Telemedicine: How to make the most of a virtual doctor visit

@johnbishop Hello John,

Good topic! Especially with the COVID-19 situation our world is facing now and the need for social distancing.

I see how valuable it is to have electronic records in that doctors from different hospital systems can access your health situation and know what meds you are taking, the type of health issues you are dealing with as well as test results.

I must admit, however, that I do have a problem with telemedicine. My problem is with the "cloud." Are these videos kept in the cloud? Are these used for other purposes other than the one-time appointment?

What do we know about this? Thanks in advance for helping answer these questions.

Good morning Teresa! @hopeful33250, Cloud security for medical data has always been one of my top concerns too. I was a little concerned when I found out Google would be helping Mayo Clinic so I was happy to see the information from this article made public.

Mayo Clinic: Google will not have independent access to patient data
-- https://www.medcitybeat.com/news-blog/2019/mayo-clinic-google-partnership

The following Q & A may provide some answers to any questions you might have -- Mayo's approach to patient data management, security and digital health: Key thoughts from CIO Cris Ross
-- https://www.beckershospitalreview.com/healthcare-information-technology/mayo-s-approach-to-patient-data-management-security-and-digital-health-key-thoughts-from-cio-cris-ross.html

@johnbishop - there is a lot of upside to Telemedicine and on line records. I had a appointment this last week over the phone with my Oncologist. No trip to the office, it was great. This of course will not work for any physical examination.

Even more important, previous to that, I was able to share a Pet Scan with my Oncologist that was taken at the Mayo Clinic by using the Patient Portal. That was priceless!!! There was no waiting for the physical data to be sent via courier or any other physical means.

Telemedicine speeds up the health care process and should be easier on our environment as an added benefit.

@johnbishop – I really like the Mayo patient portal and use it often. Just logged off after cancelling a blood lab appointment prior to my yearly checkup. I had called my local Mayo Family Health Clinic and she said they have been working with people and recommending they cancel non emergency appointments so I did it through the portal. What I like about the portal is being able to message my health care team for any non critical health related questions and getting a timely response from them. It definitely speeds up the process!

@john bishop. I like the portals also have one that subscribes to other healthcare systems called Follow my Health Anyone can sign up on it to email there Dr., Get lab @xray results Follow my health.com

@124124eva made the point in another discussion that with telephone consults providers cannot take into account body language, but rather will have to rely on questions, such as "do you understand?" Some facilities are offering video consults, which can help include body language. As with any doctor visit, I think it is important to:
1. Be honest when answering questions. Your doctor can only make decisions based on what you tell him or her.
2. Prepare questions ahead of time.
3. Repeat back in your own words what the doctor has told you. This helps to identify any item that may have been misinterpreted or poorly explained.
4. Ask if you can record the consult to listen to later or share with a family member.

I'd also like to bring @marvinjsturing @roch @danielad and @elizm into this discussion as they have had or will be having tele-consults.

What tips do you have to make the most of a telephone consult? What concerns you? What are the advantages to telemedicine?

@colleenyoung - I would also add, have a caregiver take part in the call as well. If agreeable to everyone of course.

Colleen, a couple items I can think of. My tele-visit is about week away.
- Prior to call, check with your insurance company about coverage of telephone visits.
- If call via phone, make sure your phone is charged (or plugged in). Would hate to have battery die in middle of call. Also take call in quite place where not disbursed. Have pen and paper ready. My biggest challenge will be to keep dog from barking during call.
- If your tele-visit is at Mayo, after call, review the portal notes. This is good idea for tele-visit or in person visits.
- If you discuss future appointments or test, ask when and how they will be scheduled. At Mayo, normally you stop at appointment desk to set up future appointments. Seeing this tele-visit, and future appointment scheduling is on hold, ask if someone will contact you and if there is a timeframe.

Laurie

@colleenyoung
Colleen has listed important points regarding preparing for and engaging in tele-visits. At a tele-visit, however, there is no one to alert you to anomalies in your BP, pulse, temperature, and weight... important information for any doctor visit. As much as we patients may want to resist it, it's time to start taking responsibility for tracking and conveying this information to our healthcare providers. Cancer patients are particularly vulnerable to all sorts of downstream issues.

Omron makes an excellent home blood pressure cuff. If you have ever had a blood pressure issue, you need to make an effort to see how you're doing. If it appears too high or too low, log it daily and convey the results during your tele-visit. CVS has a good digital thermometer worth obtaining, especially in light of the Covid-19 news. Keep it handy and just make sure, now and then, that your temperature is normal. If you have a respiratory issue (from radiation, or past pneumonia events, asthma, etc.), get a good pulse/oximeter which monitors the oxygen saturation of your blood. If it registers below 95, note that to your doctor. Get a good bathroom scale and weigh yourself weekly; be honest with your doctor if you have lost or put on pounds. In other words, become your own physician's assistant... help him/her help you.

And please note, any one particular abnormality which you convey, may or may not be of concern to your doctor, but it will help him/her ask you appropriate questions, and better understand what's going on inside you.

I have been using a form of tele-med for 5 years. My local hospital was part of the Sanford system. My nephrologist was at the Sanford hospital in Sioux Falls SD. I would have all my blood work done at my local hospital a few days before my appointment. On the day of my appointment I would go to my local hospital. I would be in a room with a camera and a monitor and a nurse. My doctor could see my test results. There was a stethoscope attached to the computer. The doctor could listen to my heart and lungs through the computer. This was all done through the hospital's network connection instead of through a cell phone.

For various reasons, I have had appointments at Mayo, Nebraska Medicine and Sanford. All of my doctors have access to all of my records at all of the hospitals. That became vitally important to me in the last few months when I was diagnosed with a recurrence of my pancreatic cancer. My doctors could see my PET and MRI scans done at various hospitals.