As a busy real estate agent, Antonia Williams-Gary, 71, spends much of her day on Zoom calls, so it was no big deal when she needed to see her doctor last spring and was offered an appointment via FaceTime.
“The call was scheduled at 10:15 a.m., and it came in at 10:17,” she says. “No waiting!” Pleased with the convenience, she scheduled her next three visits virtually.
Like Williams-Gary, millions of older adults in the U.S. tried telemedicine for the first time in 2020. With concerns about COVID-19, physicians shifted to providing care via Zoom, FaceTime or other video platforms and even via telephone. Medicare and Medicaid changed policies to allow reimbursement of telemedicine visits, which previously were not covered. As a result, overall use of telemedicine jumped 300 percent during the pandemic, according to a healthinsurance.com survey of Americans 64 and up. Initial studies suggest that seniors are embracing telemedicine.
But telemedicine isn’t for everybody — and it’s not right for every doctor appointment. When offered a virtual visit with her neurologist earlier this year about a bout with neuropathy, Freda Ballas, 81, of Dallas just said no.
“I had no confidence the doctor could do anything without examining me in person,” she says. “And I’m not comfortable with the technology.”
Not for everyone
Some physicians worry that telemedicine is oversold. If Medicare continues to reimburse virtual visits after the pandemic is over, some fear telemedicine will be pushed on patients who really need to be seen in person.
“There are significant limitations, even dangers, to exclusively getting your care virtually,” says Tom Davis, a medical doctor and author of Telemedicine Confidential: Keeping Your Family Safe. “It’s going to be a very long time before the technology can entirely replace the face-to-face visit. I think it’s very important that patients do not allow themselves to be steamrolled.”
As an example, he said, alcohol abuse is not unusual among older patients. A patient who is slurring his words could be suffering from a stroke — or just inebriated. In the doctor’s office, a quick whiff of the patient’s breath will offer important clues. Over a video screen, it’s a harder call to make.
On other hand, Davis says, telemedicine clearly offers advantages for older patients. Many have complex medical conditions and benefit from frequent check-ins from their doctors. Virtual visits can reduce the number of trips to the doctor’s office, a big plus for those who don’t drive or who have limited mobility.
“Traveling to a clinic or doctor’s office can be an exhausting task for older adults,” says Dr. Jessica Voit, a specialist in geriatrics and an assistant professor in the department of internal medicine at UT Southwestern Medical Center. “Sometimes a patient may need a family member to take off work to bring them to the clinic.”
Telemedicine appointments worked well for Eulaine Hall, 87, of Dallas. Her vision is impaired, so she doesn’t drive anymore. Going to the doctor means getting a cab or reserving a DART paratransit ride. When her primary care physician offered her a telemedicine appointment, she was thrilled.
“Avoiding the trip was major,” she says.
Voit adds that she’s enjoyed seeing patients in their homes, even meeting their pets, while interacting with them on virtual visits during the pandemic. “I get insight into their day-to-day lives that I might not get otherwise,” she says. “If a patient is having trouble standing up from the sofa in his living room, I see that.”
In general, some kinds of doctor’s visits lend themselves to virtual meetings: a quick follow-up to see how you’re doing with a new medication, adjusting to a medication or getting test results might be easily handled by phone or video chat.
Most doctors interviewed for this story agreed that annual checkups should be done in person. Some checkups went virtual during the first few months of the pandemic out of necessity. In general, “it’s absolutely critical to physically see someone at least once year,” says Dr. Joshua Septimus, a primary care and internal medicine physician at Houston Methodist Hospital. “Physically examining someone’s lymph nodes, throat, chest — that’s something you can’t replicate with technology.”
Bottom line: If you need to be examined, if you’re not tech-savvy, if you’re seeing a doctor for the first time or if you’re just uncomfortable with the online format, insist on an in-person appointment.
“If you think you need to see the doctor in person, don’t worry about what anyone thinks,” Davis says. “Trust your instincts.”
Get ready for your checkup
If you do opt for a visit via telemedicine, you’ll need to take steps to make the most of the appointment. Here are some tips:
Be prepared. Have a list of your current medications available and handy for the call. Keep a pen and paper ready to take notes. Make a list of any concerns or changes you’ve noticed in your condition, including any difficulties you have with daily activities, like eating and walking without fear of falling. “Write down your questions,” advises Williams-Gary. “Have a list and make sure you cover that list. Don’t be afraid to take charge.”
Include a friend or family member. Having someone serve as a second set of eyes and ears is always a good idea, especially if you expect the doctor to deliver a diagnosis or information that is complex. A family member can help move the camera, too, if the doctor needs to see a hard-to-reach spot.
Test your system. Log onto the platform a few minutes before your appointment to ensure your audio and video are working on your device. If you’re using Zoom, for example, the platform will guide you to test your microphone and camera before entering the meeting. Make sure your camera is at eye level. Have a backup plan, such as a phone number to call, in the event your Wi-Fi connection goes down.
Be camera-ready. Know how to use the camera on your device or have someone available to assist. When Donna Bening, 81, of Plano saw her rheumatologist last spring, she used her computer’s camera to show the doctor the areas on her hands and wrists where she was having a flare-up. “Having the camera access was facilitating her decision about whether to prescribe steroids or another medication,” says Bening, a retired nurse. “She was looking to see how much swelling I had and whether there was a change in the color of my skin.”
Check yourself. Before her telemedicine appointments, Bening checks her weight, heart rate and temperature. If you have the equipment, you can also check your blood pressure and oxygen levels. Write the information down and have it handy. Alert the doctor to any changes or unexpected results.
Set up a telemedicine “studio.” Choose a quiet, well-lit location for your telemedicine visits. Turn off the television and eliminate as many distractions as you can. If you wear hearing aids or glasses, remember to put them on. If you have a dog that tends to bark, move the pooch to another part of the house.
Make the most of the online format. Telemedicine offers some unique advantages. If a family member in another city is helping you navigate medical issues, ask in advance if you can loop your loved one into the call during your virtual visit. If you’re dealing with a complex medical condition that involves several physicians — as many older patients do — ask if you can get your doctors on the same virtual visit at once to confer.
Repeat what you’ve heard. “Ask questions and repeat any instructions your health care provider gave you during your visit,” says Carmel Dyer, geriatrician with UT Physicians/McGovern Medical School at UTHealth in Houston. “By doing this, you ensure you heard everything correctly.”
Know what’s next. As with any appointment with a medical provider, don’t leave until you’re clear on what’s next. If you’ve just had a regular checkup, find out when you’ll need your next one. If you’re having a test, know when you’ll get the results and how. Should you call the doctor’s office, or will someone call you? Depending on the test results, will you need further tests or another visit?
Say no if you feel you need to be seen in person. Before the pandemic, all visits were conducted in person at Voit’s clinic. Once COVID-19 hit, most appointments were moved to videoconferences or by telephone. Now the clinic offers a hybrid — some appointments take place in person and some via telemedicine. The trick is knowing when a virtual visit will work well and when you need to be seen. At Voit’s clinic, nurses go over appointments to determine which need to be handled in person.