“Telemedicine can make it easier, faster, and safer to get the healthcare you and your family need,” says Rachel Bishop, MD, medical director of telemedicine at Houston Methodist Primary Care Group in Texas. “Wait times are shorter than most in-person medical visits. You don’t have to take time off from work or find childcare. And virtual visits can reduce your exposure to viruses and other infections.” Precisely because of the coronavirus pandemic, the federal government, some local governments, health insurance companies, health systems, and private telemedicine companies are all taking steps to make virtual medical visits and online health assessments available to more people. Some systems are offering free virtual COVID-19 assessments to anyone who contacts them, and while the disease cannot be diagnosed without a lab test, a remote healthcare provider can direct you to the next appropriate step, whether it’s staying home or seeking in-person care. There’s no better time to learn about your telemedicine options than now. The American Academy of Family Physicians (AAFP), for example, defines telemedicine as the practice of using technology to deliver medical care at a distance, over a telecommunications infrastructure, between a patient at an originating site and a physician or other licensed practitioner at another site. The AAFP defines telehealth, meanwhile, as a wide range of electronic and telecommunications technologies that support a variety of remote healthcare services, such as medical, health coaching, and education services. Another term you may come across is “telecare,” which usually refers to using technology to monitor and care for elderly or disabled people remotely. Pediatricians are also increasingly offering telemedicine, and many specialists, such as cardiologists, neurologists, obstetricians, and oncologists, are also offering care to their existing patients via telemedicine. You may also want to check with your health insurance plan to see whether it has its own telemedicine interface, has partnered with a telemedicine company, or has preferred services. Using a telemedicine plan that accepts your insurance is one way to keep your costs down. Another option, if you’re employed, is to ask your human resources department if the company has a preferred telemedicine provider — and whether there’s a cost savings to you in using it. Medicaid covers some telehealth services, although the specifics vary from state to state. You should contact your healthcare provider if you have Medicaid to ask what services are available to you. Medicare beneficiaries also now have broader access to virtual visits, following changes to federal rules in March 2020, according to the Center for Medicare and Medicaid Services (PDF). Some physical urgent care centers are offering telehealth, and at the very least, most will speak to you on the phone about whether or not to come to the center. If you have any upper respiratory symptoms or other symptoms suggesting possible COVID-19, they likely will have special instructions for your visit. Telemedicine apps are another option. Many apps offer basic primary and urgent care, and some offer additional services, such as dermatology, nutrition counseling, or mental health help.
What You’ll Need for a Successful Virtual Visit
Telemedicine experts recommend having these on hand for a successful virtual visit: A Charged, Plugged-In Device With a Strong Signal You don’t want to run out of power or lose your connection during your appointment! Use Wi-Fi if your cellular data plan is limited. Ear Buds With a Built-in Microphone It will be easier to hear the healthcare provider, and for them to hear you. A Quiet Location With Good Lighting Turn off the TV, mute notifications on your phone, and tell others in your house you’ll be busy for the next 15 to 20 minutes before you start your visit. Make sure there’s enough light for the health professional to see your face — and any rashes or other physical problems you want to show them. If you’re not at home during the virtual visit, find a quiet, private spot where you can shut the door. “I’ve had people try to do virtual urgent care visits while they’re driving a car. We tell them to hang up and we’ll reschedule later,” Dr. Bishop says. A Flashlight You may need extra light to give the doctor a clear view of your sore throat, a mouth problem, or even a skin problem. “That’s a big one for our urgent care service at Mount Sinai,” says telemedicine expert Brendan Carr, MD, system chair of emergency medicine for the Mount Sinai Health System in New York City. “People often call for sore throat, but it’s hard to see back of a throat without a flashlight.” A List of Your Medication and Supplements, Health History, and Questions A telemedicine doctor who’s seeing you for the first time can better help you if they know about any chronic health conditions or other important health issues you have, as well as the prescription and over-the-counter drugs and supplements you currently take. It’s also smart to jot down your questions ahead of time, Bishop suggests. If you’re seeing your usual doctor via telehealth instead of in-person, be sure to mention any new symptoms you may be having, any new over-the-counter products you may be using, and any prescriptions you need to have refilled. Even now, there are still some benefits to telehealth coronavirus assessments, he notes. “We evaluate lots of people over telemedicine and then refer them for an outpatient test. Telemedicine allows us to deconstruct the traditional visit — the medical evaluation can happen virtually, and then you can swing by a lab and drop off a saliva sample to test for COVID without seeing a doctor again.” If you’re worried that you might have coronavirus symptoms, which include fever, cough, and shortness of breath, you can also use the free online Coronavirus Self-Checker from the Centers for Disease Control and Prevention (CDC), which can’t connect you with a doctor but can help you decide whether to contact one yourself. You can also consult one of the private telemedicine companies offering free online assessments, such as Doctor on Demand. There are also many ways to obtain free at-home COVID-19 tests, including from the U.S. government and through your health insurance. Who Provides Virtual Urgent Care A growing number of hospitals, healthcare systems, health insurance companies, and private, direct-to-consumer telemedicine companies all offer urgent care services. Virtual urgent care companies include Amwell, Doctor On Demand, MDLIVE, PlushCare, Teladoc, and others. Cost of Virtual Urgent Care A telemedicine urgent care visit could cost as little as $20 — the self-pay rate for anyone who uses Houston Methodist’s urgent care service, according to Bishop. Houston Methodist also accepts insurance for virtual urgent care visits; benefits vary based on patient coverage. Other urgent care services have varying fees. For example, you may pay more if you use a company that doesn’t take your health insurance (or you don’t have health insurance), and you may pay less if you use a service covered by your health plan or by your employer. How Virtual Urgent Care Works You need audio and video for this type of telehealth visit, so use a smartphone, tablet, or laptop or desktop computer with a video camera. Download the app for the urgent care service you want to use, and follow the directions for scheduling an appointment and providing credit card information for payment. You can usually meet with a doctor online within minutes. Other practices may offer only certain types of interactions online. For example, you doctor may be able to review your lab test results or check on your progress after some procedures via phone, video, email, or secure online messaging but still want to see you in the office for other types of care. In some cases, you’ll need to provide certain data before a virtual visit, such as readings you upload from your glucose meter to your doctor’s patient portal, if you have diabetes, or from a blood pressure monitor if you have high blood pressure. In rural areas, your family doctor may be able to help you access online health services, such as mental health appointments and visits with specialists. Indeed, video conferencing with specialists is an important way that rural patients and their doctors can get help managing complex chronic diseases. Major medical centers, including the Cleveland Clinic, Stanford, and Harvard-affiliated Partners Healthcare, offer virtual second-opinion programs that give you access to top specialists who can review a medical diagnosis or treatment plan online. If you’d like to try an online consultation with a doctor you currently see, ask the doctor, or their office assistant, if this service is available and right for you. “A consult or scheduled virtual visit with your own doctor means you’re working with someone who knows you and your health history,” Bishop says. “Some doctors in our system will also do on-demand urgent care visits for their own patients, so it’s worth asking.” Generally, you pay the same price for a virtual visit with your doctor as an in-person visit. But pricing and availability vary among doctors, health systems, health insurers, and states, so it’s worth checking with your doctor and with your health insurer to find out what’s available to you, Bishop adds. However, remote psychotherapy is hardly new. Mental healthcare was among the first disciplines to move to telemedicine or, more specifically, telepsychology, with research on the viability of counseling delivered via phone, video, or both dating back to the early 1960s. The internet and mobile communications devices such as cellphones and tablets have only added to the options in the decades since, according to the American Psychological Association. What has changed, though, is broader acceptance of telemedicine, or telehealth, within the field, experts say.
Zoom Meetings, Video Calls, and Phone Calls
“Telemedicine provides a socially distanced way for people to access professional services that support their recovery,” says Alice Medalia, PhD, director of the Lieber Recovery Clinic at Columbia University in New York City, which offers telehealth options for psychiatric services. The facility is not alone, as many hospitals and healthcare offices take similar steps. Of course, the traditional doctor-patient relationship isn’t the only telemedicine approach gaining use. Platforms such as Talkspace, Teladoc Health, and Doctor-on-Demand can help you set up virtual appointments with mental health professionals, conducted by video call or traditional phone call. However, not all online platforms offer medications management and remote prescribing; if you need those services, they may connect you to a psychiatrist in your area for further help.
Apps Based on Cognitive Behavioral Therapy
In addition, there are many apps that are designed to use the principles of cognitive behavioral therapy (CBT) to guide you through what is essentially a self-care regimen of activities and exercises. However, it’s important to note that these apps don’t connect you with a single, trained therapist who oversees your care. “Many people find CBT apps informative and helpful, and increasingly, therapists are incorporating apps into their practice with patients anyway,” Dr. Medalia says. However, “they don’t replace a therapist,” she adds. “Rather, they add a new way of accessing help.” A study published in January 2021 in JAMA Psychiatry generally found that these CBT-guided apps are effective at helping people with depression — one of the most common mental health conditions — manage their symptoms, provided they were guided by support from a care professional.
Pros and Cons of Virtual Psychological Care
As with anything else, there are pros and cons to the various virtual care services available in the mental health space, according to Medalia. Although these technologies allow you to maintain vital care services when in-person is not possible, and appointments are easy to schedule around work, school, and family obligations, some important aspects of mental healthcare — such as direct interaction with your therapist — may get lost in the virtual realm, where it may not be as easy to see and interpret changes in facial expression or demeanor, she says. “And there’s the issue of Zoom fatigue,” with so much of our social and work lives spent on the platform, Medalia adds. “My research on the use of telehealth for people with serious mental illnesses has found that the majority of clients prefer in-person sessions.” In addition, as important as these virtual services have become, particularly since the start of the COVID-19 pandemic, they haven’t solved all the problems related to access to care, according to Medalia. These technologies are “only viable for people who have access to web-connected technology and private space to engage in therapy,” she says. “There is, in fact, a significant percentage of the population that does not have access to the technology needed for telemedicine.” However, there are symptoms for which you will likely need to seek urgent or emergency in-person care. Those include, but aren’t limited to, any symptoms of a possible ectopic pregnancy, severe vaginal bleeding, complications following a gynecological surgery or other procedure, more severe vaginal or uterine pain, and symptoms of a vaginal infection with a fever. Learn More About Telemedicine Appointments With a Gynecologist There are instances where an in-person visit is better, such as for an annual skin check, in which a tool called a dermatoscope allows the doctor to see a magnified view of any skin lesions. And of course, any procedures involving the skin, such as taking a biopsy, need to happen in person. Learn More About Telemedicine for Dermatology Telemedicine typically works well for discussing your current treatment plan, refilling prescriptions, and asking your doctor any questions you might have about your health or your treatment plan. Telemedicine has the added benefit of minimizing your in-person exposure to others, and it saves you the time you’d spend traveling to and from appointments. For some people, opting for a telemedicine appointment also gives them access to allergy-immunology specialists that may be located hours away from where they live. However, when you connect with your doctor over the phone or by videoconference, your doctor can’t directly measure your vital signs, take your blood pressure, check your peak flow or other respiratory measures, or do any other type of physical examination that might be warranted. If your physician feels you need to have certain lung function tests such as spirometry or plethysmography, you’ll likely need to visit a medical facility to have them done. Learn More About Telemedicine for Asthma Care Addiction and recovery support groups are also widely available online, now that the coronavirus pandemic has made in-person meetings unsafe. Again, while some people appreciate some aspects of virtual recovery meetings, such as the anonymity they can have online, others miss the support they get from in-person meetings. Learn More About Telemedicine for Addiction and Recovery Because telemedicine eliminates travel time and time spent in a doctor’s waiting room, both routine appointments and urgent appointments to discuss symptom flares can take place more efficiently. That means less time and often less expense for you, and it also means your doctor may have more appointments available when you need them. There are some instances in which an in-person appointment for Crohn’s disease is necessary, including the initial diagnosis, which generally involves an examination of the inside of your colon and possibly imaging scans. Certain complications of the disease also require a physical exam to determine the best course of treatment. And of course, any surgical procedures must be done in person. Learn More About Telemedicine and Crohn’s Disease Remote monitoring allows your healthcare team to monitor your heart health and the function of your cardiac device without you having to be physically present. Even better, it can communicate this information in real time using wireless technology and a Bluetooth-enabled device. This means your doctor knows when your device has corrected a heart rhythm abnormality soon after it happens — provided you’re within in close-enough range of your home monitor — rather than several months later, when you make an office visit and have your device data collected with a special wand. It can also alert your provider to a problem with the device, such as a low battery. While remote cardiac device monitoring isn’t without its technological challenges — including getting knocked offline by weak cellular service — it has been credited with improving patient health through earlier detection and treatment of heart rhythm problems. Learn More About Remote Cardiac Device Monitoring Learn More About When to Use Virtual Care for Rheumatoid Arthritis But even before the pandemic, one type of remote stroke care for doctors was already well-established: In-hospital telemedicine for stroke care, called telestroke, has been around since the late 1990s. Telestroke describes an arrangement by which remote stroke experts help local emergency physicians assess patients with suspected stroke and decide how to manage their care. The practice helps ensure that people experiencing stroke will receive appropriate care, even if they don’t go to a hospital with its own on-call stroke team. Learn More About Using Telemedicine for Stroke Care Much of what a physical therapist does is analyze how people move and prescribe stretches or exercises that can make moving more efficient and more comfortable. And it turns out, that can be done pretty well remotely, using telemedicine instead of in-person office visits. Learn More About Telemedicine for Physical Therapy They save time. “A lot of people don’t have time to drive to an appointment and then sit in a waiting room for 10, 20 minutes or longer,” says Bishop. “We have patients who use Houston Methodist Virtual Urgent Care at work, going into a private office and shutting the door for their appointment, or using it from home.” They save money. While the cost of a virtual visit varies widely depending on your health insurance coverage, choice of provider and type of service (read on for details), it’s likely to cost less than a visit to an in-person urgent care center or hospital emergency room for the same problem. For example, you could spend as little as $0 to $82 for a virtual urgent care visit. That’s a wide range, but it’s less than the average $176 price tag for a visit to an in-person urgent care center or the $350 to $600-plus you could spend for treatment of an earache, bronchitis, or strep throat at a hospital emergency room, according to Dignity Health, one of the nation’s largest healthcare providers. Then there’s the cost of transportation. You won’t have to shell out money for gas and parking or for a taxi, train, or bus. “For someone who’s driving an hour and a half and paying $25 for parking for a routine checkup after a successful knee replacement, a virtual visit can be a big savings,” Carr notes. Bishop adds childcare costs to the savings, too. “You won’t have to pay a babysitter while you go to the doctor,” she notes. “Just find a quiet spot in your home, tap on the app, and get started.” You avoid exposure to infectious germs. Virtual visits keep you out of settings where you could be exposed to the flu or other infectious viruses, bacteria, or other germs, Bishop notes. “That can be important if you have low immunity, if something is going around in your community, or at times like this when coronavirus is spreading,” she says. “It can help you stay healthy if you’re not sick, but just need to see the doctor for something minor or for your annual well visit or for a routine visit to manage a chronic health condition such as high blood pressure.” You get access when health services aren’t available near you. For people who live in rural areas of the United States, telemedicine is helping to bridge big gaps in access to healthcare. According to a cross-sectional study published in JAMA Health in October 2021, of about 10 million rural Medicare beneficiaries, there were 34.8 telemedicine visits per 1,000 beneficiaries in 2019, and 76 percent of these visits were for mental health conditions. Meanwhile, the CDC is supporting telehealth services in rural areas of the United States that improve stroke care through hospital consultations with far-away neurologists, virtual programs for diabetes management and prevention, quitting smoking, managing epilepsy, and telemedicine screenings for eye diseases. You may still need an in-person appointment or a medical test. Sometimes, the doctor you see onscreen during an urgent care virtual visit may recommend a face-to-face appointment with your own primary care doctor or at a brick-and-mortar urgent care center. You may also need laboratory or other tests to confirm a diagnosis. You may receive better care in person. In plenty of studies, consumers are extremely happy with telemedicine appointments. But in a study published in May 2019 in the journal Pediatrics, of nearly 530,000 medical visits for respiratory infections in kids ages 0 to 7, researchers from the University of Pittsburgh Medical Center’s Children’s Hospital of Pittsburgh found that children received antibiotics at 52 percent of telemedicine visits, but just 42 percent of urgent care and 31 percent of primary care doctor visits. And fewer telemedicine visits followed guidelines for when to prescribe these often-overused drugs. In a study of 16 online telemedicine companies published in July 2016 in JAMA Dermatology, researchers from the University of California in San Francisco found that sometimes online doctors misdiagnosed skin cancer, herpes, and syphilis, in addition to prescribing medication without taking a patient’s medical history. You may not be able to choose your healthcare practitioner. Unlike scheduling an online appointment with your own doctor or arranging for one with a specific specialist, you may not get to choose your provider for a virtual urgent care visit, according to the 2016 JAMA Dermatology study. Best Uses for Virtual Urgent Care The following can often be handled well by virtual urgent care providers: seasonal allergies, colds, constipation, coughs, mild diarrhea, ear problems, pink eye, respiratory problems, sore throat, urinary tract infections, flu symptoms, headache, nausea, and short-term vomiting. When an In-Person Doctor Visit Is Better If you have a serious health problem that is likely to require a physical exam, lab test, X-rays or other scans, or other procedures, you will need to make an in-person appointment. When to Get Emergency Help Call 911 right away if you think you or someone else is having a medical emergency, the American College of Emergency Physicians recommends. Medical emergencies include, but aren’t limited to: broken bones, choking, stopped breathing, heavy bleeding, severe pain, head injuries with dizziness or confusion or loss of consciousness, serious burns, deep wounds, high fever, allergic reactions that include swelling and breathing trouble, heart attack symptoms (chest pain or discomfort, pain in the arm or jaw), or stroke symptoms (weakness or drooping on one side of body, trouble speaking, sudden inability to see, speak, walk, or move). Additional reporting by Brian P. Dunleavy.
