on this. And if you're having an emergency - if you're having a heart attack, if you can't breathe, if you're worried you're having a stroke - you know, all these types of things that would make you get up, go to the ER in the middle of the night, you really still should because even though, you know, the risk of exposure to COVID-19 still exists, the ER's still the safest place in a true emergency.

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MERAJI: OK. So if the decision is made that telehealth is the best option, how can you effectively advocate on your behalf in a telehealth appointment?

GORDON: So I always say that for any visit - telemedicine, not telemedicine - you should always have a list 'cause primary care appointments are just too short. This is just a reality. Most of them are almost - usually 15 minutes long. So you need to really carefully choose one or two topics that you want to make sure you thoroughly address with your doctor rather than getting distracted by lots of different topics that you sort of don't fully address and then you leave sort of thinking, what did I accomplish? Right?

I think this is especially important for telehealth because - I've noticed this in my patients that it seems like it's hard for people to sort of keep track of their train of thought. They have kids screaming in the background. You know, it's hard to hear sometimes. Like, it's just - there's a lot going on. It doesn't have the same focus of a visit in a doctor's office. And so I think making sure that you feel clear about what your agenda is is super, super important before your appointment.

And I always want to know - whenever my patients have a new problem, I want to know how long it's been going on for and how it's affecting your quality of life. Right? So I want to know what's changed for you. So for example, if you get occasional headaches but all of a sudden they're coming a lot more frequently, they're a lot more intense, it's making it difficult for you to work - I would definitely want to know about that. So if you can kind of jot down before the appointment sort of any changes and how long those changes have been occurring and any patterns that you're noticing, that can really, really help.

MERAJI: So be prepared with a list. I like that. I've never done that.

GORDON: Always. Always. Always be prepared with the list, right? And write down questions, too. So write - you may want to address headaches, but then you might also have, like, a nagging question about a blood test that your doctor had ordered a couple months before. Just you know, make sure that you don't forget anything. That's all I would say.

MERAJI: Dr. Gordon, you say patients should make tech work to their advantage in these telehealth visits. What do you mean by that?

GORDON: So I have noticed that there's a couple of different categories of sort of technology for health that have come really, really in handy as I've been doing telemedicine appointments. So the first you probably already have, which is your smartphone. Right? So just taking photos of any rashes, taking a photo of anything on your body that's concerning you. And even if it seems normal, that can be helpful, too. So for example, if your knee is hurting and you take a photo of a normal-looking knee, that can be useful information to your doctor.

Another thing that really comes in handy for a lot of patients is a home blood pressure cuff. A lot of insurances will cover it, so always ask your doctor for a prescription for one. That's something that can really help, and your doctor will want to know what your blood pressure is even if you don't have a history of high blood pressure.

The other thing is a thermometer. I do not recommend routinely taking your temperature because it's going to stress you out, and it's not going to provide any useful information. But if you start to feel sick, a thermometer can be helpful in assessing whether or not you have a fever. And a fever is defined as 100.4 Fahrenheit or above, so don't stress if it's below that, please - please. I get a lot of people saying, my temperature's 99. I'm like it's fine, normal. Don't worry.

And one final thing I want to say that is really low tech is just keeping a diary of your symptoms. Right? So this can give me so many clues to what's going on with you, especially when I can't examine you in person. Keep track of how you're feeling, what time of day your symptoms come on, if there's anything that seems to exacerbate it or alleviate it, anything you've done to make it better, what's going on in your day that day. We can really start to see patterns and clues that are super useful for me and can really help me offer you good advice about how to alleviate your symptoms.

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MERAJI: Is there a way to just bypass a telehealth visit to get what you need without having to see your doctor at all? I'm thinking about prescription refills and things like that.

GORDON: Yes, yes, yes. And I love this question because I want my patients to use it more. So a lot of doctors will offer what's called a patient portal, which is basically like a secure app that connects to the electronic medical record and sort of securely connects to your health record. It's amazing. You can use the patient portal for a couple of things. One is just sending me an email - right? - so if you have sort of a non-urgent medical question. You can also request medication refills that way.

Another really handy feature that has been a lifesaver during the pandemic is a lot of employers require notes for patients to either be excused from work or return to work. So we're able to do that virtually. Right? So I'll do a telehealth visit with you, you know, assess your symptoms, and I can write you a note that you can download through the patient portal. And you can just print it at home, print it out at work, even email it to your employer. You don't need to come in, which is really, really wonderful.

MERAJI: Use that patient portal. I am one of those people that forgets my password every single time. I am that person who is like - ugh - how do I get into this thing again? What is my password?

GORDON: I know. I know, I know. It's universal. But I really do think it's worth it. It's - I use it with my own doctor all the time.

MERAJI: You said a few times to call your doctor, et cetera. But what if you don't have a doctor right now? And how do you find a doctor right now?

GORDON: So finding a doctor is a much longer conversation. However, if you have a sense of where you would like to go - if there's a clinic near your home, if you have a place that's been recommended by family or friends, somebody else in your household has a clinic that they go to, many, many primary care doctors are now seeing new patient visits over telemedicine, which is a huge change.

So prior to the COVID-19 pandemic, a primary care doctor would pretty much only call you back if you had already established care with that doctor or with another doctor in that office, and that's because insurance, you know, wouldn't pay for that phone call basically. It's been a big change that the Center for Medicaid and Medicare Services, CMS, just said that they would start paying for initial visits - so that first visit, they would pay for it - if it's done over telemedicine. And a lot of private insurance companies have followed suit. So you should call and say you want to establish care, and most doctors will see you over telemedicine for a new patient visit now.

MERAJI: That's great. That's great news. This was really comprehensive. Did we miss anything? Is there anything else we should know?

GORDON: I would say that we really want to help. So I'm not taking it lightly now if I ask my patients to come in. And if I do ask my patients to come in, it's probably because I think that a short visit with me will help them avoid a visit to the emergency room later. Right? So it's something that I can probably take care of pretty easily, or I can help triage it in person.

The kinds of things that I'm having a really hard time assessing over the phone are things like chest pain, severe abdominal pain. Things like that can be really, really hard to tell how severe it is without being able to take my patient's vital signs, listen to the heart and lungs, examine them in person. So those are the kinds of visits that I'm asking people to come in for. And I think many of those visits, I'm able to help prevent an ER visit for my patients. And it's worth coming in for.

And we will do our best to help you stay safe. So we use personal protective equipment. My clinic, at least, is instituting some social distancing measures to help keep patients apart in the waiting room, help make sure that our clinic is clean and safe both for our staff and for our patients. So it's something that we're doing with your best interests in mind, but I'm always happy to talk on the phone, too.

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MERAJI: All right, Dr. Gordon, I'm going to tick through some of the big takeaways from this conversation. No. 1 - if you don't have a doctor, get one.

GORDON: Yes, we really want to hear from you. I've had so many new patients establishing care, and there is no time like the present.

MERAJI: No. 2 - emergencies are still emergencies.

GORDON: Even though the coronavirus pandemic is very scary to many of my patients, if you're having a true emergency, a hospital is still the safest place for you.

MERAJI: If you're not sure if you need an appointment, just ask. Three - prepare for your telehealth visit.

GORDON: Please make a list before your appointment. It will definitely help keep you focused during a short visit with your doctor. And keep a diary of your symptoms, too.

MERAJI: Four, use tech to your advantage

GORDON: If you have any equipment that your doctor has told you to use, use it and take note of the readings. So that would be something like a home blood pressure cuff, a glucometer, a scale - even your smartphone. You can use it to take photos. Photos, photos, photos - definitely.

MERAJI: And five - don't forget your doctor is there for you.

GORDON: If you have any questions, you should not hesitate to call. We really do have your best interests in mind, and we really want to keep you safe.

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MERAJI: For more episodes of LIFE KIT, go to npr.org/lifekit. We have episodes on all sorts of topics, from how to stop paying unnecessary fees to how to get a great night's sleep. If you love LIFE KIT and you want more, subscribe to our newsletter at npr.org/lifekitnewsletter. Also, we want to hear your tips. What are you doing to cope right now? Leave us a voicemail at 202-216-9823, or email us at lifekit@npr.org.

This episode was produced by Andee Tagle. Meghan Keane is the managing producer. And Beth Donovan is our senior editor. I'm Shereen Marisol Meraji. Thanks for listening.

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