There was a time not so long ago when we went to a doctor’s office, waited in a waiting area (often longer than we wanted to), and read outdated magazines until we were called into the inner sanctum.
No longer.
The new age of the doctor’s appointment is virtual, attributed in great measure to the COVID-19 pandemic. As with other social interaction in society, the doctor’s visit has changed dramatically.
So now, how best to prepare for your virtual exam?
Anyone who had shied away from technology will now need to embrace an online landscape. Facetime and Skype or Zoom or GoToMeeting are relatively easy to master because a physician relationship will quickly become more like a social media or an online shopping encounter.
The doctor is truly in the mouse, and your iPad can become a gateway to healthcare.
Get set up: Talk by phone with your physician’s office to set up a time to call or be connected. Get the details of the Skype address or Facetime phone number. If you are new to this part of technology, view YouTube videos or talk with a savvy grandchild. You need either a headset with a high-end microphone for the audio portion or reliable computer speakers or a nearby phone line. Test the set-up by connecting with someone else before you attempt your first virtual doctor visit. That initial phone call may be the best time to update health insurance information with the doctor’s billing office.
Make notes ahead of time: Keep your list of concerns and other information I am about to outline for you and a pen ready so you can take notes during the call.
Medical records: Sensible medical care must continue to be delivered within the context of a patient/physician relationship. If the doctor on the other side of the technological divide knows you or if a member of the staff knows who you are, there can be a reasonable dialogue about your medical concerns. Do not think you can contact some provider who does not know you and expect a meaningful conversation. This simply will not happen.
The provider in cyberspace should be able to access your medical records. Depending upon the setting, have in front of you your medical record number for the patient portal, insurance cards, and any pertinent documents with regard to billing. Know the name of your pharmacy, the physical address as well as the fax number and the phone number in case the doctor calls in a prescription.
Medications: In preparation for the call, also have in front of you a list of medications including doses and schedule and why the medication was prescribed and any allergies to medications you may have. Know why each medication was prescribed.
Eye to eye: Face the doctor on the screen. Try not to turn away. A virtual consultation works best if the patient is not distracted and does not defer to another person in the room for help responding to a question (for some elderly people and for children, having another person present may be helpful especially for note taking). It goes without saying, but I’ll say it anyway, minimize the usual distractions such as ringing phones, barking dogs and curious cats, and children needing attention. And this is not the time to answer the doorbell for a big box delivery. Do not conduct the call while driving (seriously, did I even have to mention this)?
Most important issue: The virtual consultation is not a formal medical visit in most circumstances. In a typical general medical practice the usual patient would have six complaints (we doctors call them complaints, but these are really your six biggest concerns and items you want to talk about). These all cannot be practically addressed across the screen, so be clear, focused, and very specific on that one issue you are worried about—the main reason for the virtual medical consultation. Be certain that the main thing stays the main thing.
Vitals: You can take your temperature (with a thermometer). You can take a blood pressure reading if you have a home monitor. You can visit a pharmacy and take your blood pressure there. You should know your weight and height. If you are monitoring your blood glucose (for diabetes), you have a monitor and test strips. Often there’s an “app for that” or a device that functions like a heart monitor. More and more, apps and devices will be available so you can report your vitals to your physician without an office visit. If you can measure any of these vitals, do so in advance of the call. Write them down in your notes.
Privacy issues: With the COVID-19 virus threatening the very fabric of the healthcare system, the usual privacy restrictions have been waived on the use of telehealth for the duration of the current public health crisis. This technology can triage patients and avoid the need for a face-to-face appointment, which protects the patient (and provider) from being in a risky healthcare environment and opens up a slot for a patient who may need that hands-on assessment. Up to now, patients had to have an actual office visit for the provider to get paid. No longer. The Medicare requirements and the HIPAA regulations have been softened during this public health crisis.
Here’s my prediction. And the current tsunami of telecommuting bears this out. The current pandemic is setting the stage for more virtual physician visits as well as visits to the nurse practitioner or physician assistant (shall we say mouse-calls?), a modern version of the old-fashioned house-call. Peter Drucker, the management guru, made the comment: “The best way to predict the future is to create the future,” and telemedicine is not creating the future, it is the future. And the future is now.
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