Make the Most of Your Virtual Rheum Visit
Going to the doctor looks pretty different since the COVID-19 pandemic initiated a massive shift in the way doctors interact with their patients. Virtually overnight, quarantine restrictions led millions of people to seek out their medical care online. (Case in point: During one week in March 2020, telehealth visits increased by 154% compared to the year before.) Now that the United States is getting back to some semblance of normal, what will telehealth look like moving forward? How can people with RA find the right mix of virtual and in-person care?
Telehealth Is Here to Stay
One thing is certain: Telehealth will remain part of our lives for the foreseeable future. “Everybody saw the convenience of it, and I think people won’t forget,” says Ariel Teitel, M.D., rheumatologist, clinical associate professor of medicine at NYU Langone Medical Center in New York City and expert panelist for the Arthritis Foundation. Prior to the pandemic, Dr. Teitel had not used telehealth in his practice, but now he estimates it makes up one-third of his total patient visits. (During the peak of COVID, he saw more than half of his patients this way.)
Some Visits Can Easily Be Done Virtually...
Many people got used to 100% virtual care during 2020, but moving forward, it might be more of a mix. “Routine follow-up visits for patients with stable disease are very easy to do over telemedicine,” says William Harvey, M.D., clinical director of rheumatology and chief medical information officer at Tufts Medical Center in Boston. If your RA is in remission or nothing has changed since you last saw your rheumatologist, it is perfectly fine to schedule your check-in visit over video call.
…While More Complex Issues Require In-Person Care
If your RA is acting up, your physician may suggest you come in to see them. “If somebody is having a flare-up of their illness that requires us to assess various aspects of the body in addition to the joints, those visits are very difficult to do over telemedicine,” Dr. Harvey explains. “Likewise … new problems are very difficult to [evaluate] over telemedicine because there can be some subtle physical examination components that video makes impossible to do.” There is no substitute for in-person care when your M.D. needs a closer look.
Telehealth Is Still Better Than Nothing
Seeing your doctor over video is better than not seeing them at all. “Data is showing that Americans have neglected their general care due to fear of going into the [doctor’s] office,” Dr. Teitel says, “so I would say that a virtual visit is better than nothing.” Early in the pandemic, routine doctors’ visits were down by 60%, and doctors are still working to get those numbers back up. Plus, people with RA are still considered high-risk for COVID-19. But even if you’re scared to go in, it’s worth scheduling a virtual check-in.
Your Doctor Will Help Decide What’s Right for You
You don’t have to make these decisions on your own. Dr. Teitel and Dr. Harvey both use a shared decision-making process with their patients to decide when telehealth is appropriate. “We certainly give our patients advice,” Dr. Harvey says. “We’re open, so all patients can be seen in person. But it’s a shared decision based on the nature of the patient’s problem, their illness stage, and other factors like how far away the patient lives and how risky it is for them to leave their house.”
Health Insurance Coverage Rules May Change
One great thing about 2020 (and let’s be honest, there weren’t many great things about it) is that insurance companies started covering telehealth more broadly. It’s unclear how long this will continue—major insurers like UnitedHealthcare are set to roll back their telehealth coverage starting this summer. “The issue of insurance coverage is a moving target,” Dr. Teitel says. “The patient may wish to have [access to telehealth], but if their insurance doesn’t reimburse for it, it’s going to be more difficult.” Call your insurer to ask for details and advocate for continued coverage.
Strong Technology Is Crucial for Virtual Care
The best way to prepare for a telehealth visit is to make sure your technology is charged up and connected to Wi-Fi. “Having a high-quality Internet connection is important, because ironically these visits can take longer than in-person visits if the call is interrupted repeatedly due to a bad connection,” Dr. Harvey notes. If at all possible, use a video screen in a well-lit space so your doctor can see your face and other parts of your body. “Having video as a component greatly improves the quality of care for telemedicine,” he says.
Show Up Early—Even to a Telehealth Visit
When you don’t have a commute, it’s easy to get lax about showing up for your appointment on time. But think of this as a way to guarantee you’ll get there early—no traffic or pesky public transit delays! “The doctor still has all the same time pressures that they have with patients being seen in person,” Dr. Harvey explains. They are still scheduling back-to-back visits, and having a patient show up late will only put them behind. Not to mention, it may cut your visit short, which isn’t ideal for you.
Be Ready to Share Changes in Your Condition
Just like any other doctor’s visit, come prepared to tell your doctor how you’ve been feeling. “It’s very helpful for us to be on the same page in terms of their recent history,” Dr. Teitel says. “I would want to know, for example, did they get vaccinated for COVID? If so, when? Have they had any new illnesses since their last visit? Have they changed their medicines? Have they had recent tests ordered by another provider?” Your rheumatologist will also want to know of any changes in your symptoms or daily functioning.
You Can Include Family or Caretakers on the Call
One perk of telehealth is the ability to include your loved ones in the visit. “Telemedicine may allow other people who might not ordinarily be part of a visit to participate,” Dr. Harvey asserts. “For example, for older patients, it’s often easier to bring in family members or other caregivers in the home into the conversation, whereas getting all those people to drive to a doctor’s visit may be a little harder.” Make sure your family member is ready to hop on the call with you at the right time.
Maintain a Personal Connection With Your M.D.
Virtual visits don’t have to feel less personal than in-clinic care. “Rheumatologists really value shared decision-making where the patient is part of the story,” Dr. Harvey says. He asks his patients what activities they’d like to do that RA is making more difficult. “It’s very important for the doctor to understand the patient’s goals and what specifically they are struggling with,” he says. “That’s far more important than any lab test or physical exam finding.” Honest, authentic interactions are key to a successful relationship with your doc, online or in person.
Telehealth Use in 2020: Centers for Disease Control and Prevention. (2020.) “Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic—United States, January–March 2020.” https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm
Drop in Doctor’s Visits: JAMA. (2020.) “COVID-19’s Crushing Effects on Medical Practices, Some of Which Might Not Survive.” https://jamanetwork.com/journals/jama/fullarticle/2767633
UnitedHealthcare Telehealth Coverage: UnitedHealthcare. (2021.) “Telehealth options.” https://www.uhc.com/health-and-wellness/health-topics/covid-19/telehealth-options