Telemedicine During Covid

The majority of primary care offices had to convert to telemedicine visits once Covid became a pandemic. The geriatric clinic I worked for initially made 95% of appointments telehealth. As covid cases started to decrease, we increased the amount of in office appointments. Our patient population is high risk so we wanted to do this gradually.

I have not worked solely for a telemedicine company, but I did use telemedicine in my normal practice. It was an interesting experience since my patients were mostly 65 years old and older. We had to teach them how to use their smart phones and talk with us via facetime or apps. Eventually, we were able to create our own telemedicine software. This was pretty easy as we just sent the patient a link via text and once they clicked on the link we were able to communicate via video.

Some challenges included that some patients only had a landline or a flip cell phone. So they had no means to do a telemedicine consult. We did phone visits with them but these weren’t ideal because it was hard to tell if a patient was short of breath or in fluid overload without seeing them.

Now that we are doing a mixture of telehealth and office visits, sometimes it is difficult to stay on schedule. The office visits sometimes run longer than planned so we end up having to call the telehealth patient 30 minutes late. I also noticed that the medical assistants aren’t used to having patients in the office. They often don’t complete all of the vital signs (only blood pressure no weight, or glucose missing etc.), and I have to constantly be on top of them.

The positives are that thanks to covid, we will likely continue to incorporate telemedicine into our care. Some patients do not need to come in to discuss lab results or to follow up on their depression. The 20 min office visit can be replaced with a 5-10 minute telehealth video session. High risk or “needy” patients can be checked up on frequently via telemedicine visits too.

The “no-show” rate has declined as we are able to reach our patients more easily via phone. This is especially helpful for hospital discharges that are “too tired” to come into the office for a follow up.

What have your experiences with Telemedicine been like?