Dr. Paul on telemedicine and the changing face of health care

Hundreds of patients are seeing their doctors through video visits because of the pandemic. There will be no going back.

Several years ago, when I was director of Behavioral Health at The Everett Clinic, I started a pilot project to test using “video visits” for our patients. I wanted to see how patients and providers would adapt to this technology.

Using an audio-video platform, like Facetime or Skype, to conduct visits with a mental health professional isn’t new. The Veterans Administration has been using video visits for decades to reach out to veterans in rural areas. But change in health care is often slow.

Or is it?

The coronavirus pandemic has resulted in a rapid explosion of telemedicine that no one could have anticipated. Almost overnight, we went from only a handful of providers using telemedicine to hundreds of providers, and their patients logging onto VSee, a secure video platform, to talk to their doctor.

Necessity is the mother of invention and innovation. It has resulted in an astonishing transformation that will change the face of health care in the years to come. There will be no going back.

Several days a week, I wake up, meditate and do my tai chi practice, and walk up the stairs to my home office where I meet with my patients through VSee. My commuting time is less than a minute — no traffic, no auto emissions, no parking and no gasoline costs.

I often have lunch with my wife, sitting on our deck. At the end of the day, I finish my paperwork, and walk down the stairs. I’m home.

From the provider’s perspective, the reduction in commuting results in more time with family, better work-life balance and less stress. I can see patients anywhere in Washington. It extends my range of access.

For patients, there are even more advantages. Some of my patients had to take two to three hours out of their day to come to my office. They had to miss work and battle traffic to come to see me. If they lived too far away, or had to fight rush hour, they might just throw in the towel.

In our automobile-impacted cities, telemedicine is a game changer.

If I have an opening in my schedule, I can see a patient in Tacoma, Whidbey Island or Olympia who wants to see a therapist. They would never be able to get to my office in Everett. It improves access for patients and productivity for providers.

Are video visits effective? In 2013, a comprehensive review of the literature and research on telemental health concluded that it was as effective as in-office visits. Is it different than an in-office visit? Yes and no.

Therapy and psychiatry rely primarily on communication, both verbal and non-verbal, from our patients. Facial expression and tone of voice is important, and is available in video visits.

But I have to work a little harder in video visits to communicate caring and warmth, which I think is easier to communicate in person. I also have to focus more and listen more carefully in video visits. And sometimes, there is internet disruption that interferes with the video or audio signal.

Video medical visits are flourishing, too. My wife met with her asthma doctor over VSee to discuss her medications. She was able to take her blood pressure at home and measure her oxygen saturation with a home pulse oximeter. With a wider use of technology, doctors will be able to listen to our hearts and lungs from a remote location. For many years, physicians have been able to monitor and calibrate cardiac pacemakers over the phone.

Will there be a place for in-office visits? Of course! But patients will have the choice — in-office or video visit.

At first, as an older adult, I was uncertain about how I would like video visits. But after a few months, I was won over by its ease, improvement in access and contributions to work-life balance. My patients appreciate the convenience.

It’s a win-win for providers and patients alike.

Paul Schoenfeld is a clinical psychologist at The Everett Clinic. His Family Talk blog can be found at www.everettclinic.com/family-talk-blog.

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