En español | While mental health appointments remain the most common type of digital medicine practiced across the country, doctors are increasingly diagnosing physical health issues over a screen, too. Case in point: Hypertension, which jumped to third place in the top five diagnoses made via telehealth during the first month of the pandemic, as, presumably, patients reacted to an uptick in stress or asked for telemonitoring of existing symptoms at a time they feared leaving their homes.
But doctors are now also offering routine physical exams, such as the Medicare wellness visit, this way.
A Virtual Physical
To prepare for the visit, find a private, quiet, well-lit space in your home (if you're using a mobile device or laptop). It's best to sit facing a window or lamp. Have a scale, thermometer and blood pressure cuff nearby in case your doctor asks you to weigh yourself, take your blood pressure and temperature, and measure your heart rate. He or she can demonstrate the proper technique for taking your blood pressure.
During the visit, your physician will review your medical history and ask about any changes in your health and family, such as the death of a spouse. He or she will also ask about your diet as well as your sleep and exercise habits. He or she will review your lab results and the medications you're taking — so have them pulled out of the medicine cabinet ahead of time. If you take several medications, your doctor may ask to see your pill organizer. He or she will recommend any vaccines and screening tests you might need (colonoscopy, mammogram and bone density, for instance).
Your physician may also ask you to walk around and move your arms and legs to check your range of motion. “Doctors can learn a lot by seeing a patient in a natural setting such as their home, as opposed to a sterile office environment,” says Todd Czartoski, M.D., chief medical technology officer at Providence Health System, which has 51 hospitals and 1,085 clinics in seven western states. “We can assess how well a patient is walking, see where his or her medications are stored and determine how safe the environment is.” Your doctor can point out any tripping hazards in your home.
At the end of the visit, your doctor will give you a plan of care. He or she may order certain tests, such as a chest X-ray or an ultrasound, which need to be done in the office.
A Virtual Sick Visit
Telemedicine is widely used to diagnose and treat a variety of common illnesses, such as upper respiratory infection, urinary tract infection and pink eye. “A visit serves as a way to determine whether a patient can be treated remotely, saving him or her a trip to my office,” says Steve Ommen, M.D., a cardiologist and associate dean of the Mayo Clinic Center for Connected Care. “In some cases, I might need to order an X-ray.”
To prepare for your visit, consider your symptoms. If you have stomach pain, wear slacks with an elastic waist so you can show your doctor your abdomen. If you have ankle pain, take off your shoes. Have a thermometer and blood pressure cuff on hand because your doctor might ask you to take your temperature and blood pressure. You might also need a flashlight to allow your doctor to check your mouth and throat. If you're short of breath or have a lung or heart condition, bring a pulse oximeter, which measures oxygen saturation in your red blood cells.
To help doctors care for high-risk chronically ill patients via telemedicine, some large health systems are sending patients a handheld device equipped with a stethoscope, otoscope, tongue depressor and temperature gauge. Produced by a company called TytoCare, the device connects by Wi-Fi to a phone or tablet and transmits medical exam results such as heart and lung sounds to a doctor. A high-density camera captures images and video of a patient's ears, throat and skin.
During the visit, your doctor will take a full medical history and will likely ask: What are your symptoms and when did they begin? He or she may ask you to feel along your jawline to see if your lymph nodes are swollen. You might need to press on your cheekbones, below your eyes and on your forehead to check for sinus pain. You may also be asked to take deep breaths and breathe into the microphone of your mobile device or computer. Your doctor may ask you to shine a flashlight in your mouth to check for signs of an infection. When it comes to a sick visit, “there are a lot of visual and auditory cues a doctor can use to evaluate a patient,” says Susan Bailey, M.D., an allergist and immunologist and president of the American Medical Association. “I'm able to listen to a patient's cough, rapid breathing, wheezing and hoarseness.” At the end of the visit, your doctor will prescribe treatment or ask you to schedule an office visit. If your doctor is concerned, he or she might tell you to go to the hospital.