How ‘seeing’ a patient has changed

We have all experienced the effects of the coronavirus pandemic in various ways. At the beginning, it was a few weeks of working from home, virtual schooling, and keeping distant from others. Yet, as the virus continued to spread, we were home for longer and business restrictions settled in. We planned grocery trips carefully, seeing friends and family turned into driving by and waving from your car, and special events were canceled.

However, seeing a doctor became easier. Remember when patients would transport themselves to appointments, check in, fill out paperwork, wait in the waiting room, see the nurse, and then see the doctor? Now, all they have to do is click on a link or dial a number and they are connected to their internist, all in the comfort of home. How long will this last? Is it working for all Americans? Will doctors continue to use telehealth?

Virtual care can benefit both the patient and doctor in terms of flexibility. Patients do not have to miss work or take time to travel to their doctor's office and can save money on related costs such as transportation, parking, and child care. Telemedicine is particularly beneficial to those living in geographic locations where they may not have access to the clinicians or specialists they need.

Given the pandemic, it is often difficult for elderly and immunocompromised patients to travel to see their doctor because of their increased susceptibility to not only COVID-19 but also various other diseases and infections. Doctors are able to “see” more patients “virtually” throughout the day, enjoy flexibility in their schedule, create more work-life balance, reduce the number of no-shows or cancelations, and increase patient satisfaction.

Virtual care during the pandemic also has the benefit of keeping patients out of already overwhelmed emergency departments. Emergency departments tend to fill up or overflow with patients with minor problems like sore throats, headaches, and fevers, leaving longer wait times for patients with major problems. Using virtual care, doctors can observe a patient's general appearance and symptoms, check temperatures if the patient has a thermometer, assess additional indicators, and triage the patient to the proper care setting.

Of course, with every pro comes a con. Nothing can replace the face-to-face, in-person interaction when seeing a patient, especially for patients new to a physician or a practice. After an internist has established a relationship with a patient, telemedicine may be appropriate for follow-up appointments, but the initial evaluation may be necessary to conduct in person. Similarly, not all appointments can take place via telemedicine, such as physical therapy, treatments for allergy and asthma, cancer treatments, immunizations, a general physical exam, and many more diagnostic or therapeutic activities.

To determine whether to schedule an in-office or a virtual appointment, assess whether patients are comfortable with a video or phone call or instead want to see their doctor in person for each visit. Many patients, especially those who are elderly or low income, do not have access to a computer, high-speed internet, smartphone, or tablet for a virtual visit.

Besides technology, one of the biggest deterrents to telemedicine has been reimbursement. Historically, CMS and private insurers paid less for a telemedicine visit than an in-person visit, providing little incentive to switch to or offer the former. When COVID-19 hit the United States, CMS and private insurers began paying doctors for telemedicine visits at the same rate as an in-person visit. How long this will last is still unknown, although there are already some indications that at least some of these flexibilities will continue after the public health emergency abates. With better payment for virtual care, will practices switch to telemedicine to ease overhead costs like office space, staff, and equipment?

The world has changed in so many ways, especially in health care. We do not know when we will go back to our offices and see our colleagues, if our children will play with their classmates at recess, or if we will ever return to life as we knew it. However, we do know that the way we “see” each other is different.

ACP Practice Advisor's online practice improvement modules “Communicate with Patients” and “Improve Patient Access” offer additional tips and resources. You can also visit ACP's telemedicine implementation module, “Telemedicine: A Practical Guide for Incorporation into your Practice.”