9 Tips for a Successful Telemedicine Appointment
By Dr. Christine Nguyen for Next Avenue
If you need to see your doctor these days, there’s a good chance you’ll be offered a telemedicine visit. That means you’ll “meet” with your physician either through a video chat or a phone call. And even after the COVID-19 pandemic fades, experts predict, telemedicine — especially video visits — will be commonplace.
Research shows that for appropriate diagnoses and situations, telemedicine can be comparable, and sometimes more effective, than in-person care. And Medicare has recently relaxed its rules to more easily allow people 65 and older to use telemedicine. More than 20% of people over 70 have had a telehealth appointment during the pandemic, according to a survey by NORC at the University of Chicago.
Here are nine ways to help ensure a telemedicine appointment is as useful as it can be:
Before Your Telemedicine Visit
It will help to be prepared before the virtual visit begins.
1. List your symptoms, medicines and questions. “Be ready with as much detail about your current condition as possible,” says Dr. Joe Kvedar, president of the American Telemedicine Association and a dermatologist in Boston.
For example, Kvedar advises his patients to take pictures of any rashes or moles because it’s hard to see detail on video. Try to send your doctor’s office any pictures ahead of time. And write down all your symptoms so you don’t forget any during the telemedicine visit.
Having a written list of your medications, vitamins and supplements at hand will come in handy when your doctor asks what you’re taking, too. This information can also prevent you from getting prescribed something that could run afoul of your current medicine.
And write down any questions you’ll want the doctor to answer so you’ll finish the visit knowing that any concerns have been addressed.
2. Take your vital signs. Think about what normally happens at the doctor’s office and replicate things at home as best as you can. Take your temperature, measure your pulse while you are relaxed and get on a scale so you can tell your physician your weight.
To take your pulse, place two fingers between the bone and the tendon over your radial artery, on the thumb side of your wrist. When you feel your pulse, count the number of beats in 15 seconds. Then, multiply this number by four to calculate your beats per minute.
“If you have a glucometer, make sure you have those readings. If you have a blood pressure cuff, make sure you have those readings. If you have other things that your doctor tracks with you to monitor your disease, have that information on hand,” recommends Kvedar.
You might be able to check your blood oxygen level and your heart rate — something very important for coronavirus — if you have a fingertip gadget called a pulse oximeter. They typically sell for $20 to $50.
3. Have your latest medical records nearby. You may have received medical care at different places, such as an urgent care facility as well as your doctor’s office. If so, you’ll want to have a copy of labs and studies with you during the telemedicine visit.
Then, if your doctor needs one of your reports, you can easily share it. This way, you’ll save time and money from unnecessarily repeating tests.
4. Set up the technology you’ll need. Test the telemedicine service on your mobile device or computer before your visit. Some applications work best on specific browsers (for example Firefox, Safari, Chrome, or Explorer). Ask the doctor’s office which browser works best.
If you will be using a computer, try to sit next to the wifi router for the strongest internet connection. Phones and tablets actually tend to work better than computers for video visits, though.
But should you plan to do the visit with an older smartphone, restart it to improve the memory speed and close all the other apps to make your device faster.
During Your Telemedicine Visit
If possible, log on the day before the telemedicine appointment begins to be sure technology is working properly. And don’t be tempted to multitask during your visit. Trying to do this while you’re at the store or driving is likely to prevent you from getting the best care.
5. Improve your picture and audio quality. You and your doctor need to establish a personal connection on video. That’s tricky if you can’t see each other well.
Go to a quiet, well-lit place away from people who don’t need to be with you during the visit. Turn off the radio, TV or any noisy appliance.
You don’t need professional studio lighting, but good lighting improves the quality of the visit, including your doctor’s ability to do a complete assessment. Don’t place your camera facing a light source, window or doorway. Backlighting makes it hard to see your face.
Is the camera right below your chin? Almost every doctor who does telemedicine has a story of a visit seeing mostly the patient’s forehead or a ceiling fan. Stably prop up the device to avoid excessive shaking and keep your whole face in view.
If there is an echo, use headphones, turn down the volume on your speakers and move the microphone away from the speakers. In general, wired headphones have less interference than wireless headphones.
6. If you’ll be doing the telemedicine visit as a caregiver for someone, be sure that person is nearby. Even if you’re the one doing most of the talking, the doctor will need to at least eyeball the patient.
Diana Isabel Tibbs cares for her 79-year-old mother, Caroline Chacon, who has had multiple brain surgeries and dementia. Recently, her mother had persistent dizziness, so they consulted a new neurosurgeon by video chat. The virtual exam was surprisingly comprehensive.
“They checked her temperature and the back of her head where the incision was made. They had her do some tests with her arms to see how her balance was. They had her do the one where she closed her eyes and had to touch her nose, “says Tibbs. “And then they had this really large screen where they were able to pull up…her CAT scan, and we talked about that.”
Chacon has since had several telehealth visits in just a few weeks. “We saw a neurosurgeon, and she got fitted for another hearing aid,” says Tibbs. “I would use telehealth for the majority of my mom’s visits, if I can.”
7. Expect for some possible troubleshooting. Due to heavy use these days, many health providers’ telemedicine systems are at capacity or overloaded. If your call is glitchy or completely drops, ask your doctor if you can use something simpler, like FaceTime or WhatsApp. Sometimes switching devices or video conferencing platforms can keep a visit from being a flop.
If all else fails, the telephone is okay, but you may have to unblock unidentified callers.
After the Telemedicine Visit
There are a couple of things you’ll want to do when the telemedicine appointment concludes.
8. When the appointment ends, ask for a summary. That can clarify the important details of the visit. If the doctor’s office forgets to provide a summary, send the office a message recapping what you understood and ask if you got it all right.
9. Give feedback to the doctor’s office or your health insurer. Note anything that went well or poorly. That can help make your future telemedicine appointments even better.
PHOTO: Diana Isabel Tibbs (right) has had success with telemedicine visits for her mother Caroline
Dr. Christine Nguyen is a clinical assistant professor at Stanford University Medical School and an online and audio journalist. She was a Gerontological Society of America Journalists in Aging Fellow.
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