Telemedicine’s big moment

Andrew Boyett is still paying for a fleeting mistake he made while studying abroad in France 15 years ago. Driven by all the hubris a 20-year-old could muster, he and some classmates decided to climb a moss-covered exterior wall at what remains of Richard the Lionheart’s castle. But after climbing 40 feet, Boyett remembered that what goes up must come down.

Boyett jumped several feet and landed upright, but he still feels the pain of the resulting herniated disk in his back. That pain flared up again earlier this year. When his doctor’s appointment finally arrived in April, the coronavirus had hit the United States, and medical practices were closed to most in-office visits. Boyett’s doctor consulted with him through an online platform. Boyett said the convenience—not having to leave work—will make him a repeat telehealth customer.

COVID-19 has consumed our collective attention, but chronic and routine ailments still gall patients. The effort to avoid coronavirus transmission in doctors’ offices has promoted the expansion of telemedicine—where health professionals provide medical consultations by internet and phone.

Andy Kahn is an ER physician turned telemedicine provider. He left hospital practice in December 2017 and transitioned to virtual visits full time. His work typically goes through busy seasons: In September, calls begin rolling in from teachers and students who picked up a bug at school. October through March, Kahn sees an increase in flu-related calls. Things typically slow down in the summer months, with patients calling in for ailments like poison oak, swimmer’s ear, and altitude sickness.

Beginning in March of this year, though, he noticed a spike in the number of patients using telehealth services due to their doctors closing office doors to nonemergency needs. Once things began opening, patients still wanted to avoid waiting room exposure. Kahn has also noticed more providers joining telemedicine networks. From April 2019 to April 2020 telehealth usage increased by more than 8,000 percent, according to the nonprofit FAIR Health.

Tara Cavazos, a nurse practitioner, runs a Dallas clinic. Before the pandemic, her office was equipped for telehealth, but those visits made up only one or two appointments per week. By mid-March, though, Cavazos and her partners took nearly all appointments virtually. Her office was authorized to do COVID-19 testing, so it was important to limit in-office exposure for healthy patients.

“We quickly decided either you’re going to come through the back door and get COVID swabbed, or you’re going to be telehealth, and there’s no in-­between,” Cavazos said.

Virtual consultations are convenient and often more affordable than an urgent-care visit. And, Kahn noted, “nearly everyone has an internet connection with their phone or their laptop,” making it easy to connect to a telemedicine provider who can then send a prescription electronically to the patient’s local pharmacy.

So much is lost over a telephone encounter.

But telehealth presents some challenges. Cavazos found that virtual visits have put an additional strain on her office’s front desk staff, who often must walk less tech-savvy patients through creating an account login for the online platform, ensuring they’re using a computer with a camera or a smartphone or tablet. She was relieved when the federal government announced in late March it would waive privacy law restrictions against providers using less secure technologies—like FaceTime or Google Hangouts—in patient consultations. The goal, stated Office of Civil Rights director Roger Severino, is to maintain medical care access for “older persons and persons with disabilities.”

Cavazos said her older patients are often accustomed to talking to their grandkids over FaceTime already, so that option made adding new telehealth patients less of a burden on her staff.

Some providers worry the growth in telehealth will widen the chasm between underserved patients and quality care. Dallas nurse practitioner Katy Vogelaar said her low-income patients—many of them refugees—don’t have reliable internet access. Often, they do not even have a phone. Language barriers also make communication by phone difficult for her clientele: “So much is lost over a telephone encounter,” she said.

Cavazos agrees: “We didn’t go into healthcare to be behind a computer. Healthcare requires a holistic approach: seeing, touching, talking to a patient.”

Her practice currently tries to sustain its providers by rotating who is on telehealth duty and using a standing desk. Even on days that feel monotonous, Cavazos said most providers endure, knowing they’re providing a valuable service to patients.

“I’ve never had a day really where I haven’t wanted to go to work, even in the midst of this pandemic,” she said. “I still love what I do. It just looks different.”