PRIMARY CARE | PRECISECAREMEDICAL

 Major medical centers, including the Cleveland Clinic, Stanford, and Harvard-affiliated Partners Healthcare, offer virtual second-opinion programs that give you access to top specialists who can review a medical diagnosis or treatment plan online.

 If you’d like to try an online consultation with a doctor you currently see, ask the doctor, or their office assistant, if this service is available and right for you.

 “A consult or scheduled virtual visit with your own doctor means you’re working with someone who knows you and your health history,” Bishop says. “Some doctors in our system will also do on-demand urgent care visits for their own patients, so it’s worth asking.”

 Generally, you pay the same price for a virtual visit with your doctor as an in-person visit. But pricing and availability vary among doctors, health systems, health insurers, and states, so it’s worth checking with your doctor and with your health insurer to find out what’s available to you, Bishop adds.

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 Having a virtual visit with a mental health professional has become a go-to option for people with anxiety, depression, and other mood or mental health disorders since early 2020, with in-person visits to therapists’ offices and healthcare facilities curtailed because of the COVID-19 pandemic.

 However, remote psychotherapy is hardly new. Mental healthcare was among the first disciplines to move to telemedicine or, more specifically, telepsychology, with research on the viability of counseling delivered via phone, video, or both dating back to the early 1960s. The internet and mobile communications devices such as cellphones and tablets have only added to the options in the decades since, according to the American Psychological Association.

 What has changed, though, is broader acceptance of telemedicine, or telehealth, within the field, experts say.

 “Telemedicine provides a socially distanced way for people to access professional services that support their recovery,” says Alice Medalia, PhD, director of the Lieber Recovery Clinic at Columbia University in New York City, which offers telehealth options for psychiatric services.

 Of course, the traditional doctor-patient relationship isn’t the only telemedicine approach gaining use. Platforms such as Talkspace, Teladoc Health, and Doctor-on-Demand can help you set up virtual appointments with mental health professionals, conducted by video call or traditional phone call.

 However, not all online platforms offer medications management and remote prescribing; if you need those services, they may connect you to a psychiatrist in your area for further help.

 In addition, there are many apps that are designed to use the principles of cognitive behavioral therapy (CBT) to guide you through what is essentially a self-care regimen of activities and exercises. However, it’s important to note that these apps don’t connect you with a single, trained therapist who oversees your care.

 “Many people find CBT apps informative and helpful, and increasingly, therapists are incorporating apps into their practice with patients anyway,” Dr. Medalia says.

 However, “they don’t replace a therapist,” she adds. “Rather, they add a new way of accessing help.”

 A study published in January 2021 in JAMA Psychiatry generally found that these CBT-guided apps are effective at helping people with depression — one of the most common mental health conditions — manage their symptoms, provided they were guided by support from a care professional.

 As with anything else, there are pros and cons to the various virtual care services available in the mental health space, according to Medalia. Although these technologies allow you to maintain vital care services when in-person is not possible, and appointments are easy to schedule around work, school, and family obligations, some important aspects of mental healthcare — such as direct interaction with your therapist — may get lost in the virtual realm, where it may not be as easy to see and interpret changes in facial expression or demeanor, she says.

 “And there’s the issue of Zoom fatigue,” with so much of our social and work lives spent on the platform, Medalia adds. “My research on the use of telehealth for people with serious mental illnesses has found that the majority of clients prefer in-person sessions.”

 In addition, as important as these virtual services have become, particularly since the start of the COVID-19 pandemic, they haven’t solved all the problems related to access to care, according to Medalia. These technologies are “only viable for people who have access to web-connected technology and private space to engage in therapy,” she says. “There is, in fact, a significant percentage of the population that does not have access to the technology needed for telemedicine.”

 Much can be accomplished during a virtual visit to the gynecologist, including discussing birth control and getting a prescription for birth control pills; getting advice on urinary tract infections (UTIs), including whether to use an over-the-counter UTI test kit; having your hormone replacement therapy regimen adjusted; having rashes or bumps in the vulvar area examined; and discussing any other health concerns you might have.

Virtual Urgent Care

 However, there are symptoms for which you will likely need to seek urgent or emergency in-person care. Those include, but aren't limited to, any symptoms of a possible ectopic pregnancy, severe vaginal bleeding, complications following a gynecological surgery or other procedure, more severe vaginal or uterine pain, and symptoms of a vaginal infection with a fever.

 Many skin problems are diagnosed primarily by appearance, in combination with a person’s medical history, and that makes dermatology a good candidate for telemedicine. So-called teledermatology is also effective for follow-up visits, when a person has been seen in person in the past, or for medication refills for an ongoing problem.

 There are instances where an in-person visit is better, such as for an annual skin check, in which a tool called a dermatoscope allows the doctor to see a magnified view of any skin lesions. And of course, any procedures involving the skin, such as taking a biopsy, need to happen in person.

 Good asthma management often requires regular check-ins with a doctor, and virtual visits can be a good alternative to in-person visits for routine appointments.

 Telemedicine typically works well for discussing your current treatment plan, refilling prescriptions, and asking your doctor any questions you might have about your health or your treatment plan. Telemedicine has the added benefit of minimizing your in-person exposure to others, and it saves you the time you’d spend traveling to and from appointments.

 For some people, opting for a telemedicine appointment also gives them access to allergy-immunology specialists that may be located hours away from where they live.

 However, when you connect with your doctor over the phone or by videoconference, your doctor can’t directly measure your vital signs, take your blood pressure, check your peak flow or other respiratory measures, or do any other type of physical examination that might be warranted. If your physician feels you need to have certain lung function tests such as spirometry or plethysmography, you’ll likely need to visit a medical facility to have them done.

 However, when you connect with your doctor over the phone or by videoconference, your doctor can’t directly measure your vital signs, take your blood pressure, check your peak flow or other respiratory measures, or do any other type of physical examination that might be warranted. If your physician feels you need to have certain lung function tests such as spirometry or plethysmography, you’ll likely need to visit a medical facility to have them done.

 A lot of the treatment for addiction and recovery is done through dialogue with a therapist or in a group, and that means that a lot can be accomplished through a virtual visit. For some people, particularly those who live far from an addiction treatment center, virtual visits with a mental health professional can even be more convenient than in-person visits. The drawback is the loss of social support that some people get from in-person meetings with a therapist or other professional.

 Addiction and recovery support groups are also widely available online, now that the coronavirus pandemic has made in-person meetings unsafe. Again, while some people appreciate some aspects of virtual recovery meetings, such as the anonymity they can have online, others miss the support they get from in-person meetings.

 In some respects, telemedicine is ideal for managing Crohn’s disease, particularly if it allows for more frequent check-ins with your doctor. This form of inflammatory bowel disease benefits from frequent monitoring by a physician and prompt attention if symptoms worsen between scheduled visits.

 Because telemedicine eliminates travel time and time spent in a doctor’s waiting room, both routine appointments and urgent appointments to discuss symptom flares can take place more efficiently. That means less time and often less expense for you, and it also means your doctor may have more appointments available when you need them.

 There are some instances in which an in-person appointment for Crohn’s disease is necessary, including the initial diagnosis, which generally involves an examination of the inside of your colon and possibly imaging scans. Certain complications of the disease also require a physical exam to determine the best course of treatment. And of course, any surgical procedures must be done in person.

 Remote cardiac device monitoring — that is, remote monitoring of an implanted cardiac device, such as a pacemaker, implantable cardioverter defibrillator (ICD), or implanted cardiac monitor–loop recorder — isn’t new. In fact, it’s been around since the early 1970s, although the technology’s improved considerably in the past couple of decades. But the COVID-19 pandemic has illuminated its benefits, including keeping people with heart problems away from hospitals or doctors’ offices, where they could be exposed to contagious illnesses.

 Remote monitoring allows your healthcare team to monitor your heart health and the function of your cardiac device without you having to be physically present. Even better, it can communicate this information in real time using wireless technology and a Bluetooth-enabled device.

 This means your doctor knows when your device has corrected a heart rhythm abnormality soon after it happens — provided you’re within in close-enough range of your home monitor — rather than several months later, when you make an office visit and have your device data collected with a special wand. It can also alert your provider to a problem with the device, such as a low battery.

 While remote cardiac device monitoring isn’t without its technological challenges — including getting knocked offline by weak cellular service — it has been credited with improving patient health through earlier detection and treatment of heart rhythm problems.