Telehealth isn’t new, but what a banner year it’s had, thanks in large part to the pandemic. Virtual visits with health care providers have gone way up, across the board, for every health matter.
Telehealth makes perfect sense for many health situations, even when there isn’t a risk of COVID. There’s that quick follow-up visit after a procedure. Or monitoring a chronic condition. A medication counsel. With telehealth, a patient with diabetes or high blood pressure patient might not have to get on the bus, which could be hard to do, or pay for travel costs, which might also hard to do. They’d be less likely to miss an important appointment.
We’ve seen a particular rise in mental health telehealth. Pandemic in-person shutdowns have something to do with that. So does attempting to live in this complex and challenging world heighten the demand for mental health services. People who might have been reluctant to see a therapist in-person, or even unable to find a therapist to see, can get help via telehealth.
Telehealth can overcome geographic limitations. One of my favorite innovative organizations is Ayana, which matches marginalized and minority people with licensed therapists who share their unique traits, values, and sensibilities. Imagine the experience of a Black transgender student living in a largely white, rural, and conservative community. Where does that person find therapy if they want it? Telehealth might feel like a lifeline thrown your way in a turbulent sea.
Telehealth is working for therapists too. I know several who will not be returning to in-person sessions. They’re not trying to take an easier way out—they’re discovering they can deliver effective care for their clients virtually.
Despite its benefits, telehealth must overcome many challenges to broaden its value. Patients and providers both need bandwidth, technology, and devices that can handle video streaming, “let me see that closer,” and “open wide and say ahh.” (Maybe there’s an infrastructure plan that can help with that?)
Some patients will be reluctant to trust telehealth. Some providers who are accustomed to in-person visits may need retraining for telehealth. When an in-depth physical exam is impossible, diagnostic and treatment techniques are bound to change. Insurance companies are an essential part of the equation: they must find ways to package and cover telehealth services, partner with telehealth providers, and educate their members.
One challenge of telehealth is the capability of matching patient needs to appropriate services. Monitoring chronic conditions and performing follow-ups is a natural match for telehealth, but acute care is a different story. Providers must be trained in triage and patients must be able to verbally and accurately express symptoms. When a patient says, “I have this pain in my side,” and can’t come up with additional language to delve further into symptoms, a provider must be able to navigate that situation. Assessment and diagnosis can suffer. There’s no opportunity to feel the patient’s spleen.
I’m very close to a certain college student who was feeling poorly and described his symptoms as a sore throat, headache, and runny nose to the telehealth provider offered by his university’s student health services.
The diagnosis was a sinus infection, the prescription an antibiotic, but the treatment resulted in a bad rash and the patient feeling worse, which led to an in-person visit and subsequently a different diagnosis: mono. Why did the initial telehealth appointment fall short? That needs to be studied. Maybe something could have gone better in the triage and examination process, but now a certain someone I know isn’t a fan of telehealth.
Just like with in-person healthcare, there will be missteps and mistakes—but also a huge majority of successes.
I have yet to use a telehealth app or service. Fortunately, the need has not surfaced. But as long as I’m not bleeding to death, I’d be happy to give it a trial run as my first point of contact on a health matter. I’d be happy not to haul myself to an in-person appointment.
