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March 7, 2023

How to decide between a virtual and in-person visit

Daily Briefing

    Telehealth, which grew rapidly during the pandemic, continues to be popular with patients and is now a common service in many practices. Writing for Kaiser Health News, Michelle Andrews explains how to decide when a virtual visit can be beneficial and when it might be better to opt for an in-person visit instead.

    Telehealth's boom during the pandemic

    During the pandemic, telehealth was "suddenly thrust into the spotlight" as both patients and physicians turned to virtual visits to reduce the risk of coronavirus infection, Andrews writes.

    "It was a dramatic shift in one or two weeks that we would expect to happen in a decade," said Ateev Mehrotra, a professor at Harvard Medical School who has researched telemedicine and other healthcare delivery innovations.

    The behavioral health field in particular has embraced telehealth, Andrews writes. According to data from FairHealth, mental health conditions made up nearly two-thirds of all telehealth claims in November 2022.

    Although telehealth usage has declined since its pandemic peaks, the service remains popular with many patients since it allows them to "avoid the time and expense of driving, parking and arranging child care than an in-person visit often requires," Andrews writes. Many providers have also integrated telehealth into their regular practices and plan to continue using it going forward.

    When to choose a virtual or in-person visit

    Although telehealth is more commonplace now, patients and providers are still figuring out what works best and when an in-person visit may be more beneficial than a virtual one.

    "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," Mehrotra said.

    Currently, there are no "hard-and-fast rules" about when an in-person visit is preferable over a virtual one or vice versa, but Andrews spoke with several health experts to gather some general guidance.

    The first visit with a new provider

    If it's your first visit with a provider, health experts recommend going in-person rather than meeting virtually.

    "As a patient, you're trying to evaluate the physician, to see if you can talk to them and trust them," said 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."

    In-person visits can also help doctors evaluate their patients in more nontangible ways, as wells. For example, an oncologist may want to assess a patient's emotional state after giving them a cancer diagnosis.

    "A diagnosis of cancer is an emotional event; it's a life-changing moment, and a doctor wants to respond to that," said Arif Kamal, an oncologist and 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 a doctor better understands how a patient is coping with and responding to treatment, incorporating more virtual visits may be an option.

    If you might need a physical exam

    Although it may seem like a "no-brainer" to have an in-person visit when you need a physical exam, there are now monitoring equipment that patients can keep at home to track their blood pressure, heartbeat, blood oxygen and more, Andrews writes.

    Obstetrics, particularly prenatal visits, is another area that may benefit from virtual visits. According to a 2020 study, there were no significant differences in C-section deliveries, preterm birth, birth weight, NICU admissions between women who received up to 12 in-person prenatal visits and women who received a mix of in-person and virtual visits.

    Nathaniel DeNicola, chair of telehealth for the American College of Obstetricians and Gynecologists, also noted that virtual visits can be helpful for patients looking to get contraception, unless they need an IUD inserted.

    However, doctors say that some health complaints, such as abdominal pain, severe musculoskeletal pain, or eye and ear pain, generally require an in-person exam since they could be symptoms of a wide variety of conditions.

    "We wouldn't know how to evaluate it without an exam," said Ryan Mire, an internist and president of the American College of Physicians.

    Older patients with multiple chronic conditions will also likely benefit more from in-person exams than younger patients who are generally healthy.

    If new symptoms appear or change

    If you experience a new symptom or symptoms of a chronic condition change, it is recommended that you schedule an in-person visit with your provider.

    "I tell my patients, 'If it's new symptoms or worsening or existing symptoms, that probably warrants an in-person visit,'" said David Cho, a cardiologist who chairs the American College of Cardiology's Health Care Innovation Council. Some potential changes to look out for include chest pain, losing consciousness, shortness of breath, or swollen legs.

    For patients whose chronic conditions are under control, virtual check-ins may be easier and more effective. These patients can also check their weight, blood pressure, and more at home unless something changes.

    However, even if a physician suggests a virtual visit instead of an in-person one, you are not obligated to follow that recommendation if you are not comfortable with it or would just prefer an in-person visit instead.

    "As a consumer, you should do what you feel comfortable doing," said Joe Kvedar, a professor at Harvard Medical School and immediate past board chair of the American Telemedicine Association. "And if you really want to be seen in the office, you should make that case." (Andrews, Kaiser Health News, 3/6)

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