When the coronavirus started to hit Central Texas, doctors’ offices had to figure out how to continue seeing patients as safely as possible.
Offices added telemedicine — virtual appointments through platforms like Zoom or Google Hangouts — for the first time or offered the option to many more patients.
Dr. Jason Reichenberg, president of Ascension Medical Group Texas, says their clinics quickly went from 100 telemedicine visits a day to 1,600 a day in two weeks.
Many of the changes arrived on March 17 when Gov. Greg Abbott’s emergency declaration waived certain regulations and required state-regulated insurance plans pay the same amount for telehealth visits as in-person visits during this time.
Now that Texas is slowly reopening, what can we expect going forward?
Patients will see telemedicine visits continue to be an aspect of care. What percentage of care will depend on virus levels in our community.
Dr. Katherine Labiner of Child Neurology of Consultants of Austin sees telemedicine as a great way to connect with patients going forward, especially for appointments made just to monitor medication, as well as for patients who live far away or are difficult to transport.
It also could be helpful during cold and flu season for patients who have conditions that make them immune-compromised. For recent surgery patients who need a post-operation visit, a virtual appointment avoids exposing them to infection or physically draining them during recovery.
The key will be for insurance companies to continue to pay the same rate as in-person visits.
Telehealth is not for everyone; it "is not a panacea," says Dr. Harish Gagneja of Austin Gastroenterology. There are issues with technology and who has access to devices and internet capacity.
Doctors want to make sure the appointment goes beyond just a phone call. "I have to see body language and make eye contact," says Dr. Devin Garza, a gynecological surgeon at Texas Robotic Surgery for Women at St. David's North Austin Medical Center.
Of course, telehealth won't work for all visits — you can't do a physical exam, an injection or blood work through a webcam.
Not all doctors’ offices are expected to go back to a full schedule any time soon. Some plan to extend hours or have weekend visits to get patients in without having too many people in the office at once.
"As we start to open up a little bit, our goal is to stay at 60 percent capacity and not go over that," says Dr. Kathryn Hudson of Texas Oncology.
If you have an in-person visit, you still will be prescreened and have to wear a face covering.
As necessary as masks are right now, doctors don’t like them either.
When delivering serious information, a mask can "take away from the personal nature of what we do," says Dr. Katherine Labiner of Child Neurology of Consultants of Austin. "They are missing something if they can’t see my own face."
Doctors also have changed their physical interactions with patients.
"I can no longer hug my patient when I am giving them bad news," Hudson says. "I can't put my hand on their shoulder or on their knee like I used to. It’s harder to have that closeness I am used to having."
If you have an appointment, call ahead to confirm whether it’s in-person or telehealth. If you’re not comfortable coming into the office, request a telehealth appointment or a hybrid that is part telehealth, part in-person to limit the amount of time you are in the office.
But don’t skip care. Many offices are reaching out to patients who delayed visits or didn’t show up for scheduled appointments.
Specialists say they saw about 40 to 45 percent fewer people come into emergency rooms for strokes and heart attacks in April, and now they’re concerned that people delayed getting treatment and will have long-term damage.
At Dell Children’s Medical Center of Central Texas, staff are worried that kids are skipping well-checks, including important vaccinations.
"You don't want to put it off," says Dr. Eric Higginbotham, chief of pediatric emergency medicine at Dell Children’s.
Some offices are having kids come in just for vaccinations, with the rest of the visit by telemedicine.
For Hudson, every patient is considered individually to decide whether a visit can be delayed or needs to be in person.
"I am spending more mental energy and deep thought about which patients will need to come in," she says.