When Jessica Johnston’s 17-month-old spiked a fever, she wanted to check in with her pediatrician.
Johnston was figuring on a simple phone call back, and instead, the office set up a telemedicine appointment, having her talk through her daughter’s symptoms through a video chat while sitting in her home.
“It was nice to have a face-to-face instead of just talking over the phone,” Johnston says. “But she was moving all over the place, and that was hard for them to see in her mouth or in her ears.”
Johnston says her doctor had her shine a light into little Charlet’s ears and mouth and hold them up to the camera. It wasn’t enough to see into the ear, but it was enough for the doctor to write a prescription to be filled if the toddler developed other symptoms.
Hesitant to enter a hospital during the COVID-19 pandemic, Johnston was glad her daughter could be “seen” over the computer, but she is eager to return to in-office visits.
“It’s so awesome to have the option and there are so many things that it will work really well for, but there was a lot my daughter didn’t understand,” she says. “He asked her to open her mouth, so I had to get a toothbrush out and have her point toward the camera. That was hard. … There are so many great reasons to use it, but sometimes it’s not great for everything.”
The surge in telemedicine allows doctors to “see” patients outside of the office, can fit well into a busy schedule and gives patients the calm of their own home. The option avoids time spent driving to the office, finding a parking place and sitting in a waiting room, and shortens visits for health concerns that don’t need in-person care.
“It is minimizing the parent’s time of being away from jobs because telehealth tends to be quicker,” says Dr. Aimee Luat, a pediatric neurologist at Children’s Hospital of Michigan. “With an in-person visit, sometimes it takes time to check in, be in the waiting room, wait for your turn, but with telemedicine, at least in my experience, the patients are always on time and I try to be on time, so the waiting time is minimal.”
How it works
Telehealth has been around a lot longer than most of us know. The COVID-19 pandemic has brought the revolution to the forefront as doctors, patients and insurance companies are trying to keep non-coronavirus patients out of the hospitals while still giving the care that parents and patients expect.
Doctors use secure, HIPPA-approved video conferencing to check out a patient remotely. So parents with sick kids can stay at home while they “see” their family physician through the computer.
Front-line nurses and medical staff can usually best recommend telehealth if parents describe their child’s symptoms.
“If a new patient is sent to us, maybe this is something that we can deal with it over the phone,” says Dr. Leemor B. Rotbert with Children’s Eye Care of Michigan. “Maybe it’s a child with a blocked tear duct or pink eye, or an evaluation of a droopy eyelid, and there are certain things that you can screen them with. But then we can tell a parent, maybe you know what, this child needs to be seen or it can wait a few months and we’ll see you when (the COVID-19 Pandemic) is over.”
Doctors are heavily encouraged to keep doctor attire, says Dr. Adrian J. Rawlinson, vice president of medical affairs with Upswing Health, an orthopedic telemedicine service. While a teenager with an ankle injury might be comfortable being seen while wearing sweatpants and a T-shirt, he might not be as comfortable if his doctor is, too.
“Patients need to be reassured by the healthcare professional at the other end of that video,” Rawlinson says. “We work on instilling what I describe as ‘excellent Webside manner.’ That’s a skill that requires good eye contact, making sure on a telemedicine call that you’re engaging with the patient. Someone who is glancing away and taking notes is unnerving with patients.”
Through telehealth, prescriptions can be sent electronically to a pharmacy for pickup or delivery (depending on the pharmacy).
What can be diagnosed
Did your kid wake up with a fever and vomiting and you’re not sure if this is food poisoning, the flu or something else? Let your child’s doctor know.
Even something like hand-foot-and-mouth that is new to first-time parents can be diagnosed without bringing a toddler into an office.
Parents are encouraged to take pictures in good light and upload them to the doc’s preferred platform. Some doctors use a private Zoom room or others use private, telehealth-inspired programs.
“Patients that are established and just need a follow-up with no new concerns, or a new routine checkup, these are great for telehealth,” Luat says. “Other applications are for patients who live in remote areas or patients with physical disabilities who, sometimes it’s hard for them to travel in and out.”
For older kids, sports-related injuries are oftentimes perfect for telehealth visits, Rawlinson says.
Just like certified athletic trainers who treat patients on the sidelines of a football game, doctors can see changes in how a patient walks or looks to help create a plan for muscle pain.
“A lot of triage can be done online when nobody wants to go to the ER right now for anything that’s not coronavirus related,” he says.
You might still need to go in
Some common illnesses will still need an in-person checkup.
Ear infections, for instance, will need a look inside a baby’s ear to determine the severity and best course of treatment. Broken bones are also a necessity to see a doc in the ER to have it properly set and have an X-ray taken.
Johnston says she is also pregnant, and her ultrasound appointments are still in-person visits while her next OB appointment will be done through telemedicine.
Other doctors, like dentists and ophthalmologists, might not have a long-term use for telemedicine because of the microscopic nature of looking at eyes and cleaning teeth.
“For half of our patients, if not more, we use dilating drops and we’re using microscopic equipment that you can’t see remotely,” Rotberg says. “There are some things we can use it for, and we can have parents check the vision at home, however you have to take that with a grain of salt. … Having parents take vision at home is an OK alternative for now, but if there are some things that it seems like are getting better or things we really should be concerned about, we’re going to want to see them in person.”
The follow-up appointments to some initial in-person visits, however, are perfect for telemedicine.
Will it last?
Rawlinson was in the works to create Upswing Health before the pandemic and sees a bright future for telemedicine in some fields.
Not having to staff a brick-and-mortar office and seeing patients at their convenience is just a start. Keeping costs low will help both patients and insurance companies.
“If you look at traditional care, if I go to an orthopedic office and I have an X-ray of an ankle, my insurance is billed $200-$300 just for the visit, because you have to pay an office staff and building maintenance,” Rawlinson says. “To set up telemedicine, some companies are offering it at $0 cost to the employee and in some cases the appointment will cost much less because you’re not coming in and spending your time in a waiting room.”
Still, Rotberg is eager to return to her routine at Children’s Eye Care.
“What we do is so different because it’s on such a microscopic level and the age of the children that we’re dealing with,” Rotberg says. “There are certain things you can’t do for glaucoma or problems with the retina or see any tumors, those are certain things that telemedicine isn’t really an option for. There are some things, at least if you let us know we can tell you ‘this is an emergency or with this child it’s OK to wait,’ and at least this helps us a little bit figuring out who is urgent who is not urgent and who we can safely see later in the summer or in the fall.”
Luat said a 2018 study in Neurology, a peer-reviewed journal, that surveyed parents of telemedicine patients within the University of California San Francisco Pediatric Headache Program found that through time, distance and insurance costs, each saved on average $486 per appointment through telemedicine visits.
“Our response from patients has been very positive,” Luat says. “Many times a child and patient has been really engaging with me. Children like the computer and they like seeing their doctor in the computer. I think it would be beneficial to do a study about satisfaction comparing in-person to telemedicine visits and the clinical outcome.”
How to prepare your child for a teleheath appointment
- Fill out the forms in advance. Just like in a waiting room, there will still be forms to fill out. Most will need to be done before your appointment can start.
- Find a well-lit room. Doctors need to be able to see your child on the screen. Make sure you’re not sitting with a window behind you that will wash you out or in a dark basement.
- Check your technology. Is your computer’s microphone working, is your internet connection
- strong where you’re sitting and is the volume turned up on your computer? You can use the video and microphone functions on your phone, too, if you’re in an area that has better cell reception.
- Know your child’s current temperature and symptoms. You’ll be counted on for a good medical history, so write down your child’s current health stats: when it started, fever, how much vomiting, stomach pain, etc.
- Make your child comfortable. Little kids LOVE to see themselves on the screen of a video conference call. Let them know what’s going to happen or even practice in advance with a parent in another room.