Telehealth Appointments for Cancer Patients

Until last spring, most of us had never heard of, let alone participated in, a telehealth, telemedicine or televisit medical appointment. My own therapy practice shifted overnight to Doxy and Zoom in March, and it has been a steep learning curve. Being on the clinician side is a bit different from being on the patient side, but we all have had to learn how to best use the technology and experience.

We have learned that there is no diminishment of care and people do just as well as they would with in-person meetings.

The reason for this change has primarily been to protect the health and safety of both practitioners and patients. In the beginning of the pandemic and, again, during times of surge or higher numbers, hospitals have wanted to keep patients away from their doors. Doctors have been asked to try to schedule as many virtual appointments as possible and all non-urgent procedures have been delayed or cancelled. Many of us missed annual mammograms and other screening tests last spring, and one very unfortunate result has been a rise in the diagnosis of malignancies. That, however, is another topic. My intention today is to think about how to adapt to seeing your doctor over a screen and feel that you have had a reassuring and complete interaction.

There are some things that cannot be done via computer. A physical exam, an EKG, giving injections or drawing blood are impossible. Any visit that does not require hands-on care is feasible. Conversation is possible, and it has turned out that rashes and some other symptoms can be observed and that patients can be talked through some movements to consider function or injury. Some people are delighted not to have to make the trip to a hospital while others are less happy with the distant discussion.

Now that we have had almost a year’s experience with this new world, there have been some studies of satisfaction and value of telemedicine. The general conclusions are that virtual appointments can increase access to cancer care, result in generally high patient satisfaction due to convenience and availability of caregivers, and maintain safety as patients are kept away from possible COVID-19 exposure. There have been fewer missed appointments as patients can participate from their homes. Aside from the sense of security, this means that people can avoid the hassles of a commute, parking, and needing significantly more time to travel and complete the appointment. Perhaps most importantly, we have learned that there is no diminishment of care and people do just as well as they would with in-person meetings. If, during a virtual conversation, you and your doctor feel that there is a reason for an exam or some other kind of hands-on procedure, that will happen.

It is always smart to prepare for a medical appointment, and there are a couple of extra considerations for a virtual visit. Perhaps the most important is to be certain that you have the right technology and that your half of the system is operating correctly. If you plan a telephone appointment, be sure that you have the right number. If you are using a video connection, find out if you need to download a Zoom or other application on your device. Some hospitals mandate a particular platform; ask about this and ask whether you need to do anything on your end. My own experience is that sometimes there are glitches that could not be foreseen. Sometimes, as we all know, the internet is spotty or suddenly not working correctly. If possible, ask in advance what to do should this happen. For example, is there a back-up telephone number that you could call if your internet fails? Ask, too, if there is anything else that the doctor’s office or practice can suggest to make this smoother. Find out how long the appointment will last so that you can monitor the best use of the time.

One concern expressed by many people is privacy. We are all aware of HIPPA regulations and the great lengths that medical systems have gone to in order to ensure patient confidentiality. This is the primary reason that some hospitals require specific platforms that are HIPPA compliant. Zoom is not.

Most insurance companies now routinely cover televisits and medical offices have learned how to code and submit these claims. If you are worried about it, call your insurance company first to inquire about coverage and any co-pay or deductible that may apply.

In addition to the convenience and safety of telemedicine, the biggest benefit is the ease of including family or close friends on the visit. For years, we have sometimes had distant family members call into visits and listen by phone to what is happening in the doctor’s office; that is usually only somewhat successful. Now your spouse or sister can sit right with you or sign on from another place.

The expectation is that televisits are not going to disappear when the pandemic is under control. There likely will continue to be times when they are the best option. In my psychotherapy practice, I know that I have clients who will prefer to stick with virtual visits because of convenience and others who are eager to return to sitting in a room together. All of us will figure out what is best for each person and each appointment.