As health care systems across the country focus on fighting the coronavirus pandemic, many have halted nonessential and non-emergency services. But plenty of people still need medical care for other reasons. What should you do if you need a doctor right now?
For some, the answer lies in telemedicine. CNN Chief Medical Correspondent Dr. Sanjay Gupta speaks to Dr. Gregory Esper, who leads Emory University’s telehealth initiatives, about how technology is changing the way health care is delivered.
You can listen on your favorite podcast app or read the transcript below.
Dia Sue-Wah-Sing: I felt like I had symptoms about two weeks prior, and I was just concerned about having to have an emergency trip to the hospital during the pandemic. But because I knew the appointment hadn’t yet been fully flat-out canceled yet, then I was like, OK, I’m just going to ride this out.
Dr. Sanjay Gupta: Two weeks before Dia Sue-Wah-Sing had a previously scheduled doctor’s appointment in April, she started experiencing some pain in her side.
But with concerns of Covid-19 cases overrunning hospitals, Dia was faced with a question many of us are asking right now: Should I still go in to see my doctor?
Today, we’ll talk about when to seek care not related to Covid-19, and how doctors and hospitals are reaching their patients from a distance.
I’m Dr. Sanjay Gupta, CNN’s chief medical correspondent. And this is “Coronavirus: Fact vs. Fiction.”
Sue-Wah-Sing: It’s like, running and being dehydrated and having like a significant cramp on your side.
Gupta: At the beginning of April, in the middle of this pandemic, Dia Sue-Wah-Sing began having some pain. At first, she didn’t know what it was.
Sue-Wah-Sing: Oh, maybe I just like slept funny, or you know, sometimes you’re like, maybe I’m just sitting in a weird spot because we’re all doing a lot of Zoom and trying to get cozy for those. But I’d had it for a while, and I had it for a few days.
Gupta: Then, Dia began to recognize the symptoms. She has a history of kidney stones and realized that that would explain the pain.
Fortunately, Dia was scheduled for a routine ultrasound on April 15. Because she was nervous about Covid-19, Dia initially wasn’t sure if she should go in for her appointment. So she called the hospital and spoke to a nurse about what they were doing to keep patients safe.
Sue-Wah-Sing: She talked about general precautions that the hospital had in place. So there are checkpoints, they have less entrances open. You know, there is kind of that basic medical screening. So, you know, have you traveled? Do you have a fever? Do you have a new cough?
Gupta: After speaking with the nurse, Dia decided to go in for her appointment. So, on April 15, she drove to the hospital and had an ultrasound of her kidney.
Sue-Wah-Sing: And it was like kind of being at the airport. There were two booth setups that were legitimately like health-screening checkpoints.
So it’s like there’s hand-sanitizing stations, sanitize your hands, come to the booth, say who you are, check in. And in the waiting room, they had it cornered off. And they had 2 meters or 6 feet apart for the waiting room chairs. So you could only sit in selected chairs.
Gupta: Dia was in and out of the hospital in less than an hour. Later that day, she got a call from her doctor to discuss the results.
Sue-Wah-Sing: We went through my symptoms, my imaging. And the next steps. So I thought it was kind of nice because I think sometimes your physicians don’t always look at your stuff until you’re like, hold on. Who are you again?
But I think they have the time to take a breath right now, that they actually are coming to the table prepared in the telemedicine appointments. So it’s like, huh, this is the most efficient it’s been. I should do this all the time. Instead of, you know, being there for two-thirds of the day.
Gupta: Because of the coronavirus pandemic, Dia’s experience has become a common one. Hospitals have quickly taken their services online, doctors are seeing their patients on video or over the phone, and medical records are being shared more often electronically. It’s a process that minimizes exposure to the virus and could also save people some travel and wait time.
These practices are a part of what’s known as telemedicine. The number of medicare beneficiaries who received telemedicine visits rose from 10,000 a week to 300,000 a week in the last week of March, according to the Wall Street Journal.
To learn more about it, I spoke to my colleague Dr. Gregory Esper, a neurologist and also director of telemedicine at Emory University.
Gupta: Whenever I’m looking at new technology as a doctor, but also as a journalist in the back of my mind, I’m asking myself, is this technology just a substitute for what already exists or is it adding value in a way that this technology can do differently in some way?
How about with telemedicine? Is it just a substitute for an in-person visit? Or can it do things that you otherwise wouldn’t be able to do?
Dr. Gregory Esper, professor and vice chairman of Emory University’s department of neurology: One of my favorite examples is there was a Parkinson’s patient who was falling at home, and the Parkinson’s physician looked at their environment and noticed that there were multiple trip hazards in place on the floor and directed the patients to take care of all of those trip hazards by moving the shoes or moving this or moving that to clear walkways.
So that is something we haven’t seen before, which is an advantage to telehealth. But here’s another one. Let’s say that the patient desires more frequent contact with their provider, but they live 200 miles away. Telemedicine becomes the venue by which that contact happens.
Gupta: So as a neurologist, if you’re doing a telehealth visit the right way. What does that entail? What does that visit look like?
Esper: Well, it starts far before I see the patient. It starts when our staff is contacting the patients and asking them if they would be comfortable to do a telemedicine visit. Then we schedule the appointment, and we’ll have the medical assistants prep those patients. And then the patient will be ready for the physician.
And then we open the video and then we, we actually begin the conversation with a consent. We actually will ask the patient, is it OK for us to continue with this telemedicine visit? And the patient will generally say, yes.
And then we proceed. We do the history. Tell me about your headache? What side is it on? Patient might point to the side. Is your vision affected? Do you have nausea? And we then proceed to a physical examination.
There are so many things that we can do on video that will help us confirm our hypothesis for what’s happening in the history.
Gupta: When the patient is seeing you or the health care provider on a screen, what are you seeing in addition to the patient? Are you able to look at previous laboratory values that the patient may have had drawn through their blood or previous scan results?
Esper: Everything that is accessible in an in-person visit is accessible in a telemedicine visit. And we have actually implemented systemwide capabilities for image capture where we are asking the patients to upload their MRIs, or their prior scans, or we can obtain those from partner organizations that have electronic connections with us.
Gupta: It’s been really interesting, Dr. Esper, with my kids at home and doing Zoom school. You know, one of the things that comes up sometimes with three kids is just the speed of the connection and then downloading things at the same time.
How much of a factor is that just in terms of the quality of the online services?
Esper: Well, I think it ranges from people who actually don’t have internet service in their area, for which we do telephonic visits, to those who have spotty coverage, in which the video is a little bit choppy.
And part of getting comfortable with the technology is learning how to mitigate those factors during the examination.
Gupta: Because of the novel coronavirus, the government has temporarily allowed Medicare and some other health insurers to cover these sorts of procedures. We’re going to see how that carries out going forward. But how is the coverage?
Esper: Medicare has really stepped up and has made it easy and not a barrier, I would say, for patients to get care because the reimbursement is at parity compared to what it was before.
Gupta: I remember hearing at the White House when they said there is going to be a significant investment in telehealth necessary, because of the contagiousness of this virus.
How much has telehealth changed? Just even over the last few months now?
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Esper: Well, I can give you some statistics from Emory. We basically were doing zero outpatient telemedicine at the beginning of March.
Since that time, we have trained and certified almost 2,200 physicians, residents, fellows to do telemedicine and do it in the right way. And we have seen almost 50,000 patients since the beginning of March through audio video telemedicine.
Gupta: So from basically zero, as far as patient care, to 50,000. Is this now here to stay? Or will it go back, do you think, once the Covid pandemic is addressed?
Esper: Well, I can tell you that my hope is that it is here to stay because I think it is a critical care model for us to be able to continue, especially for those patients who have difficulty making it to appointments, that potentially need more frequent follow-up; for patients where you need to see them in their own environment, which is their home.
And we hope there is no going back. It’s not the solution for everything, but it certainly is an arrow in our quiver for how to take care of patients effectively.
Gupta: Telemedicine is being used for so many health services right now. So, for those of you who are wondering whether you can or should get your mammogram, see your dentist, take your child to the pediatrician, see someone for your mental health. … Here’s what CNN found:
For preventative check-ups, like mammograms or colonoscopies, until things change, you might have to wait until your hospital reopens before doing it. But do check with your doctor for details.
For parents, if it’s urgent, try to take your child to the ER at a chidren’s hospital, if possible. If it’s not urgent, talk to your primary care doctor and get their advice.
As for dentists, they’re unfortunately at very high risk of catching the virus because it spreads through droplets of saliva in the air. That’s why most dentist offices have canceled everything but emergency procedures. But no matter the situation, still call your dentist, and they’ll walk you through it.
If you’re hearing a pattern here, you’re right. The bottom line is, if you’re feeling unwell, still call your doctor. They may even have more time nowadays to take your call. They can help you figure it out and make the safest possible plan for your care.
But if it’s an emergency, especially if you’re experiencing chest pain, or shortness of breath, or stroke symptoms, don’t hesitate then. Just call 911 and get to the nearest emergency room.
We’ll be back tomorrow. Thanks for listening.
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