Telemedicine: Log on to Feel Better through Virtual Visits
by Dr. C.H. Weaver Updated 10/2021
You’ve had a stuffy nose for about a week. It has become progressively more congested, and you now have some pretty significant sinus pain. It’s feeling like a sinus infection, but you are just not sure. Dr. Google isn’t meriting any new information. If it is a sinus infection, you know that a prescription for antibiotics would clear it up. But do you really want to get in the car, traipse across the city to urgent care, and wait for an hour to see a doctor? What if it’s really just a stuffy nose?
We have all found ourselves in a similar scenario—a nagging cold, an annoying rash, symptoms that may or may not be a urinary tract infection—in need of professional medical advice but short on time and not ready to commit to the waiting room. Now an increasing number of individuals are using telemedicine, and specifically virtual doctor visits, to get more-efficient care for a variety of common health concerns. Instead of spending hours traveling to, waiting for, and checking in and out for an in-person appointment with a physician, people are logging on for diagnosis and care.
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An Expanded Healthcare Landscape
Virtual visits with healthcare providers are one offering within the growing field of telemedicine. The term telemedicine, also referred to as telehealth, is used broadly to describe the exchange of medical information from one site to another via electronic communications—a definition that includes a wide range of technology and applications across video, e-mail, smartphone, and other telecommunications technology.1
Telemedicine has long been an important aspect of medical care delivery, enabling the transmission of information and images, continuing medical information for providers, and remote healthcare delivery, among other uses. Now, as telecommunications and healthcare technology advances intersect, opportunities for telemedicine to affect patient care are expanding.
Jonathan Linkous, chief executive officer of the American Telemedicine Association, says that “the use of video, advanced technology, and broadband is allowing telemedicine to expand into surprising areas, enabling greater access and helping improve care and lower costs.” The wide availability and use of smartphones and Wi-Fi means that patients have the opportunity to use the technology at their fingertips to research and access medical care. According to the Pew Research Center, “62 percent of smartphone owners have used their phone in the past year to look up information about a health condition.”2 After finding information, the next logical step for consumers is to seek care using their smartphone or laptop.
Virtual Visits, Real Benefits
Among the many services emerging in the telemedicine field, applications that connect patients with medical experts directly for virtual doctor visits are especially popular among consumers seeking efficient care in their busy lives. Women of all ages and stages of life are tapping into expert medical care online.
Mia Finkelston, MD, a primary care physician from Maryland who practices on Amwell, the direct-to-consumer telehealth service created by American Well, says that some of the wide-ranging health issues she addresses with women include urinary tract and yeast infections, questions related to symptoms of menopause, dermatologic issues like rashes, orthopedic injuries, and upper respiratory infections.
Dr. Finkelston says that while patients new to virtual care may worry that a video visit will not allow a thorough exam or an accurate diagnosis of physical symptoms, the reality is that the video interaction is surprisingly intimate. As she asks questions to establish medical history and understand her patients’ current issue, Dr. Finkelston says she is also observing them carefully, as she would in an in-person visit: “I focus in on details in their appearance and environment,” she says. “Are they in bed, or are they feeling well enough that they are up and dressed? Are they coughing through every other word?”
Dr. Finkelston says that in the comfort of their own homes, patients are often very candid, and the environment visible in the back ground during the video chat can offer up important clues that add to her ability to get a full picture of their physical and emotional states. And, she says, she’ll use the video technology to her best advantage, asking patients to bring the phone or microphone close to their mouth so she can hear them breathe, point it directly at the rash they are concerned about, or even observe them palpate their own stomach. “By demonstrating and offering careful instructions, you can really guide a patient to show you what you need to see and assess them accurately.”
Dr. Finkelston is quick to point out, however, that there are limitations to virtual care delivery. “Telehealth services are not meant to be a replacement for in-person care; it’s meant to augment care—to provide additional access. Virtual visits should not be used to address symptoms like chest pain, neurologic pain, or signs of stroke, which should be seen in an emergency room.” In general, she says, “patients are pretty smart about how to use our services and select themselves out for issues that require specialized care or are more serious.”
Experience with RA Beginning to Emerge
A study was performed before the onset of the COVID-19 pandemic and published in September 2020 shows no significant difference in outcomes and quality measures in patients with rheumatoid arthritis (RA) who were managed by telemedicine when compared to usual in-person care.3
The study from the Alaska Tribal Health System evaluated outcomes and quality of care for RA patients seen by video telemedicine follow‐up compared to in‐person only visits. Patients were offered either in‐person or video telemedicine visits as part of their follow‐up care and were assessed by telephone survey at 6 and 12 months.
After 12 months no significant differences were identified between telemedicine and in person follow up for disease activity, quality of life and other measures. Although patients in both groups expressed a preference for in-person visits, those seen by telemedicine were more likely to have favorable opinions of it. This study suggests that telemedicine follow‐up visits can be effective and reasonable to incorporate into ongoing RA management.
Added Value: A Prescription for Peace of Mind
While getting a diagnosis and prescription online can offer a quick fix to many common health concerns, the value of these virtual visits can be more long lasting. Just as patients develop ongoing relationships with their primary care physicians, online providers can become trusted sources of information and support, offering continued benefit after patients log off.
Rebecca Callahan, NP, who sees patients through Maven, a digital clinic for women, says that one of the most rewarding aspects of her work is connecting with women and educating them about their health so that they can make informed decisions for the long term. Callahan addresses issues ranging from birth control to screening for postpartum depression to questions about diet and lifestyle changes. No matter what the topic, she says, her goal is to meet women where they are—emotionally and physically—and develop a trusting relationship. “Many people just want to be heard and understood,” she says. “They are seeking accurate information, and I provide that information and empower them to take better care of themselves.”
Dr. Finkelston agrees, noting that the opportunity to provide accurate, timely information and become a trusted source of support is one of the things she likes most about practicing online: “I love providing patient education and reassurance; the calming effect of information is an important aspect of telemedicine.”
Care Comes Full Circle
While the rapidly evolving telemedicine space is offering up new options for access and treatment that reflect innovations in technology, for many the draw of a virtual visit is about the desire for a kind of care that is much older: the house call. This new iteration of that tradition has the potential to bridge a gap, providing patients with access to trusted providers on their own terms and in their own time.
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Patient Profile
Lauren Barth and her family, including her two toddler-age children, moved from Connecticut to Long Island more than a year ago, but the busy reality of life as a working mom has meant that Lauren still hasn’t found a local pediatrician. They had made the 40-minute drive back to Connecticut on occasion to visit their beloved family physician, but when the whole family came down with what Lauren refers to as the “preschool plague” (think lingering cold symptoms and sinus issues), packing up the kids felt daunting.
“I really just didn’t have the time, energy, or patience to pack up the kids and take them to the doctor’s office,” Lauren says. “I dread taking my three-year-old to the pediatrician’s office because he always wants to play with the communal waiting-room toys, which makes me cringe. It’s like, ‘Here, have some germs with your germs!’ And it can occasionally be a notoriously long wait to see my doctor. I don’t need my kids having meltdowns in the waiting room.”
Instead of facing the drive, the wait, and the yuck factor, Lauren logged on to Amwell, the direct-to-consumer tele-health service created by American Well.
“I was curious and optimistic,” Lauren says of her first experience with a virtual physician visit. And her expectations were met: a quick, streamlined process put her face-to-face with a physician who could assess her symptoms and offer medical advice in no time. “I was able to take control of the situation, pick my preferred healthcare provider, and talk to her within minutes,” Lauren says. “It was far less stressful than a traditional in-office visit.”
Based on her experience, Lauren doesn’t hesitate to recommend a telehealth appointment: “I would just say to give it a shot. It’s so easy, and for me it really took the stress out of the situation—and all of us could use a little less stress in our lives.”
Answering The Call:Insurance Provider Embraces Virtual Trends
Insurance providers are recognizing the interest among consumers for the access and efficiency that virtual visits provide. In April 2015, UnitedHealthcare expanded coverage options for virtual physician visits to self-funded employer customers through video visits with physicians from virtual care provider groups and will be offering coverage to 20 million members in 2016.
Karen Scott, senior director for product innovation at UnitedHealthcare, says, “Demand among consumers, coupled with key guidance both from the American Medical Association and the Federation of State Medical Boards around virtual visits, led us to create a strategy to cover [virtual] visits for patients.” Scott says the focus of the initial virtual visit offering is to provide coverage for “simple, nonemergency medical needs: things like colds, flu, basic upper respiratory infections, and some women’s health needs.”
As part of its coverage of virtual visits, the company is working to educate customers about how and when to use them. Scott says that these visits should be considered one additional place of service within the bigger landscape of healthcare: “They will not be appropriate for everything. What they become appropriate for will continue to expand as other technologies expand.”
Some of the emerging advances on the horizon that might expand virtual offerings include devices that can be plugged into smartphones to transmit vital signs, expanding the information available to the virtual provider. The technology is available now and is part of an exciting, evolving story: “I think what’s so fascinating,” Scott says, “is that you’re never quite sure what the next piece will be that will leap-frog the market in what we can do in virtual care.”
Women’s Telemedicine Innovator:Q&A With Maven Ceo Katherine Ryder
Maven is the first digital clinic for women, offeringonline visits with a wide range of women’s health practitioners.
What Inspired You To Start Maven?
I started Maven to empower women to take control of their health and wellness via better information and access to the best women’s and family health providers.
During my twenties and early thirties, I witnessed firsthand just how many gaps there are in healthcare for women. Even as a college student, if you need birth control, you need to navigate the health system independently in a way that is entirely unique to women. This happens again when you think about starting a family. I’m surrounded by friends who have had subpar experiences with the fertility industry and navigating pregnancy, childbirth, and early motherhood.
Most of the family care falls on a woman’s shoulders, too. Nothing really prepares you for these experiences, but they are complex and can be confusing. A lot of what is needed isn’t formal care but rather someone to talk to, who can answer basic questions, who can help you understand if what you are going through is normal. This is especially true when it’s so easy to Google your symptoms and misdiagnose yourself or your children with some horrible disease.
What Services Do You Currently Offer Women Seeking Healthcare?
We provide women with on-demand access to video appointments through our iOS app. Women can see doctors, nurse practitioners (who can also prescribe), mental health providers, midwives, doulas, lactation consultants, nutritionists, and physical therapists, many of whom specialize in women’s health. This list also includes pediatricians and pediatric nurse practitioners, so women can call in about their children. There is usually someone available 24/7.
What Do Women Tell You Is Motivating Them To Seek Out Your Services Versus In-Person Appointments With Clinicians?
Convenience, quality, and trust. It is often difficult for the modern woman to make time in her busy schedule to excuse herself from work, bundle up her children, travel to a medical office, and spend hours in the waiting room. Our patients can see us whenever and wherever they need us. They know that we have a highly vetted team of health and wellness providers (we have a healthy rejection rate), and they are empowered to choose their own clinician. We have found that this increases trust in the patient/provider relationship.
What Motivated You to Start the Maven Foundation?
We just launched our social innovation arm, Access for All. I am incredibly excited about this. Every time a woman buys an appointment on Maven, the Maven Foundation donates $1 to an appointment for a woman in need. But we’re not just donating money to other nonprofits; we’re actually delivering the care ourselves. Our first initiative is around breastfeeding. At the beginning of every month, our four nonprofit partners get a certain allocation of appointments to hand out to the lower-income women they work with, and these women see Maven’s International Board Certified Lactation Consultants for free via Maven’s platform.
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References
- What is Telemedicine? American Telemedicine Association website. Available at: . Accessed January 18, 2016.
- U.S. Smartphone Use in 2015. Pew Research Center website. Available at: . Accessed January 18, 2016.
