This is a really weird time in America. Everyone is staying at home. Restaurants and bars, museums, malls, zoos, movie theaters, parks and playgrounds are closed. Hospitals are empty of “elective” cases like knee replacements and spine surgery. At the same time, in many areas the health care system is completely overwhelmed by COVID-19.
Doctors’ offices are empty of patients. My practice is only seeing patients online. I have unfortunately gotten pretty comfortable doing something I never wanted to do – the virtual visit.
I was taught in medical school and residency that good medical care requires an examination. You can’t come to a reliable diagnosis if you can’t examine the patient. For over 20 years that has been “reality” for me.
Now I can’t examine anyone. It is extremely uncomfortable for me as a physician to have to diagnose someone’s illness based only on their symptoms. To know why someone is coughing without being able to listen to their lungs and heart is very difficult! To diagnose a UTI without checking a urine specimen is tough!
The very real danger is in overdiagnosing. Treating the earache caused by a viral infection with fluid in the ear is fairly simple, and doesn’t need antibiotics. However, if I can’t see the eardrum, I’m tempted to treat with antibiotics “just in case” it’s a bacterial ear infection. Antibiotics are potentially dangerous and only useful in certain cases.
But virtual visits are where it’s at right now, and they are safer for my patients, for me and my staff, and for all our families until the risk of this infection has subsided to some sort of “new normal.”
So how can you make sure that, if you need to do a virtual visit with your doctor, it’s as safe and effective as possible? Here are a few pointers:
- If you are vomiting and unable to keep food or liquids down, or have chest pain or shortness of breath, you will likely need to be seen in the office, urgent care or ER. If you are severely sick you probably should bypass the virtual visit altogether and get checked out in person.
- Do the visit on a laptop or desktop computer, not your phone or tablet if possible. Interfaces are more glitchy with the smaller electronics. (Also, your doctor doesn’t really want to look up your nose which is what happens when your phone or tablet is on your lap!)
- Make sure your computer has the webcam, microphone and speaker (or headphones) all enabled.
- Make sure you are not sitting with your back to a light source, like a lamp or brightly lit window. The light should be in front of you, behind the computer, so the light falls on your face.
- You should have a home blood pressure meter available to take your blood pressure and pulse and show it to the doctor. If you have a known history of high blood pressure you need to have one of those, it’s a good time to get one. They’re available at your drugstore or on Amazon.com. Wrist meters are not as accurate as the ones that go on your upper arm.
- While you’re ordering medical supplies, make sure you have a thermometer to take an oral temperature. The forehead scanners used in hospitals are very expensive – oral thermometers are cheap and accurate.
- I love meeting your pets and your kids (and seeing what you’ve done with the place!) but please make sure they’re not going to be disruptive of the visit.
- Be aware of and understand the limitations of the visit. There is an inherent risk of a missed diagnosis which is larger in a virtual visit (because there is no physical examination) than in an in-person visit.
I have high hopes that we will be able to start seeing patients in the office again soon. But the virtual visit probably isn’t going to go away. There are instances when it makes a lot of sense. Mental health follow ups. Reviews of lab results. Stable blood pressure follow ups when the patient has a reliable home blood pressure meter. (In fact, some of my patients would be better off having their BP checks at home!)
In this super weird time the virtual visit is what I would consider a necessary evil. We need to make sure we’re doing everything possible to make your online visit as safe and effective as possible.
QUESTION: Have you had a virtual visit with your doctor? Was it a good experience?