Virtual visits bring real change to healthcare

NICK EICHER, HOST: Coming up next on The World and Everything in It: Seeing a doctor without an actual office visit.

MEGAN BASHAM, HOST: Despite COVID-19, patients still have chronic and routine ailments to deal with. To avoid potentially catching the virus in doctors’ offices, many are trying out telemedicine. That’s where health professionals provide medical consultations by internet and phone.

EICHER: The nonprofit group FAIR Health says that use of telemedicine increased 8,000 percent between April 2019 to April 2020. But patients and doctors alike say the tool presents both benefits and challenges. WORLD senior correspondent Katie Gaultney reports.

KATIE GAULTNEY, REPORTER: 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. 

BOYETT: My goal in life was to climb higher than everybody else, which I did…

But after climbing 40 feet, Boyett remembered that what goes up must come down.

BOYETT: So I jumped and I didn’t think I was as far up as I was.

He still feels the pain of the resulting herniated disk, and it flared up again earlier this year. His doctor’s appointment arrived in April, just as the coronavirus hit the United States and medical practices canceled most in-office visits. Boyett’s doctor consulted with him through an online platform. Boyett didn’t even have to leave work. And he says that convenience will make him a repeat telehealth customer.

Telemedicine has been around for several years. But the pandemic has caused many patients to experience it for the first time. And like Boyett, many of them will likely continue utilizing it when they can. 

Andy Kahn is an ER physician turned telemedicine provider. He left hospital practice in December 2017 and transitioned to virtual visits full time. Some doctors have brick-and-mortar offices and offer the option for telehealth, but others, like Kahn, contract with online-only telehealth providers. Kahn says his work has an annual rhythm.

KAHN: You see kind of seasonal things. So in the summer there’s not as many patients, but you see more like swimmer’s ear and poison ivy from hiking and people wanting medicine before they go traveling somewhere with altitude or motion sickness… 

But once school starts, calls begin rolling in from teachers and students who picked up a bug in class. October through March, Kahn sees an increase in flu and respiratory-related calls. Then, in a typical March, things slow down a bit.

But if 2020 has proven anything, it’s that things just aren’t typical these days. Mid-March this year Kahn noticed a spike in the number of patients using telehealth services because their primary care doctors weren’t taking non-emergency cases.

KAHN: There were so many people calling in that, you know, there weren’t enough doctors on telemedicine, so people were waiting a long time and sometimes the system would crash. 

He said online platforms quickly got the bugs worked out after that initial influx of patients. As weeks went on and doctor’s offices began reopening, patients still wanted to avoid waiting room exposure, so telehealth patient volume has remained steadily high. Kahn has also noticed more providers joining telemedicine networks. 

Tara Cavazos is a doctor of nursing practice who runs a Dallas clinic. Before the pandemic hit, Cavazos’ practice was set up for telemedicine visits through its electronic health record system.

CAVAZOS: And we probably were doing, I mean, I would do one or two telehealth visits a week at most, if even that…

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. With the huge shift from office visits to nearly all virtual visits, Cavazos and her partners faced some hurdles—mainly figuring out the financial side of the technology, plus dealing with less tech-savvy patients.

That may be the biggest obstacle to telehealth. On the one hand, Kahn says most patients can get online.

KAHN: Everyone has either internet connection with their phone or their laptop…

But that’s just the first step. Patients also need to create an account login for the online platform and make sure they’re using a computer with a camera or a smartphone or tablet. Cavazos says providing that tech support puts an additional strain on her office’s front desk staff. 

She was relieved when the federal government announced in late March it would waive privacy law restrictions against providers using less secure technologies for patient consultations.

CAVAZOS: And so our office, when that came out, we made the decision to use something more familiar with patients. Like older patients know how to FaceTime their grandkids. So they knew how to pick up the call. So we used our in-office iPads to do FaceTime or Google Hangout. 

Virtual consultations are convenient and often more affordable than an urgent-care visit. But Kahn and Cavazos say they don’t hesitate to tell an e-health patient when they should be seen in person by a provider. 

CAVAZOS: There are the few that we just need to get into the office to get blood work, or we need to listen to the heart and lungs or they’re complaining of ear pain and, you know, we need to look in the ear. 

Some providers worry the growth in telehealth will widen the chasm between underserved patients and quality care. Dallas doctor of nursing practice Katy Vogelaar says her low-income patients—many of them refugees—have language barriers that make telephone encounters difficult. That is, if the patient even has a phone: 

VOGELAAR: To do telemedicine, you have to have a way to communicate with someone first. So you have to have a reliable telephone. Some places require you to do a video chat. Well that requires you to have a smartphone. 

Cavazos says many doctors agree that telemedicine isn’t for every patient. Even providers get a little weary from it. 

CAVAZOS: We didn’t go into healthcare to be behind a computer. You know, we went into healthcare to, you know, part of a holistic approach is seeing, touching, talking to a patient. And when you are behind a screen, you lose some of that.

But like so many trends sped up by the pandemic, telemedicine is here to stay. And it’s poised to make lasting changes to healthcare, for patients and providers alike.

Reporting for WORLD, I’m Katie Gaultney.

(Photo/iStock)

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