45 Degrees North: What You Should Know About Telehealth

In late 2011 when my rural county’s economic development office announced the launch of a tourism app, I had to email the director to ask, “What’s an app?” Now we’re using apps for everything from maps to shopping to banking. And I kept getting nudges from my health care providers and insurance company to try their telehealth options. In principle, they sounded good. But I had trouble imagining how it would actually work where unreliable internet and cell signals are a fact of life. Until last summer.

While mowing the lawn I ran over a hornet nest and got stung. Despite the usual home remedies, that evening my hand was still swollen and throbbing. It felt silly to worry about something as not-unusual as an insect sting. But years ago when I was stung by my eye, the swelling seemed reasonable at bedtime but by morning it had spread to the other side of my face — a potential airway threat. This time it was a Friday night so I wouldn’t be able to see my usual provider over the weekend. That meant if things got worse I would need to go to the emergency room 26 miles away. I didn’t want to pay for an emergency room visit if I could avoid it. And my husband was away on a fishing trip so that would mean driving myself…then waiting to be seen on what is usually a busy night in the ER…then waiting after treatment to be sure it didn’t give me a heart attack. For the record, getting a shot of epinephrine is not fun like a shot of adrenaline from whitewater canoeing.

So I had plenty of incentive to try telemedicine for the first time. Luckily, I had previously downloaded both my insurance provider’s mobile app and the Teledoc app and registered accounts for each. It seemed like a prudent thing to do in a pandemic, but that’s as far as I got. So while I iced the stung hand, I used the other to research my options.

The home screen for my insurance provider’s app included selections for both Virtual Care (a link to Teledoc) and a Nurse Advice Line. On summer weekends when my area’s population swells with visitors and cottage people, mobile data service stinks even worse than normal. And we didn’t have WiFi at home. So I chose the Nurse Advice Line, reasoning that a) a voice call was more likely to work than a video chat and b) there was no fee, and c) a nurse could tell me if I was being a wuss and should just rub some dirt on it and get back in the game.

Teledoc is offering free non-emergency general medical and mental health services to those directly affected by the deadly December 10 tornadoes. 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 intake call. Then there was a 12-minute wait for a callback from a nurse. She spent about 12 minutes talking with me. Altogether that’s still less time than it takes me just to drive to the ER. 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 being a cause for going to the ER.

My first experience with telehealth was easier than learning how to use digital coupons in my grocery store’s 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 do, too. So here are some things that might help you prepare your family to use these tools.

No waiting. Okay, there’s some waiting. But the average wait time for a virtual visit with a doctor in the U.S. is only about 20 minutes. By contrast, the wait time for an office visit with a primary care physician can be a few days to a few weeks. It’s common for elders to defer care (“I’ll ask the doctor at my appointment next week”). A virtual visit might be an acceptable alternative when, say, the pain from an ingrown toenail is impacting your dad’s balance and infection appears to be spreading. If the virtual provider says something requires immediate in-person treatment, it’s not just the daughter nagging.

No excuses. It’s also common for caregivers to defer their own medical concerns rather than leave a loved one home alone or drag them along to an in-person appointment. With virtual options, they may be able to address those needs in a more timely and less stressful fashion. The same is true for healthy younger people. When a neighbor suspected a tick bite might be responsible for his fever, he used a telehealth app to talk 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 let mental health issues go untreated and convenient support for people trying to stop smoking.

You can schedule a time. I learned this recently when I used Teledoc to “see” a doctor for a non-emergency referral to physical therapy. In the app, I was offered the choice to begin a virtual visit asap or to make an appointment for a specific time. I chose to schedule a time. Shortly before that time, I got a text reminder about my appointment. Then a call connected me to the doctor at the scheduled time (actually, about two minutes before that time).

On-demand visits for more urgent concerns were available 24/7/365. Scheduled visits were available from 7 am to 9 pm in my time zone — choices that minimize disruptions to work and school attendance. And if you’re traveling, a virtual appointment can help you address some concerns before they become more serious without incurring charges from an out-of-network walk-in or urgent care facility.

Expect fee transparency. In 2017, the average cost for an emergency room visit was $1,389. For those of us with high deductible health insurance, that’s a big hit — and one that arrives after services are rendered when it’s too late to rethink options. By contrast, a virtual visit under the options available to me might cost anywhere from $0 to about $45, and that amount is clearly stated when you make the appointment. That won’t solve all the problems of surprise billing, but I appreciate any shred of control I can take over my health care spending.

Come as you are. Telehealth options will appeal to people who have had to help a person with dementia bathe and dress for an in-person doctor visit. Or needed to go straight back to the barn or some other dirty job after an appointment. Or when a stomach bug makes you reluctant to venture far from your own bathroom let alone make a long drive on rural roads: Even if you’re a pro at copping a squat on the shoulder, a bladder infection or diarrhea can raise the level of difficulty and make you wish you hadn’t given up halfway through registering with a telehealth provider.

While making an appointment… In my vast experience (twice so far), remote health care workers seem to be very good at both asking questions and active listening. Nevertheless, it’s in your best interest to help them gather the information they need to get you the care you need. So get some good pictures of your kid’s pinkeye, and attach those pics when you have the opportunity to do so while making the appointment.

For the appointment… Have your cell phone or other device fully charged or plugged in before a virtual appointment. In fact, restart the device to clear out unseen debris that might misbehave. And close all other open apps before your appointment begins.

Prepare for the visit. Gather all your medications (just like an in-person visit). Make notes beforehand (just like an in-person visit) about things like:

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

Have medical devices at hand (blood pressure cuff, blood glucose monitor, thermometer, bathroom scale). The U.S. Department of Health and Human Resources offers additional advice on preparing for virtual appointments here.

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

Old school telehealth. Once you get started, some of the newer telehealth options might feel not that much different from a good old-fashioned phone call to the office of an in-person health care provider. Those folks have been doing telephone triage and follow-up support for years. And they’re still doing it, even if that care doesn’t come packaged in a fancy app. It’s always worth asking if it’s possible to meet them remotely instead of in person.

Finally, whether you call a local health care provider or use a telehealth app, expect to hear or see warnings that some conditions need an immediate medical intervention that cannot be delivered remotely. So if you’re experiencing chest pain, difficulty breathing, uncontrolled bleeding, or have broken bones, call 911 or go to your nearest medical facility. Don’t wait for your wife to get home from work to get that broken shoulder seen to. But that’s another story.

Donna Kallner writes from rural northern Wisconsin.

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