For a lot of us, the way we perform our work looks much different than it did a year and a half ago. The concept of working from home was frequently discussed but infrequently put into practice. Delivery of groceries and online shopping has taken on a whole new meaning.
Covid has brought a lot of changes to the practice of medicine as well. We got a crash course in providing medicine in a different way. South Lake has talked about trying to use telehealth for a long time. However, due to insurance restrictions, technology, and, well, change in general, telehealth was not something readily embraced in many primary care offices. In March 2020, that all changed. Everyone had to figure out how to get on board with telemedicine. The government was able to change some regulations with laws and insurance companies to make it possible to provide this service during the pandemic. Now that we have a handle on how to get patients in and out of our office safely as well as some more experience with telemedicine, I thought it would be helpful to talk about when telemedicine is the right choice for your child versus when an office visit is appropriate.
I think the most effective way we have been able to use telehealth is when a family has an exposure to Covid. We have all received that dreaded email from school telling us our child has had an exposure. Probably the last thing you want to do is wait in the office with all the kids to go over the recommendations only to be told that it is too early to test. Telehealth has provided a relatively quick and timely way for us to talk to you about your child’s risks, testing options, and quarantine recommendations. We often schedule a lab only visit after these visits to collect a test. The process is very streamlined and, when the test isn’t recommended to be collected until a couple of days after the televisit, you haven’t had to make an extra trip into the office.
I have found telehealth to be helpful for SOME mental health visits. There are visits that require height and weight measurements, a blood pressure check, and an exam that can’t be done via telehealth. However, when a follow up is needed that doesn’t require a physical exam, telehealth can be a great way to connect. I care for a lot of busy teenagers that have a much easier time making an appointment via telehealth instead of missing an extra hour of activities for travel to see me. I have found there is some better continuity of care and follow up when some of these visits can be done via telehealth.
And now, the pitfalls! Our number one priority is the health of your child and practicing medicine at our office is done to the highest standards. Nothing replaces a physical exam, especially when working with young children who can’t tell you what’s wrong. Sometimes things may seem straight forward such as “my child’s ear hurts.” But an exam will tell us if it’s an inner or outer ear infection, pain from a molar being felt in their ear, or the annoying Barbie shoe that “mysteriously” shows up on a child’s ear exam. (Side note, I could dedicate an entire blog to the things I have found in kids’ ears and noses!) Pink eye is often accompanied by ear infections. Strep needs to be diagnosed with a test. There is no “classic” strep exam. I get very weary when I see a urinary tract infection treated with antibiotics over a virtual visit. Many different bacteria can cause those infections, and some are highly resistant to antibiotics. Without collecting a urine culture BEFORE starting antibiotics, your child may end up in a worse place than they started.
There are also some limitations with the legality of televisits. Our clinicians are licensed in Minnesota. A few states have allowed us to have televisits with kids in other states during the pandemic. However, many have started revoking those privileges making it illegal for us to provide that service. I would love to be able to easily meet with my college age patients around the country if I could, but states are cracking down! These kinds of changes will continue to occur and affect the ability to provide telehealth visits.
I think jumping into the world of telehealth was a good thing. While it isn’t an option for every type of visit, it has helped us provide important services for our patients that we couldn’t before the pandemic. When you call, ask if a telehealth visit is the right kind of visit for your child. And know that when we recommend a visit in person, we are doing it in the best interest of the health of your child.