Virtual visits with the doctor may be here to stay

Apr. 10--The age of the coronavirus may be ushering in a new era in medicine: the era of video appointments.

The idea has been around for a while: instead of sitting in a waiting room, leafing through a 1997 copy of Popular Mechanics or zapping a few more pigs with angry birds while you wait in the treatment room, you can just follow an e-mailed link and meet your doctor face-to-face, in the comfort of your own home.

The problem was, insurance made it difficult to cover such a concept. But with the advent of social distancing and an unwelcome virus, insurance companies have agreed to give it a try -- as a means of protecting both patients and caregivers.

Area doctors who are giving it a try -- and that's most of them -- seem pleased with the results, and they report that patients are happy, as well.

Of course, not all doctor visits can be done via video -- though a doctor can show someone at home how to take a pulse for him, there's no way for him to check your heart or do any procedure that requires him or her to touch you to examine you, run x-rays or tests, or to give you an injection.

But doctors can evaluate your need to be tested for COVID-19, explain test results, examine some wounds, prescribe meds or just see how your treatment is coming along, be it pain control or a post-operative checkup.

Area doctors and practices are taking slightly different approaches.

According to Chief Executive Officer Stephen Nuckolls at CCHC, Coastal Carolina Health Care has melded the real-time visits with drive-thru medicine, thus taking the whole concept of medical social distancing a step farther.

"We combine the virtual visit with a drive-thru service," he said. If, through the virtual visit, the doctor decides the patient needs an injection, blood work, or to be tested for COVID-19, they are instructed to drive to the primary care office at 670 Cardinal Place, located behind the hospital's Surgery Center. There, a tent awaits that can handle two cars at a time.

"We're working with patients during this time," he said. "We understand these are extraordinary circumstances."

He noted that more than 50 percent of the visits that CCHC handles right now are virtual.

And when the virus has finally let the community get back "to normal"?

It's up to what insurance companies decide to cover, but it is likely that virtual appointments will stay.

It's also easier to squeeze in an appointment on short notice, if you're meeting your doctor face to face but across the miles.

That doesn't mean that person-to-person appointments will end -- new patients will likely always have to make a physical visit, and better than half of visits will require the patient to actually be present.

"Once we get past this episode, it's not going to be 50 percent virtual," Nuckolls said. "There's stuff that's just going to be better done, face to face."

Still, virtual visits have found an important function, and they're probably here to stay.

"There are a lot of industry observers that think it's going to be hard for the insurance companies to not pay for this," Nuckolls said. "Patients like it, and doctors are realizing that it's not so bad, that you can do a lot this way. It has a potential to be one way medicine is delivered in the future."

Diana Gliga, an internist with Internal Medicine has been using teleconferencing with patients as much as possible. "With COVID-19 we can enforce social and medical distancing," she said. "Those with mild symptoms can get care this way."

In fact, according to Michael Smith, vice president of physician practice management at CarolinaEast Physicians, roughly 850 video appointments have been held already in the few days it's been in use. "From the feedback we get, the patients like it a lot," he said.

He noted that the sites are also encrypted and HIPPA-protected, meaning it's unlikely anyone will be able to hack into your visit, as they might if you were using a more public platform like Facebook.

It also allows doctors who might find themselves in quarantine to keep working, Gliga said.

The system works a little differently, using different platforms, depending on the doctor or practice you use. Carolina Orthopedics has patients download Google Duo, a free app, onto their phone or computer, if it has a camera.

CarolinaEast, meanwhile, emails patients a link that they are to click at the time of their appointment. The link becomes active about 10 minutes before the appointment officially begins.

A nurse or other staff member will meet you first to do any set-up tasks -- co-pays, checking med lists, and that kind of thing. Then you see your doctor, PA or nurse practitioner.

And, no, there's no guarantee that a doctor will be talking to you at exactly 3 p.m. on a 3 p.m. appointment -- they can still get behind with other patients. But, Gliga says, she will usually be talking to the patient within 10 minutes.

And, waiting at home, you can be getting a little work done or responding to Princess's demands for attention while you do, instead of sitting in a chair at an office watching the muted TV.

Gliga noted that there are a lot of good reasons for it to become a regular practice.

"We are reaching out to a higher patient number than we used to," she said, including patients who have real travel complications or otherwise cannot make it into the office.

"In our office, we are not able to do new patient visits with Telehelp, but if the patient has been seen for some other issue we can see them," Dr. Kristen Hedge, who specializes in hand surgery with Carolina Orthopedics, said.

"For me, it worked well for following up on MRI scans, for following up on the results of an injection," she noted. "I had some people with saw injuries to their hands or infections of the nail bed, and we could actually see in the exam and decide what to do next."

"I started it last week and I found it useful," she said.

She had about two dozen such patient interactions last week, she said.

"I think some patients will actually like the virtual visits, even when we're not dealing with COVID. It doesn't take much of their time to come to the office."

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