Up to 82% of people have yet to use telemedicine as a method of seeking medical care. While our primary interaction with healthcare has yet to fully follow the path of our online first interactions with banking and shopping, it is clearly becoming more the norm year upon year. Just like much in life, if our initial experience with something new is less than pleasant, we are unlikely to engage in that experience again. So, in order to make that initial use of telemedicine more successful and enjoyable here is a list of 12 recommendations for you to consider before and during your telemedicine encounter.
With modern video conferencing software, a video visit should be successful even over a cellular connection. Most modern systems should only need about 0.6 Mbps of bandwidth to "work" but generally they do better with at least 1.2 Mbps or higher. A cellular 4G LTE connection can provide between 5 and 12 Mbps of download bandwidth according to Verizon's website . . . more than enough right? Well, numbers on paper do not always equal numbers in reality. We have all had the experience of garbled phone calls and pixelated Skype or FaceTime video calls leading to an awkward, disjointed interaction associated occasionally with the complete failure and dropped or frozen videos.
Even if you have much higher internet speeds coming into your location, each device that is using that bandwidth adds to the load on the system. A single device streaming Netflix for example can use 5 Mbps for an HD movie and up to 25Mbps for an Ultra HD Movie. The more devices using the same network, the more likely it is that the quality of the interaction could be affected.
For the best experience, it is worth running a speed test beforehand. If you are on a phone or tablet, you can search for services to use, such as Bandwidthplace to check your speeds. On a laptop or desktop, you have even more choices, such as Speedtest or Speakeasy. If you get at least 1.2 Mbps upload/download speeds, you should be good to go.
If you are using a telemedicine service that uses an independent secure videoconferencing system, you should probably make sure you have the necessary software installed on your device ahead of time. Two popular videoconferencing systems used for telemedicine are VSee and Zoom. You can download each of them through the VSee Download link here and the Zoom Download link here.
It can be frustrating if you are about to engage in a visit with the doctor online and your video camera doesn't connect. Sometimes it is simply a matter of giving the software permission to use your camera. You may see a pop-up box asking for your permission to use video and audio. Go ahead a give the software permission. But sometimes, the video just does not connect. If you have other video software running, like Skype or FaceTime, make sure those are shut down as they may be hijacking your video connection and preventing the telemedicine software from using it. If that still does not work, sometimes a restart of your computer will fix the problem and allow you to establish a connection.
But the best way to ensure a good quality audio-visual interaction is to test the audio and video beforehand. Many telemedicine services and software packages have some way for you to test your sound and video before the visit. Doing so may help save you some anxiety and confusion when it comes time to be seen.
As a last resort, make sure your phone is handy to at least conduct a phone conversation should the internet audio and video fail. The medical provider or a technical assistant may be able to walk you through the steps needed to get things rolling smoothly. Videoconferencing systems also often have a chat feature that would allow you and the healthcare provider to text back and forth if you cannot hear each other.
We all lead a busy life. Sometimes telemedicine visits occur in the passenger seat of a car. But in order to maintain your medical privacy as best as possible and to allow the medical evaluator hear you well, a private location is recommended. Find a quiet area, preferably in a room where you can lock the door so others do not interrupt. Turn off you cell phone ringer. You will be amazed at how much face-to-face time you can get with a telemedicine doctor when it is just the two of you having a focused conversation and exam. Compare that to many in-office visits where you often only get a few minutes of time despite with the doctor.
This is one of the most important features of a great physical exam. Checking yourself on video is like checking yourself in the mirror before you go out in public. Make sure that you are not completely in the dark or draped in shadow during the video visit. Having a light that is directly in front of you is incredibly useful. Even if that simply means turning towards a table lamp or window. When you sit with a light source behind you, like a open window during the day, your face becomes completely dark and some important physical exam cues can be easily missed without good lighting.
Grab a flashlight or just the light on your smartphone to help in examining the back of your throat, your eyes, and some rashes.
It is not uncommon during medical visits that patients get caught up in the moment. There are many things that you want to say but everything seems to get jumbled up and out of order. Or you completely forget something that you really wanted to talk about. It happens to all of us. To help avoid missing important information or forgetting important questions...Write them down! It is okay to look over your notes during a visit. Plus it is helpful for the doctor or other healthcare provider for you to have a good timeline and account of your medical issues.
Just like an in-person visit, a physical exam is needed for many issues. If there is a pain in the elbow, having a skin tight turtle-neck with a bulky jacket on top of that does not lend itself to a good elbow exam. Same with rashes. The medical provider will want to see what the rash looks like. Dressing appropriately for the expected exam will improve the ability to get a quality exam and diagnosis. This will also allow for the visit to continue forward smoothly without delay of trying to work around the situation.
Similar to finding a quiet, private location to have a telemedicine visit, using headphones adds to the quality for both sides. Your privacy is improved because others cannot listen in on what you are being told. Your exam will improve because you will hear better exactly what you need to do. The telemedicine providers diagnosis may be better because they can hear you better and focus on your voice rather than a bunch of background noise. For an upgrade to standard headphones, using a noise-cancelling headset would improve the sound quality by helping to decrease the distracting noises in the room like the fan spinning or the cat meowing.
Many videoconferencing systems allow you to screen-share items from your computer. If you want a second-opinion on a medical report or just a plain English interpretation of an X-ray result, you can screen-share the report with the telemedicine provider. Same goes with pictures. Maybe you had a rash yesterday that you took a picture of but it is gone today. You can screen share that pic to get an opinion on what it could be. (See "What the Rash is That?!")
However, if you can't find your report or pictures because they are buried somewhere in your computer files, it isn't going to do you much good. So before you join the visit, make sure these items are easily found. Like maybe on your desktop. Of course, if you have printouts, you can always just show them on video, but sometimes they are hard to see and read when doing this.
Your visit with the medical provider should be as close to an in-person visit as possible. When you go to the doctor's office, one of the first things that usually happens when you are taken back from the waiting room is that someone will check your vitals signs such as temperature, heart rate, blood pressure, and sometimes your oxygen levels(pulse oximetry/oxygen saturation).
Well, having a telemedicine encounter should not be different. Vitals signs are called vital signs for a reason. If you have a very high fever and fast heart rate, that could affect the decision of the healthcare provider as to the best course of action to take care of you. It is recommended that you have these devices handy and you know how to use them. Preferably, you are using equipment with a digital display so that you can show it over video. Even if you are not doing a video visit, it would be helpful for the medical provider to know what your heart rate, temperature, blood pressure, and possibly pulse oximeter reading is.
More and more medical devices are available to help you monitor your health or do some self-diagnosis. If you have diabetes, having your blood sugar monitor ready to use might be important. Asthmatics that have a peak flow meter should have that ready for use during the exam. For parents with children who get lots of ear infections or for adults who get a lot of ear problems, having a method of allowing the clinician on the other end of the connection to see inside your ears would be useful. Some devices such as the ENTO USB otoscope or the Cellscope OTO iPhone otoscope are available online and can save you time and money on evening or weekend trips to the urgent care or emergency room.
In addition to the telemedicine devices listed above, ask your doctor or telemedicine service provider if any other available devices might be able to be used to enhance your exam. For example, Clinicloud makes a thermometer and stethoscope kit and Tytocare will soon be launching TytoHome, a consumer version of its combination camera for throat and ears plus stethoscope for heart and lungs. While these devices may be a bit pricey right now, over time as telemedicine becomes more the norm for everyone's initial exam, the prices will come down.
Some question whether or not a good exam can be conducted by video, phone, or text. At least with video, we would reply with a resounding YES! But there is one key qualifier to this response: You, the patient, need to be an honest and active participant in the exam. The entire process should start with your honest history of what is going on, not with what you think the provider might want to hear or what your think you should say to get what you think you need(like antibiotics). Then, when it comes to the exam, the provider may ask you to do some things which may seem awkward, such as jumping up and down in front of the camera if you say you have stomach pain. There is a reason for all of this and hopefully the evaluator explains why some of these steps are needed. As a bonus, this part can often be quite educational, where the provider may teach you something new about how the body works and what the medical words for various body parts and functions are.
But the importance of your participation in these examination maneuvers while providing serious and honest feedback to the telemedicine provider cannot be overstated. The quality of the physical exam can have a significant effect on the precision of your diagnosis and the outcome of your treatment plan.
Being part of a telemedicine exam is usually pretty straight-forward. However, sometimes you need more than two hands. This is particularly true if you are using your phone or tablet for the visit. If you are holding the device with one hand, that only leaves the other to perform parts of the physical exam that you are being directed to do. And while doing that you are trying to follow along with the camera so that the telemedicine provider can see what is going on. Things can get a bit tricky sometimes.
On occasion, it might be useful to have a trusted assistant be part of the conversation and exam. A good example of this is an exam of the stomach. It can be very difficult to push on your own stomach(which often takes two hands to do) while holding the camera towards your own stomach so that the evaluator can guide you through the exam and monitor your responses to it.
Having a second person to either hold the camera or to be the examiners assistant can make the process easier. A second person also can come in handy for things like holding a flashlight to highlight key areas or going to get things like thermometers or other devices that would be helpful as part of the evaluation.
SUMMARY: Telemedicine encounters are generally very straightforward and not much different than getting seen in person. Most patients really enjoy the experience. Published patient satisfaction surveys are generally in the 95% range compared to much lower satisfaction rates with Emergency Room visits. Take a minute to prepare using the 12 recommendations above and you should be impressed with how well things go and the number of medical issues that can be well-evaluated through a video visit.