Telehealth or in-person: Which type of doctor visit is better, and when it matters

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When the COVID-19 pandemic ravaged the country in early 2020 and emptied doctors’ offices nationwide, telemedicine suddenly came into the limelight. Patients and their physicians turned to virtual visits by video or phone rather than risk meeting face-to-face.

During the early months of the pandemic, telehealth visits for care exploded.

“It was a dramatic change in a week or two from what we would expect to happen in a decade,” said Dr. Atit Mehrotra, a professor at Harvard Medical School whose research focuses on telemedicine and other health care delivery innovations. Is. “It’s great that we served the patients, but we didn’t submit to the norms and [research] Papers that we usually submit so that we know what works and what doesn’t work.”

Now, three years after the start of the pandemic, we’re still figuring it out. Although Telehealth use is moderatedIt has found a role in many physician practices, and is popular with patients.

Behavioral health has embraced telehealth more than any other field. Mental health conditions accounted for only two-thirds of telehealth claims in November 2022, according to FairHealth, a nonprofit that manages a large database of private and Medicare insurance claims.

Telehealth appeals to a wide variety of patients because it allows them to simply log on to their computers and avoid the time and expense of driving, parking, and arranging for child care that often entails traveling in-person. is required.

But how do you figure out when to opt for a telehealth visit versus seeing your doctor in person? There are no hard-and-fast rules, but here’s some guidance on when it might make more sense to choose one or the other.

if this is your first visit

“As a patient, you’re trying to evaluate the therapist, to see if you can talk to them and trust them,” says a family physician and board member of the American Academy of Family Physicians. Member of Dr. Russell Cole said. “It’s hard to do that on the telemedicine journey.”

Maybe your insurance has changed and you need a new primary care doctor or OB-GYN. Or perhaps you have a chronic condition and your doctor has suggested adding a specialist to the team. Meeting face-to-face can help you feel comfortable and confident with their participation.

Sometimes a personal first visit can also help doctors assess their patients in non-tangible ways. After a diagnosis of cancer, for example, an oncologist may want to examine the site of the biopsy. But just as important, he may want to assess the patient’s emotional state.

“A cancer diagnosis is an emotional event; it’s a life-changing moment, and a doctor wants to respond to that,” said Dr. Arif Kamal, an oncologist and chief patient officer for the American Cancer Society. “There are things you can miss unless you’re a foot or two away from the person.”

Once it is clear how the patient is doing and responding to treatment, it is a good time to discuss the inclusion of telemedicine visits.

If a physical exam seems necessary

It may seem like a no-brainer, but there are nuances. Increasingly, monitoring devices that people can keep at home — a blood pressure cuff, a digital glucometer or stethoscope, a pulse oximeter to measure blood oxygen, or a Doppler monitor that checks for fetal heartbeats — are available to doctors. information they need, reducing the number of in-person visits necessary.

A person’s overall physical health can help determine whether an in-person exam is needed. A 25-year-old in generally good health is a better candidate for telehealth than a 75-year-old with many chronic conditions.

But some health complaints usually require an in-person examination, such as abdominal pain, severe musculoskeletal pain, or problems related to the eyes and ears, the doctors said.

Abdominal pain can indicate trouble with the gallbladder, liver, or appendix, among many other things.

“We wouldn’t know how to evaluate that without an exam,” said internist Dr. Ryan Meier, president of the American College of Physicians.

Unless a doctor does a physical exam, children with ear infections often receive prescriptions for antibiotics, said Mehrotra, a study comparing the difference between telemedicine visits, urgent care and primary care visits. Pointing to co-authors.

In obstetrics, the pandemic hastened a gradual shift to fewer in-person prenatal visits. Typically, pregnancy involves a visit of 14 people. Some models now recommend eight or less, Dr. Nathaniel DeNicola said. One study found no significant difference in rates of cesarean delivery, prematurity, birth weight, or admission to the neonatal intensive care unit among women who received more than a dozen individual prenatal visits. and who get a mix of the personal and the virtual. seizure.

DeNicola said contraception is another area where less can be more. Patients can virtually discuss the pros and cons of the various options and may only need to make an appointment if they wish to have an IUD inserted.

if something is new, or changes

When a new symptom appears, patients usually must schedule an in-person appointment. Even if the patient has a chronic condition such as diabetes or heart disease that is under control and cared for by a familiar physician, sometimes things change. He also usually asks for a face-to-face meeting.

“I tell my patients, ‘If it’s new symptoms or a worsening of existing symptoms, an in-person visit is probably warranted,'” said Dr. David Cho, a cardiologist who is a member of the American College of Cardiology. Chairs the Health Care Innovation Council. Changes may include chest pain, loss of consciousness, shortness of breath, or swelling of the legs.

As patients sit in front of him in the exam room, Cho can listen to their hearts and lungs and do an EKG if anyone has chest pain or palpitations. He’ll check their blood pressure, check their legs to see if they’ve retained fluid, and look at the jugular veins to see if they’re bulging.

But all of this may not be necessary for a patient with heart failure, for example, whose condition is stable, he said. They can check their weight and blood pressure at home, and watching videos from time to time may be enough to check.

Experts said video check-ins are effective for many people who have chronic conditions under control.

When someone is undergoing cancer treatment, some critical moments require face-to-face visits, said Kamal of the American Cancer Society.

“The cancer has changed or the treatment has changed,” he said. “If they’re going to stop chemotherapy, they need to be there in person.”

And one clear recommendation applies to almost all situations: Even if a doctor or office scheduler suggests a virtual visit, you don’t have to agree to it.

“As a consumer, you should do what you feel comfortable doing,” said Dr. What Kedar said. “And if you really want to be seen in the office, you should make that case.”

KHN (Kaiser Health News) is a national newsroom that does in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three major operational programmes. kff (Kaiser Family Foundation). KFF is a thriving non-profit organization that provides information on health issues to the nation.

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