Life Kit - Telehealth Tips: How To Make The Most Of Video Visits With Your Doctor

Episode Date: June 1, 2020

A visit to the doctor's office looks a little different during the pandemic. Doctors are using telemedicine services to treat patients more frequently. In this episode, Dr. Mara Gordon provides tips to help you get the most out of your telehealth visit.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This message comes from Wondery Kids and the number one kids science podcast, Wow in the World. Be wowed by fascinating companion audio stories that come exclusively with each Wow in the World STEM toy. Shop the full collection today at Amazon.com slash Wondery Kids. My name is Jenny Lynn Sturvidge. My tip is about rolling out pie crust. To roll out the perfect size pie crust every time, take a piece of foil and line your pie dish with the foil. Leave enough length over the top for the amount that you want to roll your pie crust under

for that thick crust at the top. And then use that as a pattern when you're actually rolling out the crust so you can get it the perfect size. LifeKit wants to hear from you. If you've got a random tip, leave us a voicemail at 202-216-9823 or email us at lifekit at npr.org. I'm Shereen Marisol Maragi, and this is NPR's Life Kit. Prior to the COVID-19 pandemic, I was doing zero telehealth.

That's Dr. Mara Gordon. She's a primary care physician and fellow Life Kit host. I would call my patients, chat with them on the phone briefly about test results or medication renewals or specific questions that they had. but pretty much everything, I always ask my patients to come in. My whole schedule was packed with appointments, and so that was sort of the unit of time that we use in primary care, and it was really hard to squeeze anything else in. The COVID pandemic has changed Dr. Gordon's routines, and telemedicine is now a big part of her day. Hello? Hello, this is Dr. Gordon. Okay, they hung up. All right. Dr. Gordon's a lot more familiar with the ups and downs of phone and video visits with her patients,

and she's here to share some tips on how to get the most out of your telehealth appointments. We're going to cover everything from how to prep for an appointment to what sort of equipment you might want to have at home. This message comes from Money for Couples, a new book and podcast that help you and your partner build and share financial vision. Discover clear, actionable steps for spending and saving that bring you closer together. Start your financial future today. Search Money for Couples wherever you listen. After the election, the economy feels like one big, huh? Good thing there's the Indicator from Planet Money podcast. We take a different economic topic

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Listen to the 1A podcast from NPR. All right, Dr. Gordon, let's start with the basics. When we say telehealth, what exactly does that mean? So telehealth means having a doctor's appointment over the phone or over video chat. It's something that some doctors offered and some people were able to take advantage of prior to the coronavirus pandemic, but it was not really in widespread use prior to a month or two ago. So it's pretty new. What sorts of things can patients use telehealth for? Things that it's good for, things that telehealth is good for. Something that's changed

and you aren't too worried about it. You don't think it's an for, things that telehealth is good for. Something that's changed and you aren't too worried about it. You don't think it's an emergency, but something that ordinarily you might make a sort of semi-urgent appointment with your doctor within the next week or so. A lot of those work really, really well over telemedicine. Mental health concerns work great over telemedicine. I do a lot of mental health care and primary care, and those kind of visits are totally seamless over telemedicine. A lot of chronic disease management. So if you've been stable with high blood pressure for months and months and months, and you just want to check in about it, that works great over telemedicine. So those are the main categories that I'd say work really well.

We all know that healthcare workers like you are really overloaded right now. And I know for sure that there are folks out there who are delaying calling their doctor because they don't want to add more to your plates. So when should people call you? And is it ever okay to wait? A month ago, I would have said, wait. Now we are in this swing of things with telehealth. We have it up and running. We have adapted really, really quickly.

And I don't think you have to wait. I think it's totally fine to try to address routine issues now. And I think it's totally fine to establish care with a new doctor. You can always, always call. And you should never feel like you can't talk through what's going on with your doctor. I think the question rather should be not, you know, should you call? But the question should be, should you choose one of three options, which is do a telehealth appointment, should you do an in-person appointment, or should you schedule an in-person appointment for a couple months in advance? So how do you decide which one's best?

So a good rule of thumb is that if you have a problem that's been going on for years and you have a good treatment plan for it, those kinds of visits can generally be delayed. So for example, if you have high blood pressure but it's really well controlled on medicines, you just need a renewal on those medicines, that's the kind of thing you can delay. Your doctor is going to want to see you and talk about it, but that could probably wait a couple months. Check in with your doctor just to make sure that it truly is as stable as you think it is. But many of those can safely be delayed for a couple months. The other thing that can wait a few months is preventative care. So when I say preventative care, I mean things like pap smears for cervical cancer screening, mammograms, colon cancer screening, that kind of

stuff. I'd say it can wait a couple months, but not too long. You should always call your doctor if you have questions about it. But I would say a lot of those types of preventative procedures can safely be delayed. For acute concerns, acute concerns mean things that are new, unexpected. those we can break up into two categories, things that need to be addressed in person and things that can be addressed via telemedicine. You know, emergencies are still emergencies, right? So if it's the kind of thing that you would go to the emergency room for, you should definitely still go. I have a lot of patients who are calling me who feel afraid to go into the ER. And there's some new data coming out about people who are dying of heart attacks because they're afraid to go into the ER during the coronavirus pandemic.

There's a lot of emerging research on this. And if you're having an emergency, if you're having a heart attack, if you can't breathe, if you're worried you're having a stroke, you know, all these types of things that would make you get up, go to the ER in the middle of the night, you really still should. Because even though, you know, the risk of exposure to COVID-19 still exists, the ER is still the safest place in a true emergency. Okay, so if the decision is made that telehealth is the best option, how can you effectively advocate on your behalf in a telehealth appointment? So I always say that for any visit, telemedicine, not telemedicine, you should always have a list because primary care appointments are just too short. This is just a reality.

Most of them are almost usually 15 minutes long. always have a list because primary care appointments are just too short. This is just a reality. Most of them are almost usually 15 minutes long. So you need to really carefully choose one or two topics that you want to make sure you thoroughly address with your doctor rather than getting distracted by lots of different topics that you sort of don't fully address. And then you leave sort of thinking, what did I accomplish, right? I think this is especially important for telehealth because I've noticed this in my patients that it seems like it's hard for people to sort of keep track of their train of thought. They have kids screaming in the background. You know, it's hard to hear sometimes. Like,

it's just there's a lot going on. It doesn't have the same focus of a visit in a doctor's office. And so I think making sure that you feel clear about what your agenda is is super, super important before your appointment. And I always want to know whenever my patients have a new problem, I want to know how long it's been going on for and how it's affecting your quality of life, right? So I want to know what's changed for you. So for example, if you get occasional headaches, but all of a sudden they're coming a lot more frequently, there's a lot more intense, It's making it difficult for you to work. I would definitely want to know about that.

So if you can kind of jot down before the appointment sort of any changes and how long those changes have been occurring and any patterns that you're noticing, that can really, really help. So be prepared with a list. I like that. I've never done that.

Always, always, always be prepared with a list, right? And write down questions too. So right, you may want to address headaches, but then you might also have like a nagging question about a blood test that your doctor had ordered a couple months before. Just, you know, make sure that you don't forget anything. That's all I would say.

Dr. Gordon, you say patients should make tech work to their advantage in these telehealth visits. What do you mean by that? So I have noticed that there's a couple of different categories of sort of technology for health that have come really, really in handy as I've been doing telemedicine appointments. So the first you probably already have, which is your smartphone, right? So just taking photos of any rashes, taking a photo of anything in your body that's concerning you. And even if it seems normal, that can be helpful too. So for example, if your knee is hurting and you take a photo of a normal

looking knee, that can be useful information to your doctor. Another thing that really comes in handy for a lot of patients is a home blood pressure cuff. A lot of insurances will cover it. So always ask your doctor for a prescription for one. That's something that can really help and your doctor will want to know what your blood pressure is, even if you don't have a history of high blood pressure. The other thing is a thermometer. I do not recommend routinely taking your temperature because it's going to stress you out and it's not going to provide any useful information. But if you start to feel sick, a thermometer can be helpful in assessing whether or not you have a fever. And a fever is defined as 100.4 Fahrenheit or above. So don't stress if it's below that, please, please. I get a lot of

people saying, my temperature is 99. I'm like, it's fine. Normal. Don't worry. And one final thing I want to say that is really low tech is just keeping a diary of your symptoms, right? So this can give me so many clues to what's going on with you, especially when I can't examine you in person. Keep track of how you're feeling, what time of day your symptoms come on, if there's anything that seems to exacerbate it or alleviate it, anything you've done to make it better, what's going on in your day that day, we can really start to see patterns and clues that are super useful for me and can really help me offer you good advice about how to alleviate your symptoms. Is there a way to just bypass a telehealth visit to get what you need without having to see your doctor at all? I'm thinking about prescription refills and things like that. Yes, yes, yes. And I love this question because I want my patients to use it more. So a lot of doctors will offer what's called a patient portal, which is basically like a secure app that connects to the electronic medical record and sort of securely connects to your health record. It's amazing. You can use the patient

portal for a couple of things. One is just sending me an email, right? So if you have sort of a non-urgent medical question, you can also request medication refills that way. Another really handy feature that has been a lifesaver during the pandemic is a lot of employers require notes for patients to either be excused from work or return to work. So we're able to do that virtually, right? So I'll do a telehealth visit with you, you know, assess your symptoms, and I can write you a note that you can download through the patient portal, and you can just print it at home, print it out at work, even email it to your employer. You don't need to come in, which is really, really wonderful. Use that patient portal. I am one of those people that

forgets my password every single time. I am that person who is like, oh, how do I get into this thing again? What is my password? I know, I know, I know. It's universal. But I really do think it's worth it. I use it with my own doctor all the time. You said a few times to call your doctor, et cetera. But what if you don't have a doctor right now? And how do you find a doctor right now? So finding a doctor is a much longer conversation. However, if you have a sense of where you would like to go, if there's a clinic near your home, if you have a place that's been recommended by family or friends, somebody else in your household has a clinic that they go to, many, many primary care doctors are now seeing new patient visits over telemedicine,

which is a huge change. So prior to the COVID-19 pandemic, a primary care doctor would pretty much only call you back if you had already established care with that doctor or with another doctor in that office. And that's because insurance wouldn't pay for that phone call, basically. It's been a big change that the Center for Medicaid and Medicare Services, CMS, just said that they would start paying for initial visits. So that first visit, they would pay for it if it's done over telemedicine. And a lot of private insurance companies have followed suit. So you should call and say you want to establish care.

And most doctors will see you over telemedicine for a new patient visit now. That's great. That's great news. This was really comprehensive. Did we miss anything? Is there anything else we should know? I would say that we really want to help. So I'm not taking it lightly now if I ask my patients to come in.

And if I do ask my patients to come in, it's probably because I think that a short visit with me will help them avoid a visit to the emergency room later, right? So it's something that I can probably take care of pretty easily, or I can help triage it in person. The kinds of things that I'm having a really hard time assessing over the phone are things like chest pain, severe abdominal pain. Things like that can be really, really hard to tell how severe it is without being able to take my patient's vital signs, listen to their heart and lungs,

examine them in person. So those are the kinds of visits that I'm asking people to come in for. And I think many of those visits, I'm able to help prevent an ER visit for my patients. And it's worth coming in for. And we will do our best to help you stay safe. So we use personal protective equipment. My clinic at least is instituting some social distancing measures to help keep patients apart in the waiting room, help make sure that our clinic is clean and safe, both for our staff and for our patients. So it's something that we're

doing with your best interests in mind, but I'm always happy to talk on the phone too. All right, Dr. Gordon, I'm going to tick through some of the big takeaways from this conversation. Number one, if you don't have a doctor, get one. Yes, we really want to hear from you. I've had so many new patients establishing care and there is no time like the present. Number two, emergencies are still emergencies. Even though the coronavirus pandemic is very scary to many of my patients, if you're having a true emergency, a hospital is still

the safest place for you. If you're not sure if you need an appointment, just ask. Three, prepare for your telehealth visit. Please make a list before your appointment. It will definitely help keep you focused during a short visit with your doctor. And keep a diary of your symptoms too. Four, use tech to your advantage. If you have any equipment that your doctor has told you to use, use it and take note of the readings. So that would be something like a home blood pressure cuff, a glucometer, a scale, even your smartphone. You can use it to take photos photos photos photos definitely and five don't forget your doctor is there for you if you have any questions you should not hesitate to call we really do have your best interests in mind and we really want to keep you safe

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