45 degrees north: what you need to know about telehealth


At the end of 2011, when my rural county economic development office announced the launch of a tourism app, I had to email the manager asking, “What is a tourist app?” application ? Now we use apps for everything from cards to shopping to banking. And I continued to receive advice from my health care providers and my insurance company to try out their telehealth options. In principle, they rang Well. But I found it hard to imagine how that would actually work where the internet and unreliable cellular signals are a reality. Until last summer.

While mowing the lawn, I crushed a hornet’s nest and got stung. Despite the usual home remedies, that night my hand was still swollen and throbbing. It was silly to worry about something as unusual as a bug bite. But years ago, when I got stung in my eye, the swelling seemed reasonable at bedtime, but by morning it had spread to the other side of my face – a potential threat to the respiratory tracts. This time it was a Friday night so I couldn’t see my usual supplier on the weekend. This meant that if things got worse I would have to go to the ER 26 miles away. I didn’t want to pay for an emergency room visit if I could avoid it. And my husband was gone on a fishing trip so that meant driving myself… then waiting to be seen during what is usually a busy night in the ER… then waiting after treatment to be sure it didn’t caused heart attack. For the record, taking a shot of epinephrine isn’t as much fun as a shot of adrenaline in a whitewater canoe.

So I got a lot of incentive to try telemedicine for the first time. Fortunately, I had already downloaded both my insurer’s mobile app and the Teledoc app and registered accounts for each. It seemed like a safe thing to do in a pandemic, but that’s all I got. So, while I glazed the pricked hand, I used the other to research my options.

The home screen of my insurer’s app included selections for virtual care (a link to Teledoc) and a tip line for nurses. On summer weekends, when the people in my area fill up with visitors and cabins, the mobile data service stinks even more than normal. And we didn’t have WiFi at home. So I chose the nurse advice line, thinking that a) a voice call was more likely to work than a video chat and b) there was no charge, and c) a nurse could help me. say if I was a wimp and I should just rub some dirt on it and get back into the game.

Teledoc offers free non-emergency general medicine and mental health services to people directly affected by the deadly tornadoes of December 10. Call the Teledoc Natural Disaster Hotline at (855) 225-5032 or learn more at https://www.teladoc.com/disaster-hotline/.

First, there was a 4 minute admission call. Then there was a 12 minute wait for a nurse callback. She spent about 12 minutes talking with me. All in all, that’s even less time than it takes just to get to the emergency room. By the time our conversation ended, I felt more confident about things like how much more Benadryl I could take and what exactly I should consider a reason for going to the ER.

My first experience with telehealth was easier than learning to use digital coupons in my grocery store app. And now I can think of a bunch of situations where telehealth would be a great option. But I still had questions, and you probably have some too. So here are a few things that might help you prepare your family to use these tools.

No waiting. Okay there is some waiting for. But the average wait time for a virtual visit with a doctor in the United States is only around 20 minutes. In contrast, the wait time for a visit to a primary care physician’s office can range from a few days to a few weeks. It is common for older people to postpone care (“I’ll ask the doctor for my appointment next week”). A virtual tour may be an acceptable alternative when, for example, pain from an ingrown toenail is affecting your father’s balance and the infection seems to be spreading. If the virtual provider says something needs immediate in-person treatment, it’s not just the girl who is harassing.

No excuses. It is also common for caredonors to postpone their own medical problems rather than leaving a loved one at home alone or taking them for an in-person appointment. With virtual options, they may be able to meet these needs in a faster and less stressful way. The same goes for healthy young people. When a neighbor suspected that a tick bite might be responsible for his fever, he used a telehealth app to speak with a doctor and get a prescription for oral antibiotics to treat early-stage Lyme disease. And telehealth offers discreet options for people who might otherwise leave mental health issues untreated, and practical support for people trying to quit smoking.

You can schedule a time. I learned this recently when I used Teledoc to ‘see’ a doctor for an elective referral to physical therapy. In the app, I was offered the choice to start a virtual tour as soon as possible or to make an appointment for a specific time. I chose to schedule an hour. Shortly before this time, I received an SMS reminder of my appointment. Then a call put me in touch with the doctor at the scheduled time (actually, about two minutes before that time).

On-demand tours for more urgent issues were available 24/7/365. Scheduled tours were available from 7 a.m. to 9 p.m. in my time zone – choices that minimize disruption to work and school attendance. And if you are traveling, a virtual appointment can help you sort out certain issues before they escalate without incurring any expense from an emergency care center or nursing home. off-grid emergency.

Expect fee transparency. In 2017, the average cost of an emergency room visit was $ 1,389. For those of us with high deductible health insurance, this is a big hit – and one that is coming. after services are rendered when it is too late to rethink options. On the other hand, a virtual tour under the options available to me can cost anywhere from $ 0 to around $ 45, and this amount is clearly indicated when making an appointment. It won’t solve all surprise billing issues, but I appreciate any control I can take over my healthcare spending.

Come as you are. The telehealth options will appeal to people who have had to help a person with dementia wash and dress for an in-person doctor’s visit. Or need to go straight back to the barn or other dirty work after a date. Or when a gastric bug makes you hesitate to venture away from your own bathroom let alone take a long drive on rural roads: Even if you’re a pro at crouching on your shoulder, a skin infection bladder or diarrhea can increase the level of difficulty and make you regret not having dropped out halfway through your registration with a telehealth provider.

When making an appointment … In my vast experience (twice so far), remote healthcare workers seem very good at both asking questions and actively listening. Nonetheless, it is in your best interest to help them put together the information they need to provide you with the care you need. So take good photos of your child’s pink eye and attach them when you get the chance when making a date.

For the meeting … Make sure your cell phone or other device is fully charged or plugged in before a virtual date. In fact, restart the device to remove invisible debris that might behave badly. And close all other open apps before your date starts.

Prepare for the visit. Gather all of your medications (like on an in-person visit). Take notes ahead of time (just like an in-person visit) on things like:

  • medical background
  • allergies
  • symptoms you experienced (what, when, how much and what you did to relieve them)
  • a record of recent readings for things like temperature, blood pressure, or blood sugar.

Have medical devices close at hand (blood pressure cuff, glucometer, thermometer, bathroom scale). The US Department of Health and Human Resources offers additional guidance here on preparing for virtual appointments.

Concerns related to Covid. On the advice of a nurse practitioner in my rural area, we added a rapid test kit ($ 25 for two tests) and a pulse oximeter ($ 18) to our home tool kit. My husband and I are both healthy and fully vaccinated with recent SARS-COV-2 boosters. But I have a long history of bronchitis, pleurisy, pneumonia, and other respiratory illnesses. If I received a revolutionary case of Covid, I would use the oximeter to trace the level of oxygen in my blood. Low oxygen levels can be an early warning that just hanging out at home may not be enough.

Old-fashioned telehealth. Once you get started, some of the new telehealth options may not sound like much different from a good old-fashioned phone call to a healthcare provider’s office in person. These people have been doing telephone triage and follow-up support for years. And they still do, even if that care doesn’t come packaged in a fancy application. It’s always worth asking if it’s possible to meet them remotely rather than in person.

Finally, whether you call a local healthcare provider or use a telehealth app, expect to hear or see warnings that some conditions require immediate medical attention that cannot be administered remotely. So if you experience chest pain, difficulty breathing, uncontrolled bleeding, or broken bones, call 911 or go to your nearest medical center. Don’t wait until your wife comes home from work to get that broken shoulder treated. But this is another story.

Donna Kallner writes from rural northern Wisconsin.

Teledoc offers free non-emergency general medicine and mental health services to people directly affected by the deadly tornadoes of December 10. Call the Teledoc Natural Disaster Hotline at (855) 225-5032 or learn more at https://www.teladoc.com/disaster-hotline/.


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