Marin Independent Journal
Virtual or in person: Which kind of doctor's visit is better
When the COVID-19 pandemic swept the country in early 2020 and emptied doctors' offices nationwide, telemedicine was suddenly thrust into the spotlight. Patients and their physicians turned to virtual visits by video or phone rather than risk meeting face-to-face.
During the early months of the pandemic, telehealth visits for care exploded.
“It was a dramatic shift in one or two weeks that we would expect to happen in a decade,” said Dr. Ateev Mehrotra, a professor at Harvard Medical School whose research focuses on telemedicine and other health care delivery innovations. “It's great that we served patients, but we did not accumulate the norms and [research] papers that we would normally accumulate so that we can know what works and what doesn't work.”
Now, three years after the start of the pandemic, we're still figuring that out. Although telehealth use has moderated, it has found a role in many physician practices, and it is popular with patients.
More than any other field, behavioral health has embraced telehealth. Mental health conditions accounted for just under two-thirds of telehealth claims in November 2022, according to FairHealth, a nonprofit that manages a large database of private and Medicare insurance claims.
Telehealth appeals to a variety of patients because it allows them to simply log on to their computer and avoid the time and expense of driving, parking, and arranging child care that an in-person visit often requires.
But how do you gauge when to opt for a telehealth visit versus seeing your doctor in person? There are no hard-and-fast rules, but here's some guidance about when it may make more sense to choose one or the other.
“As a patient, you're trying to evaluate the physician, to see if you can trust them,” said Dr. Russell Kohl, a family physician and board member of the American Academy of Family Physicians. “It's hard to do that on a telemedicine visit.”
Maybe your insurance has changed and you need a new primary care doctor or OBGYN. Or perhaps you have a chronic condition and your doctor has suggested adding a specialist to the team. A face-to-face visit can help you feel comfortable and confident with their participation.
Sometimes an in-person first visit can help doctors evaluate their patients in nontangible ways, too. After a cancer diagnosis, for example, an oncologist might want to examine the site of a biopsy. But just as important, he might want to assess a patient's emotional state.
“A diagnosis of cancer is an emotional event; it's a life-changing moment, and a doctor wants to respond to that,” said Dr. Arif Kamal, an oncologist and the chief patient officer at the American Cancer Society. “There are
things you can miss unless you're sitting a foot or two away from the person.”
Once it's clearer how the patient is coping and responding to treatment, that's a good time to discuss incorporating telemedicine visits.
This may seem like a nobrainer, but there are nuances. Increasingly, monitoring equipment that people can keep at home — a blood pressure cuff, a digital glucometer or stethoscope, a pulse oximeter to measure blood oxygen, or a Doppler monitor that checks a fetus's
heartbeat — may give doctors the information they need, reducing the number of in-person visits required.
Someone's overall physical health may help tip the scales on whether an in-person exam is needed. A 25-year-old in generally good health is usually a better candidate for telehealth than a 75-year-old with multiple chronic conditions.
But some health complaints typically require an in-person examination, doctors said, such as abdominal pain, severe musculoskeletal pain, or problems related to the eyes and ears.
Abdominal pain could signal trouble with the gallbladder, liver, or appendix, among many other things.
“We wouldn't know how to evaluate it without an exam,” said Dr. Ryan Mire, an internist who is president of the American College of Physicians.
Unless a doctor does a physical exam, too often children with ear infections receive prescriptions for antibiotics, said Mehrotra, pointing to a study he co-authored comparing prescribing differences between telemedicine visits, urgent care, and primary care visits.
In obstetrics, the pandemic accelerated a gradual shift to fewer in-person prenatal visits. Typically, pregnancy involves 14 in-person visits. Some models now recommend eight or fewer, said Dr. Nathaniel DeNicola, chair of telehealth for the American College of Obstetricians and Gynecologists. A study found no significant differences in rates of cesarean deliveries, preterm birth, birth weight, or admissions to the neonatal intensive care unit between women who received up to a dozen prenatal visits in person and those who received a mix of in-person and virtual visits.