[Reprinted: Las Vegas Sun, 6-10-2020]
As cities across the country began shutting down when the COVID-19 pandemic hit the United States, people still needed to receive advice and treatment from doctors for symptoms non-COVID-related. Physicians had to figure out another way to reach patients.
Dr. Thomas Hunt, chair of family medicine at Henderson’s Roseman University of Health Sciences and program director of Valley Health System’s Family Medicine Residency Program, says “it became very clear” early on that telehealth needed to be incorporated into the residency curriculum. That has included training residents how to use telehealth visits effectively, determining when online medicine is most appropriate, managing chronic illness from a distance and learning the technology.
“What I hear from both patients and physicians is that this is convenient, it works pretty well and, while it’s not for everything, it’s an additional tool for primary care doctors and all physicians,” Hunt says.
Hunt took similar action at Roseman Medical Group, the clinical arm of the university. “On March 16, we all had an emergency meeting and quickly made a decision that it was time to protect our patients who would be at increased risk of complications from COVID-19,” Hunt says. “That’s where we looked at the available technology and started to do tele-video visits. Prior to March 16, we didn’t do any, and within three weeks, 90% of our visits were via tele-video.”
Not everyone is well-suited for online medical visits. Neurology patients, for example, need in-person procedures that cannot be carried out from a distance. A routine checkup can easily be done online, but complaints of sudden severe pain, like in the abdomen, should be assessed in person, Hunt says.
“A big portion of the switch to telehealth was to also train our patients,” Hunt says. “Lots of patients are not adept at getting online, setting up a camera and being able to chat like this. We’ve all gotten much better at it, but two months ago that was a brand-new thing.”
For any medical treatment to be effective, the patient needs to take an active role in their care—and that especially applies to telehealth.
“One tenet that myself and family physicians across the country have always said is, ‘Health care is really about shared decision-making,’” Hunt says. “In order for individuals to be cared for, they do have to meet us halfway and they do need to take responsibility.”
If you have high blood pressure or hypertension, Hunt advises purchasing a blood pressure monitor or cuff. If you feel sick or feverish, have a thermometer ready to take your temperature, since a doctor won’t be able to.
John Nixon, assistant professor in residence and assistant director of the Practice mental health clinic at UNLV, agrees that telehealth—and teletherapy, in particular—have been helpful in managing people’s well-being during the shutdown.
Teletherapy, a branch of telehealth, refers to talk therapy conducted online instead of in person.
“You don’t have to worry about, ‘Am I going to catch something?’ You can stay in an environment where you feel safe,” Nixon says. “Initially, there was a lot of anxiety about coming to the clinic, so we were seeing people canceling appointments. Video offers the security of your own environment, as far as potential exposure to something.”
But, like an online physician’s visit, Nixon says teletherapy has its advantages and disadvantages. “When we have someone in the office who is in crisis, we are better able to [ensure that they are in] a situation that is safe. When we’re counseling over telephone or video, and we have a person at a remote location who’s in crisis, we’re not physically there, and that’s probably the biggest concern,” Nixon says.
Still, he adds that teletherapy is better than no therapy at all, especially for those in need of a more flexible schedule.
Hunt agrees. “Patients find doing a tele-video meeting with their doctor actually saves them a bundle of time. Now you don’t have to come sit in the waiting room for 15 minutes, then sit in the [exam] room for another 15 minutes and have to take half a day out of work.”
Barriers to access
The COVID-19 pandemic has reminded us that not everyone has the same access to medical care in the United States. Whether because of age or income, many people are unable to access the technology required for telemedicine.
“It has been a barrier for many, many people,” Hunt says of the switch to telehealth. “It’s the same thing that we’re seeing with the school district, right? If a family doesn’t have internet access, how does that work? How do you have a telehealth visit?”
While video is still preferred, some physicians’ offices like Roseman Medical Group offer telephone visits in lieu of an online meeting. Still, “There is no question that this is not a level playing field,” Hunt says.
“If there’s one thing I’d like to get across, it’s that people should not be neglecting their health care,” Hunt says. “We’re trying to prevent people from falling through the cracks. That being said, across the country and in our community, we do know there are people who are neglecting [their health], people who have chosen not to see their doctors, people falling behind on their vaccinations, people who have put off other health care maintenance things, such as a mammogram or cancer screenings.”
With the Valley entering Phase 2 of Gov. Steve Sisolak’s reopening plan, Hunt says people are feeling more confident about returning to the doctor’s office, but online health care will remain an option.
“We’re seeing more people every day who are feeling comfortable enough to be seen in person, but the telehealth visit is here to stay,” he says. “A lot of the barriers that were preventing it from being widely incorporated were suddenly taken away during this pandemic, and it will be one of the silver linings that we see at the end of this.”