The use of telehealth and telemedicine has skyrocketed dramatically during the COVID-19 pandemic, thanks to payment and regulatory changes designed to make it easier for patients to get high-quality care while staying safe at home. Knowing how best to use telehealth will help patients continue to receive the care they need, even from a distance.
Two AMA members took time to discuss how doctors can best ensure each telehealth visit is productive for patient care. They are:
- Daniel Marchalik, MD, medical director of physician well-being at MedStar Health. He also is director of the kidney stone program at MedStar Washington Hospital Center and directs the Literature and Medicine Track at the Georgetown University School of Medicine.
- David Winter, MD, an internist at Baylor Scott and White Health in Dallas. He is also an attending physician at Baylor University Medical Center.
The AMA Telehealth Implementation Playbook walks physicians through a 12-step process to implement real-time audiovisual visits.
There may still be kinks to work out
"The most important thing to remember is that telehealth is still quite new," said Dr. Marchalik, adding that "we are still in the early stages of this technology, so it’s hard to gauge its full reach and potential."
"Yet, it’s also clear that telehealth has quickly become an indispensable tool in health care," he added. "As with any new technology, I think it will take time to iron out some of the nuances."
"It’s important to remember that telehealth is an amazing new tool that holds a tremendous amount of potential," said Dr. Marchalik.
Learn how the AMA is advancing telemedicine during the COVID-19 pandemic.
As with an in-person visit, patients should come prepared with questions or topics to discuss. It is also helpful to take notes while completing the telehealth visit.
"Patients should approach their telehealth visits the same way they would approach a regular visit. The more information and questions they bring with them, the more likely they are to have all their questions answered," said Dr. Marchalik.
"The same thing as with an office visit: prepare in advance," said Dr. Winter. "And if you've got several things you want to ask me, but you didn't write them down, then you may forget one and need to call me back."
Include a family member
Among other things, including a family member or loved one in the telehealth visit can be "very helpful if you have to see something on the backside," said Dr. Winter. The day before speaking with the AMA, a patient’s spouse was able to aim the device’s camera to help show detail about a rash of concern.
"She let me look at it there because he couldn’t quite get it," he said, adding that "two sets of ears are also better than one, so I always encourage someone to be with them if they want or if it’s possible."
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Know when to skip telehealth and come in
"For some visits that require a physical exam, telehealth may not be the best option," said Dr. Marchalik, adding that this includes "a new lump that can’t be seen on video or something that requires touch to make a diagnosis."
Telehealth is "also not an option for visits that require a procedure," he said. This includes "a biopsy or a catheter exchange."
"This very much depends on the nature of a patient’s complaint and should be decided in conjunction with their provider," said Dr. Marchalik. "Some people also feel much more comfortable meeting someone face-to-face."
"On the other hand, there are real potential advantages to being able to see patients in their own home, including being able to assess safety concerns, meet family members, look in the medicine cabinet," he said.
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Face to face—from a distance
Telehealth offers "a tool for patients to connect with their providers in a way that’s sometime more convenient, sometimes more accessible, and sometimes the only option," said Dr. Marchalik. "Being able to leverage the power of telehealth during the pandemic surges has been incredibly important."
Telehealth is "the next best thing to a face-to-face visit. It really is," said Dr. Winter. "A call is fine too, and I give a fair amount of advice on the telephone—but when I can see you, I can see if I'm making sense."
"It's all about communication and I can see if you have a puzzled look on your face. Are you paying attention?" he said, adding that "I much prefer telemedicine when possible because the communication is better."