I'm a primary care doctor, and in normal times, my favorite part of the job is getting to see my patients regularly. But because of the COVID-19 pandemic, I've had to substantially cut down on in-person visits to help put the brakes on the spread of the coronavirus.
In this time of high medical anxiety, the phones at my clinic have, understandably, been ringing off the hook.
Lots of patients have questions about symptoms that might signal COVID-19. (This coronavirus risk tracker from Emory University can help you there too.) But they still need to know whether the pain in their knee after a fall signals a broken bone that requires treatment, whether their child with a fever needs antibiotics or whether a family member's fatigue is a sign of a serious illness.
For many such cases, I once would have said, "Come on in, and let's get you checked out." But now, I'm increasingly turning to email, phone calls and video chats.
Here are some tips to help you know when to call your doctor and how to get the most out of your telemedicine visit:
If you don't have a doctor yet, get one. Because of the pandemic, many primary care providers are allowing new patients to establish care via a telemedicine appointment. (Previously, many practices would return only the calls of patients who had already been seen in person at some point.) Your new doctor will probably ask you to come in for an in-person visit when it becomes safe to do so.
Many urgent care centers and walk-in clinics are also offering telemedicine visits. You can call or check out their websites to set up an appointment.
Emergencies are still emergencies. Some of the same rules from pre-pandemic days apply: Sudden chest pain, weakness in one side of the face or body, or sudden difficulty breathing are all red-alert symptoms. Call 911 pronto in these cases.
Urgent, but not an emergency? Call your primary care provider's office. Ask yourself if, in pre-pandemic times, these symptoms would have led you to call your doctor in the middle of the night for advice. Common concerns in this category include high fevers, a new source of pain or a minor injury. If the answer is yes or if you aren't sure, please give your doctor a call right away.
"If you feel as though this is a ... situation that can't wait, that would make you pick up and go to the urgent care or the hospital, you need to be giving me a call," Dr. Gary LeRoy, an associate professor of family medicine at Wright State University and president of the American Academy of Family Physicians, tells his patients.
Note that you probably won't immediately reach your primary care provider. Most doctors and nurse practitioners work with a team of office staff, including nurses and other clinicians, who can quickly help you talk through your issue over the phone.
Help the triage nurse. To get the most out of this triage call, try to summarize what's going on in one or two sentences. Start with your most urgent symptom first; note how long it has been going on and what has changed.
If the triage nurse determines your symptoms sound like an emergency, you might be advised to go to the emergency room right away. If that's what you're told, don't hesitate — do it. Even during the COVID-19 crisis, the hospital is still the safest place for true emergencies.
Otherwise, if your concern can best be treated via telemedicine, you'll be scheduled for a phone or video appointment. Whether you'll have a copay for that conversation depends on its length and your health insurance. (To avoid getting unexpected bills, make sure you ask the triage nurse or administrative staff if your call is considered an appointment.)
Prepare the Converstation
Make a list. Even for in-person visits, I always recommend that my patients write down a list of two or three issues they want to address, so they won't forget anything important. This is especially vital when the visit is via phone or video chat, where, I've noticed, my patients are more likely to lose their train of thought.
LeRoy recommends patients ask themselves: Why do you need to be seen today? What's the biggest priority? "I spend so much of my time," he says, "trying to figure out, 'What are you really here for?' "
Keep track of when your symptoms started and if they've changed. A symptom diary may reveal clues to what's causing your condition. Keep a brief record of when symptoms occur, what seems to trigger or aggravate them, and what alleviates them.
Take and send a photo of obvious symptoms. Some medical issues — bites, moles, rashes and other skin issues — are particularly well suited to telemedicine. To help a doctor know how quickly a rash or skin reaction is spreading, draw a circle around it with a pen and send a sequence of photos taken over a couple of hours, noting the time each was taken.
Address routine issues before the visit. Medication refills, notes from a doctor that are required by your employer or insurer, or other paperwork may not even require a telemedicine visit.
Sign up for your doctor's online patient portal if it's offered — that's the secure app that's connected to your medical record, where you can see your test results and request appointments. You can often ask for medication refills that way without needing to be seen.
You can also use that portal to submit any scanned forms you need completed; that way you can spend the virtual visit going over any questions or details with your doctor. If you need a note for work, make sure you have an email address or fax number where you'd like it sent.
Be ready to talk
Call from a quiet place. So many of the telemedicine appointments I've fielded during the coronavirus pandemic have been tough for a simple reason: It was hard to hear. Try to find a quiet place with good cellphone reception to receive your doctor's call. If you're using a video chat app, give it a try before the appointment, so you can troubleshoot any challenges.
Avoid phone tag. Be prepared to answer your phone at the appointed time, even if it comes from an unknown number. Make sure you've disabled any spam blockers or functions that reject calls from private numbers.
Use health tech and equipment to your advantage. Have on hand any medical devices your doctor has prescribed or recommended.
A thermometer will confirm whether you have a fever. If you're experiencing chills or body aches, check your temperature orally — or use a rectal thermometer for babies who can't hold the thermometer in their mouths. And avoid forehead or armpit readings, since they tend to be inaccurate. A fever is defined as 100.4 degrees Fahrenheit or above.
If a condition like heart failure is causing you to retain fluid, you'll be able to help a doctor detect that by measuring your weight at the same time every day on a home scale and keeping a record.
A blood pressure cuff can help you make sure any medicine you take for hypertension is working correctly. Your blood pressure goal depends on your age and underlying medical conditions, so make sure you ask your doctor what number you need to aim for. And a glucometer can help people with diabetes keep blood sugar levels under control. If you've been told to use one, track your values.
Sometimes an office visit is best.Know that for urgent issues, your doctor's office is still open for business. In my experience over the last few weeks, the telemedicine approach has worked really well for certain concerns — mental health care, medication refills or skin problems that can be easily examined with a photo.
But it doesn't work so well for more complex issues, like an elderly patient who can't walk after a fall or a child who has gotten dehydrated from vomiting. In those scenarios, I really need to examine my patients and check their vital signs. I'll still ask them to come into our clinic if I think a brief appointment with me may help them avoid a trip to the emergency department later.
Telemedicine also doesn't work for preventive procedures such as Pap smears, colonoscopies and mammograms. Many of these have been put on hold, but some hospitals are now adding back more in-person visits and elective procedures when they can do it safely.
I certainly miss seeing my patients in person. But I also hope that we doctors can learn from this experience and start using technology to offer our patients more convenient care.
Especially now, when so much of daily life has been upended, "it's gratifying to be able to offer this additional service to our patients," LeRoy says. "We can interact with them. They feel connected and not marginalized or forgotten."
Mara Gordon is a family physician in Camden, N.J., and a contributor to NPR. You can follow her on Twitter: @MaraGordonMD.