Surviving the “brave new world” of telemedicine

5 simple tips for getting the most from your virtual doctor’s appointments

As I predicted all last year, government response to the coronavirus pandemic is resulting in massive health consequences—in addition to economic and political consequences.

Societal shutdowns have resulted in a year of increased drug abuse (prescription and non-prescription), unmanaged pain conditions, and both intentional and accidental overdose deaths.

Of course, the opioid drug epidemic was already a national crisis well before the coronavirus arrived on the scene. And now, it’s only getting worse. In fact, according to a recent report from the American Medical Association, more than 40 states have reported increases in opioid-related deaths during the pandemic.1

And in my view, government is partly to blame. After all, they blocked access to safe and effective non-drug treatments for pain like acupuncture, bodywork, massage, meditation, spinal manual therapy, swimming, and yoga for months. Which means more and more people turned to dangerous prescription drugs.

The fact is, however, pain is often poorly managed by drugs. And leads to accidental or intentional drug overdoses.

But pain isn’t the only condition being overlooked throughout this pandemic. Fear and isolation have increased depression and anxiety. Missed, real cancer diagnoses are climbing. And neglected heart disease remains the No. 1 cause of death in the U.S.

So, here’s what you can do about it…

More Americans stopped seeing their doctors

According to an analysis of health insurance claims from nearly 17 million Americans between Jan. 1 and June 16, 2020, routine in-person doctor visits for preventive care and well-being plummeted during the pandemic.2 (For both mainstream and holistic health practitioners.)

The analysis found that total in-person outpatient doctor’s appointments fell from 102.7 visits per 1,000 people to 76.3 visits per 1,000 people. And I think this is just the tip of the iceberg, especially as the pandemic continues to rage on.

Plus, fears of contracting coronavirus from a visit to a doctor or a hospital—and concerns about overtaxing an already burdened healthcare system by a “routine” doctor’s visit—are keeping people from important preventive care check-ups.

This means fewer cancer screenings, fewer blood screens for diabetes and other problems, fewer blood pressure readings, and other lapses in routine preventive care. All of which leads to countless conditions being left undiagnosed and untreated.

In fact, a RAND Corporation study of 6.8 million people with private health insurance found that during the first pandemic shutdowns in March and April of last year, colon cancer screenings declined 70 percent and breast cancer screenings dropped 67 percent, compared to 2019.3

Plus, during those two months, blood sugar testing for diabetes dropped more than 50 percent, as did routine blood pressure tests. Cataract surgeries fell by 50 percent, and orthopedic surgeries decreased by more than 45 percent.

There’s no doubt that some patients were spared unnecessary, inappropriate procedures and treatments—but what about the subset of people who really needed care?

Telemedicine patient consultations kicked in

According to the analysis I mentioned above, the long-discussed option of telemedicine physician consultations finally got a jump-start during the pandemic.

Between last January and June, weekly telemedicine consultations increased from 0.8 per 1,000 patients to 17.8 per 1,000 patients. These numbers translate to an increase of more than 20 times for telemedicine visits…although total doctor’s visits still declined by nearly 10 percent.

The analysis also showed that telehealth visits varied widely from state-to-state. Massachusetts had the highest proportion of telehealth versus in-patient visits—at 48 percent—while South Dakota had the lowest, at 8 percent.

Which isn’t great news. In small, densely populated, urbanized states like Massachusetts, most people are physically quite close to doctors as well as high-tech tertiary medical care, so they don’t need telehealth as much as rural states like South Dakota do.

Plus, as Dr. Michael Barnett of the Harvard School of Public Health told Reuters: “I think the major takeaway is that telemedicine is a new normal for healthcare delivery, but that, as a country, we will have a huge amount of healthcare to catch up on given the large drop in doctor visits that we saw.”4

Dr. Barnett added that one way to “catch up” on healthcare is through telemedicine…and he’s certainly not the only medical professional saying so. After all, it looks like telemedicine is here to stay, and you may find yourself virtually “visiting” your doctor more often in the future.

While I don’t believe telemedicine will or should replace all doctor’s visits—many times you need a hands-on examination—it can have some benefits. Whether those benefits outweigh the negatives remains to be determined. But it can be helpful to know exactly what telemedicine entails, and how best to survive in this brave new virtual world.

So, here’s how you can make the most out of your telehealth visits…

How telemedicine works

Telemedicine is a broad term that encompasses phone calls, video chats, emails, or text messages with doctors or other healthcare professionals.

These appointments are still set up through your doctor’s office, just like in-person appointments. And the staff can walk you through any technological requirements they have to ensure a successful visit.

A benefit to an online visit is that most doctor’s offices will now set up an individualized patient portal that contains handy health stats like your blood pressure reading history, test results, and other information you can access electronically, around the clock. It also provides you with an outlet to email your provider.

This is particularly helpful if you run out of time, think of something later, or were simply too uncomfortable to ask about certain subjects during a doctor’s visit (either in-person or virtually). Plus, sending questions privately and securely through your patient portal allows you to review answers in the convenience and calm of your own home.

Your patient portal can also include information and instructions provided by your doctor regarding the background and treatment recommendations for your condition(s). This allows you to read up on your healthcare plan whenever it’s convenient for you.

Another benefit to your patient portal is that it may allow you to upload photos of rashes, suspicious moles, or anything else you want your doctor to “see” electronically. Your doctor can also share images with you, like ultrasounds or x-rays.

In addition, you can “virtually” share home readings like blood pressure or blood sugar levels with your doctors, without having to take the time and effort to go into their office. And you can schedule some time to chat with your doctor about those readings.

If you have an earache, a sore throat, or other ailments that don’t seem serious, a telehealth consultation can also save you a trip to your doctor’s office. And during cold and flu season—and the coronavirus pandemic—telemedicine eliminates the risk of contagion in medical waiting rooms.

Plus, some private health insurance plans charge less for these types of telemedicine visits than they do for in-patient consultations, which can save you money on routine medical care.

Get the most out of your doctor’s visit

The key to using telemedicine is to make the most of your time with your doctor, just as you would with in-person doctor’s visits. In fact, the “low-tech” approach to medicine is becoming a bittersweet memory, when patients typically spend more time in the waiting room than the exam room.

As I wrote in the June 2017 issue of Insiders’ Cures, a survey of nearly 20,000 physicians nationwide found that a whopping 70 percent of all doctors spend just 10 to 20 minutes with each patient.5 And another study found that patients talked for only a minute and a half, on average, during their doctors’ visits.6

Even worse, the researchers noted, “the average patient visiting a doctor in the United States gets 22 seconds for his initial statement, then the doctor takes the lead. This style of communication is probably based on the assumption that patients will mess up the time schedule if allowed to talk as long as they wish to.”

(A typical country western song can take 10 times that long to list all the troubles and woes of the singer…so just imagine what that song would be like if it lasted only 22 seconds!)

This draconian limit certainly doesn’t give a doctor much time to listen to you—let alone probe for any less-obvious health issues you might have. And sadly, this is highly unlikely to get any better with telemedicine, as doctors still have to adhere to timelines set by insurers rather than medical professionals.

But there are things you can do to ensure you get the most out of every doctor’s visit…

My top 5 tips for a successful doctor’s visit—either virtually or in-person

1.) Do your homework. Before your appointment, do some homework. Make a list of every symptom or concern you have. This will help save time and reduce the chance of miscommunication, or incomplete communication, during the visit itself.

You can even ask if you can email your written list to your doctor’s office, or upload it to your patient portal before your appointment to help save time during the visit and to help your doctor prepare beforehand.

And remember, if you have a problem that has arisen since your last visit, make sure your list includes it. Never accept that any new symptom is just another sign of aging.

2.) Put yourself to the test. When you schedule your appointment, ask what medical tests you can do at home, and which need to be done in your doctor’s office (if any).

And remember—doctors often want to subject you to unnecessary screens. (They can also be cagey about their results.) So always ask your doctor why they are recommending a certain test—and always ask them to explain your results clearly. Don’t be afraid to put them to the test, too.

3.) Break the ice. Once your appointment begins, there’s certainly nothing wrong with a little conversational ice-breaker. In fact, I encourage it.

Asking your doctor how his or her own day is going, or even telling a joke, serves as a subtle reminder that you’re more than just another body to be examined (and potentially forgotten) during a doctor’s busy day.

4.) Phone a friend. If you’re unclear about any information regarding your diagnosis or treatment, ask your doctor to go over it again—and make sure to take notes so you can consult them later or share them with others. If you’re visiting with your doctor via computer, it’s easy to create and keep handy a document where you can make notes as you go along, in real time.

You can even have a family member or close friend sit next to you during your tele-visit. A second set of ears is particularly valuable when your doctor is discussing a serious diagnosis or complication, as it’s common for patients to emotionally shut down in these situations.

5.) Ask for an explanation. The time you’ve saved by doing advance prep before your appointment should be spent on getting answers from your doctor during your appointment about the recommendations he or she makes.

For instance, doctors may not be aware of the costs of the follow-up treatments they prescribe. Or they may suggest onerous exercise routines or drastic diets that can feel impossible to achieve. So you’ll want to fully understand the reasoning behind their recommendations.

Further, as you know from reading Insiders’ Cures, most doctors don’t really understand nutrition and lifestyle—and tend to repeat faulty, politically correct diet and lifestyle recommendations from public health or crony-corporatist medical and health organizations.

So don’t be afraid to ask your doctor to suggest an alternative to a recommendation you can’t afford, or flat out can’t do or don’t want to—for any reason.

And if your doctor prescribes a drug, always ask if a generic is available. Generics are not only less expensive, but they have also stood the test of time—meaning their side effects have been uncovered and evaluated, and the drug has been permitted to remain on the market (which is not true of all drugs, especially new ones!).

Also, make sure you have clear instructions about any medications (and, preferably, dietary supplements) your doctor recommends. Ask about potential side effects, so you can anticipate whether certain treatments will make you feel worse before they help you feel better (if ever). These instructions can also be delivered to your patient portal, where you can access them at any time.

At the end of the day, even in today’s pressure-cooker medical environment, there are still doctors who treat their patients as individuals—rather than putting them into a one-size-fits-all pigeonhole. And the same is true with telemedicine.

So…be wary of doctors who want to consult with you only electronically. But also be aware that there are times when telemedicine visits are just as good as in-person visits, for both you and your doctor. And no matter how you “visit,” the key to success is actually being able to talk to your physician—and putting your health first, all year long.

Sources:

1https://www.ama-assn.org/system/files/2020-11/issue-brief-increases-in-opioid-related-overdose.pdf

2“Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US.” JAMA Intern Med. Published online November 16, 2020.

3“Prevalence and Characteristics of Telehealth Utilization in the United States.” JAMA Netw Open. 2020;3(10):e2022302.

4https://www.medscape.com/viewarticle/941080

5http://www.medscape.com/features/slideshow/compensation/2016/public/overview#page=1

6“Spontaneous talking time at start of consultation in outpatient clinic: cohort study.” BMJ. 2002 Sep 28; 325(7366): 682–683.


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