How to Prepare for a Telehealth Appointment

When Jessica Johnston’s 17-month-old spiked a fever, she wanted to check in with her pediatrician.

Johnston was figuring on a simple phone call back, and instead, the office set up a telemedicine appointment, having her talk through her daughter’s symptoms through a video chat while sitting in her Downers Grove home.

“It was nice to have a face-to-face instead of just talk over the phone,” Johnston says. “But she was moving all over the place, and that was hard for them to see in her mouth or in her ears.”

Johnston says her doctor had her shine a light into little Charlet’s ears and mouth and hold them up to the camera. It wasn’t enough to see into the ear, but it was enough for the doctor to write a prescription to be filled if the toddler developed other symptoms.

Hesitant to enter a hospital during the COVID-19 pandemic, Johnston was glad her daughter could be “seen” over the computer, but she is eager to return to in-office visits.

The surge in telemedicine allows doctors to “see” patients outside of the office, can fit well into a busy schedule and gives patients the calm of their own home. The option avoids time spent in a waiting room and shortens visits for health concerns that don’t need in-person care.

Dr. Katherine Riff, a physician at Alzein Pediatrics in the Southwest Suburbs, says that telemedicine can give “a presumptive” diagnosis in sick kids.

“There’s plenty of different reasons that people come in (to a doctor’s office),” she says. “Some of those reasons I don’t need to see them in person, and for those, it can be convenient for everyone: the patient, the parents and the doctor.”

How to prepare your child for a telehealth appointment

  • Fill out the forms in advance. Just like in a waiting room, there will still be forms to fill out. Most will need to be done before your appointment can start.
  • Find a well-lit room. Doctors need to be able to see your child on the screen. Make sure you’re not sitting with a window behind you that will wash you out or in a dark basement.
  • Check your technology. Is your computer’s microphone working, is your internet connection strong where you’re sitting and is the volume turned up on your computer? You can use the video and microphone functions on your phone, too, if you’re in an area that has better cell reception.
  • Know your child’s current temperature and symptoms. You’ll be counted on for a good medical history, so write down your child’s current health stats: when it started, fever, how much vomiting, stomach pain, etc.
  • Make your child comfortable. Little kids LOVE to see themselves on the screen of a video conference call. Let them know what’s going to happen or even practice in advance with a parent in another room.

What can be diagnosed

Did your kid wake up with a fever and vomiting and you’re not sure if this is food poisoning, the flu or something else? Let your child’s doctor know.

“Much of figuring out a diagnosis is getting a good history from the patient or the parent, and you can easily do that over video or phone by asking a series of questions and examining the patient via video, if possible,” says Kathryn Schlee, M.S., FNP-BC, director of clinical services and family nurse practitioner of the Saint Xavier University Health Center.

Even something like hand-foot-and-mouth that is new to first-time parents can be diagnosed without bringing a toddler into an office.

Parents are encouraged to take pictures in good light and upload them to the doc’s preferred platform.

Schlee says: “If we were concerned about hand-foot-and-mouth, I would want to know things like, does the child have a fever? Are they complaining of mouth or throat pain? Are they acting fussy? Are they taking in enough liquids? And although I won’t be able to do a full physical exam over video, I can see the child’s general disposition. Do they look sick and feverish? Are they running around and playing? Are they crying? Are they breathing fast? I also may be able to see any sores in the mouth and I can ask to see the child’s hands and feet to assess for a rash.”

For older kids, sports-related injuries are oftentimes perfect for telehealth visits, says Dr. Adrian J. Rawlinson, vice president of medical affairs with Upswing Health, an orthopedic telemedicine service. Just like certified athletic trainers who treat patients on the sidelines of a football game, doctors can see changes in how a patient walks or looks to help create a plan for muscle pains.

“A lot of triage can be done online when nobody wants to go to the ER right now for anything that’s not coronavirus related,” he says. 

You might still need to go in

Some common illnesses will still need an in-person checkup.

Ear infections, for instance, will need a look inside a baby’s ear to determine the severity and best course of treatment. Broken bones are also a necessity to see a doc in the ER to have it properly set and have an X-ray taken.

Johnston says she is also pregnant, and her ultrasound appointments are still in-person visits while her next OB appointment will be done through telemedicine.

Other doctors, like dentists and ophthalmologists, might not have a long-term use for telemedicine because of the microscopic nature of looking at eyes and cleaning teeth. 

The follow-up appointments to some initial in-person visits, however, are perfect for telemedicine.

How it works

Telehealth has been around a lot longer than most of us know. The COVID-19 pandemic has brought the revolution to the forefront as doctors, patients and insurance companies are trying to keep non-coronavirus patients out of the hospitals while still giving the care that parents and patients expect.

Doctors use secure, HIPPA-approved video conferencing to check out a patient remotely. So parents with sick kids can stay at home while they “see” their family physician through the computer.

Front-line nurses and medical staff can usually best recommend telehealth if parents describe their child’s symptoms.

“The biggest challenge is what you get out of a physical examination,” Riff says. “It’s not super helpful if you’re concerned your child has an ear infection or if they’re wheezing and have significant congestion, but for a lot of other things an exam is not necessary. Things like behavioral issues, ADHD follow-ups or follow-ups with an older child with anxiety or depression. It is just as effective to see those patients over telehealth as it is to have them come into the office.”

Doctors are heavily encouraged to keep doctor attire, Rawlinson says. While a teenager with an ankle injury might be comfortable being seen while wearing sweatpants and a T-shirt, he might not be as comfortable if his doctor is, too.

“Patients need to be reassured by the healthcare professional at the other end of that video,” Rawlinson says. “We work on instilling what I describe as ‘excellent Webside manner.’ That’s a skill that requires good eye contact, making sure on a telemedicine call that you’re engaging with the patient. Someone who is glancing away and taking notes is unnerving with patients.”

Through telehealth, prescriptions can be sent electronically to a pharmacy for pickup or delivery (depending on the pharmacy). 

Will it last?

Rawlinson was in the works to create Upswing Health before the pandemic and sees a bright future for telemedicine in some fields.

Not having to staff a brick-and-mortar office and seeing patients at their convenience is just a start. Keeping costs low will help both patients and insurance companies.

“If you look at traditional care, if I go to an orthopedic office and I have an X-ray of an ankle, my insurance is billed $200-$300 just for the visit, because you have to pay an office staff and building maintenance,” Rawlinson says. “To set up telemedicine, some companies are offering it at $0 cost to the employee and in some cases the appointment will cost much less because you’re not coming in and spending your time in a waiting room.”

Riff says that she’s able to see more telepatients in a day than in-person patients.

“You don’t think about how much time it really takes you to walk into and out of rooms, but all of that time is cut when once one is done you can stay in your seat and start the next one,” she says.

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This article originally appeared in Chicago Parent’s May 2020 magazine. Read the rest of the issue here.

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