Contributed by Roberta Carson, Zaggo
Thanks to COVID-19, many of us have visited the doctor via a phone or video call. But even before this pandemic, telemedicine provided a way for patients to connect with a doctor when they could not physically get to a doctor’s office or hospital. For instance, telemedicine is great for patients who are geographically isolated, too sick to travel, or without transportation.
The convenience of Telemedicine offers many advantages for caregivers. However, before you schedule a virtual appointment for your loved one, consider the benefits and drawbacks of telemedicine.
What exactly is telemedicine?
Telehealth is the broad term for all healthcare services that use telecommunications, including telephone alerts regarding disease outbreaks. Telemedicine, a subset of telehealth, is the use of telecommunications to provide clinical services to patients. (Although it’s worth noting that people use these terms interchangeably.)
For telemedicine appointments, doctors and other healthcare professionals conduct virtual appointments with patients via phone or video. You may even be able to send photos via integrated software, allowing doctors to see areas of concern more clearly, such as moles, burns or bruises.
Additionally, telemedicine may include the use of at home monitoring systems that make it easy for doctors to track a patient’s important health parameters, such as heart rate and blood pressure.
There are 2 avenues for telemedicine services.
Many doctors use phone and video appointments with their patients, allowing you to have a virtual appointment with your own doctor at a prescheduled time.
On the other hand, large telemedicine companies, like Teladoc and Amwell, employ doctors who never see patients in person. When using a service like this, you will meet with doctors you do not know. Your doctor may use a 3rd party telemedicine company to handle their virtual appointments, or your employer may provide access to these services as a benefit to employees.
Five benefits of telemedicine.
- Telemedicine limits exposure to dangerous germs.
Clearly, telemedicine protects both patients and doctors from dangerous germs. It’s best for everyone, including the greater community, if patients stay home if they suspect they have a potentially dangerous, contagious illness. - Improved access to doctors, including specialists.
Plain and simple – telemedicine improves access to doctors. With widespread shortages of doctors and other healthcare providers, in both rural and urban areas, telemedicine can help you access doctors you would otherwise be unable to see. Similarly, patients with rare diseases can connect with hard-to-find specialists who are too far to see in person. And of course, telemedicine is a great tool if you cannot get to the doctor due to illness, transportation issues or other impediments. - It’s so convenient!
Certainly, virtual visits save time and eliminate travel-related stresses and expenses. Interestingly, one study found the average in-office medical visit takes 121 minutes – 20 minutes seeing the doctor and 101 minutes traveling to/from the doctor and sitting in the waiting room. Additionally, some telemedicine systems allow clients to sign on for an appointment from 2 different locations, allowing you to attend an appointment with your loved one without actually being with him/her. But don’t assume this option is available. While setting up virtual appointments, ask your doctors if their systems allow for simultaneous log-ins from more than one location. - It can minimize unneeded visits to the doctor or ER.
It can be a waste of time and money to go to a doctor or the emergency room if your health doesn’t require an in-person visit. With telemedicine, you can speak with a doctor and together you can decide if you need to visit your doctor in person or go to the ER. - Potential for improved quality of healthcare.
Telemedicine can make it easier for healthcare providers to stay engaged with patients, which can improve the quality of care. Additionally, when doctors remotely track a patient’s health via monitoring systems, they can identify problems as soon as they develop.
But there are drawbacks to telemedicine as well.
You can’t get physical!
Firstly, it goes without saying that physical exams are impossible via phone of computer. And of course, sometimes an in-person visit is essential for diagnosis and treatment.
For instance, virtual appointments make it impossible to swab noses and throats to test for infections. Additionally, doctors can’t screen for blood pressure or cholesterol levels over the phone. In fact, the decrease in the number of in-person doctor visits due to COVID-19 led to a significant decrease in cardiovascular screenings, both important for preventing heart attacks and strokes. Researchers compared primary care visits in the 2nd quarter of 2020 with the 2nd quarters of 2018 and 2019. They found:
- Blood pressure checks dropped by 50.1%
- Cholesterol tests fell by 36.9%
- New medication visits decreased by 26.0%
However, for patient follow-ups and minor conditions, a virtual visit may be enough. Importantly, if your loved one is too ill or weak to leave his/her house, or is contagious with a potentially dangerous germ, a virtual appointment can be a good place to start. And if your loved one cannot travel far distances for an in-person appointment, a virtual appointment is far better than no appointment at all.
Technical glitches and obstacles.
It’s bad enough to cope with frozen images and poor sound quality when video chatting with friends and family. But when glitches occur during a telemedicine appointment, it can force you to cut the appointment short or reschedule altogether.
Additionally, connecting to a telemedicine appointment can be frustrating and time consuming, particularly for the elderly and other non-computer savvy patients. For some telemedicine appointments, you can simply click on a link you receive via email or text. But other times you must download a computer application and then click through multiple steps to log in.
Not everyone can use video for appointments.
Unfortunately, it can be difficult, if not impossible, for some people, especially those with lower incomes, to have virtual appointments via video. In fact, a 2020 study of telemedicine appointments among lower income patients found that most of the telemedicine appointments were conducted over the phone. Could this impact the quality of care? Probably. Experts express concerns about the quality of audio-only appointments, as compared to video appointments.
You might not know the doctor on the other side of the phone.
Depending on your circumstances, you may end up in a virtual appointment with a doctor who doesn’t know you, or your medical history, which can be frustrating and lower the quality of care.
Distractions can lower the quality of the appointment.
When patients meet with doctors in person, it’s easy to stay focused on the conversation. However, with virtual appointments, it’s easy to be distracted, which can lower your level of engagement, which in turn can negatively impact your health and care.
How distracted are we during virtual medical appointments? According to a 2020 survey conducted by DrFirst, many patients are distracted during telemedicine appointments. Interestingly, 73% of male respondents and 39% of female respondents reported multitasking during telemedicine visits. Distractions include:
- Surfing web, checking email, texting – 24.5%
- Watching the news, TV, or movie – 24%
- Scrolling through social media – 21%
- Playing a video game – 19%
- Exercising – 18%
- Driving a car – 10%
- Having an alcoholic beverage – 9.4%
Data security concerns.
Cybersecurity is a huge concern in medicine these days, and telemedicine is no exception. Frighteningly, cybercriminals can hack into telemedicine systems to steal personal and private healthcare information. Unfortunately, right now no one has an effective way to stop these criminals, but experts are hard at work trying to thwart these attacks.
State laws can narrow access to out-of-state doctors.
It’s worth noting that each state sets their own laws regarding patient access to doctors licensed in other states via telemedicine. Many states do not allow their residents to have telemedicine appointments with doctors licensed in other states. Importantly, if an out-of-state doctor is also licensed in your loved one’s state, a telemedicine appointment should not be a problem.
Money and insurance considerations.
Just like any other medical appointment, telemedicine visits come with a fee.
If you schedule a virtual appointment through your doctor, your insurance will likely cover it. But don’t assume theses visits are covered – and don’t assume your co-pay will be the same as for in-person visits. Most states have laws requiring telemedicine coverage, but state policies change frequently. To learn about coverage in your state, visit the Center for Connected Health Policy website. It’s also a good idea to call your insurance company and ask them about coverage, including co-pays, for telemedicine services.
Additionally, it’s important to realize that some doctors charge a convenience fee, which can range from $35 – $125, on top of the normal visit fee. These fees are not covered by insurance, so ask about fees before your virtual appointment!
If you use a telemedicine company provided through your employer, there may be little or no charge, but it also might come with a bill like any other medical appointment, with the same copays and deductibles. To avoid unexpected bills, ask your employer about cost and possible copays before you make an appointment.
Medicare and telemedicine.
In 2018, the Centers for Medicare & Medicaid Services (CMS) updated their rules to cover some telemedicine services for patients in rural areas. However, due to COVID-19, CMS is now covering telemedicine services by doctors and other healthcare providers to treat patients with COVID-19 and for other “medically reasonable purposes”. The new rules, effective March 6, 2020, cover virtual visits from offices, hospitals, and places of residence. Note that coinsurance and deductibles apply.
Get the most of every virtual appointment.
Even though your appointment is virtual, don’t just sit back in your favorite TV chair and relax. Prepare for these appointments the same way you would prepare for any in-person medical appointment. For starters, write down your questions prior to your appointment. And have a list of medications taken, along with a record of symptoms and side effects. Additionally, as with any appointment, make sure your doctor understands your concerns, listens to your story, and answers your questions. Finally, make sure you understand next steps.
My final thoughts.
In the right circumstances, telemedicine appointments can be a fabulous way to have a doctor’s appointment from the convenience of your own home. However, there are drawbacks as well, particularly the obvious fact that virtual appointments mean you must skip physical exams. I personally know of a case where a serious, life-threatening illness was missed during several telemedicine appointments, likely because the doctor could not see the patient in person to get a sense of how pale and sick she was. So, use your judgement when deciding between in-person and telemedicine appointments, and in all cases, speak up if something doesn’t seem right!
About Roberta Carson, Zaggo
Roberta Carson started Zaggo, a nonprofit organization, to help patients and family caregivers manage illnesses and injuries, after her experience as caregiver for her teenage son Zachary during his 27-month battle with terminal brain cancer. The ZaggoCare System provides patients and families with the educational information, tools, and resources they need to become empowered, engaged, effective members of their medical teams for the best possible care.
100% of profits from Zaggo are donated to the Zachary Carson Brain Tumor Fund. Thanks to the support of people who buy the ZaggoCare System, we’ve raised more than $900,000 to date for one of the rarest and most deadly pediatric cancers, which otherwise receives little funding.
