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In Some Cases, Telemedicine Makes Sense for RA Checkups
When you live with rheumatoid arthritis (RA), it is important to stay in touch with your doctors and remain on your medications and treatment protocols. But with the shelter-in-place mandate, that can seem difficult. A telemedicine visit (consulting with your healthcare provider using a smartphone, tablet, computer or other technology), while not perfect, is a very good alternative. Indeed, telemedicine has exploded in just four short months because of pandemic constraints. For example, according to Brandon Welch, PhD, the founder of Doxy.me, the telemedicine portal logged 5.9 million minutes and 236,000 calls in January 2020. By April, those figures had jumped to 315.4 million minutes and 18.9 million calls. RELATED: Rheumatoid Arthritis: Determining When You Need to See a Doctor and Get Treatment
When Are Virtual Visits With a Rheumatologist as Effective as In-Person Ones?
The consensus seems to be that telemedicine is helpful during a challenging time, but that it has some significant limitations. Vinicius Domingues, MD, a rheumatologist and a medical adviser to CreakyJoints, says that when the patient is doing well, telehealth is as effective as live. The doctor can review medications and lab results and make sure patients understand their particular protocol. “However, when there is an issue, it’s very hard not to be able to perform a proper physical exam, feeling the joints for swelling and warmth, to see better if there’s a rash. Plus, I can’t give injections over video, obviously. Thankfully we have telemedicine, because otherwise it would be challenging during these times, but it’s not a complete replacement for a full visit,” he says. RELATED: Telemedicine for Physical Therapy: It Works!
Don’t Make Any Changes Without Consulting Your Doctor First
Chris Phillips, MD, the chair of the American College of Rheumatology’s insurance subcommittee and a member of the ACR’s committee on rheumatologic care, understands that people with RA are anxious about COVID-19. “A lot of them are older or immune suppressed, so they’re worried about getting sick. They’re worried about coming into the office to see us and getting exposed to patients who are sick,” he says. More important, he has seen a few cases where patients, concerned that their immunosuppressant medications make them more vulnerable to getting the virus, just stop taking their meds, with disastrous results. This is dangerous, Dr. Phillips says. “If you go off the medicine without checking with your doctor, you run the risk of having a significant flare of underlying disease, which you then may or may not get back under control successfully when you go back on treatment. For most patients we’re recommending they continue that treatment but be extra cautious about sticking to safety guidelines. I think now more than ever, it’s important that we be in communication either in person or by phone or telehealth with people who have those concerns.” RELATED: Why You Shouldn’t Miss Your Ob-Gyn Visit Because of the Pandemic
What Types of Appointments Should You Do Virtually?
When you feel you are having higher disease activityAs a first screening to see if you should be seen in person. Your physician can see a swollen joint over video and make that callA follow-up to an in-person visit
A Telehealth Rheumatologist Appointment: What Can You Expect?
According to Dr. Domingues, your doctor should review all your symptoms that have arisen since you were last seen, your lab tests, and discuss your medications. “Obviously, I don’t have the ability to perform a full physical exam, but I can see a swollen knee via telemedicine and make the determination that the patient needs to come in for a shot,” he says.
How to Get Prepared for Your Telemedicine Appointment
Check for coverage by your insurance. Private insurance companies differ in whether they cover telehealth appointments and at what rate. Also, some cover video visits but not phone. But this is changing every day. Many are now following the example of Medicare and Medicaid, which have loosened their restrictions to provide more coverage of phone-only visits and allow healthcare facilities to use platforms such as FaceTime, Zoom, and Skype that are not compliant with the Health Insurance Portability and Accountability Act (HIPAA). Whether this remains in place once the pandemic is over remains to be seen, says Phillips.Find your comfort spot, where you feel safe. “When you’re in a good mood, you’re more receptive to thoughts, ideas, and creativity,” says Louis Tharp, the executive director and cofounder of CreakyJoints and the Global Healthy Living Foundation.Set up the correct technology and test-drive it before your appointment. Make sure your camera and microphone are enabled. Most doctor’s offices will gladly walk you through their particular platform ahead of time. If you don’t have access to the internet and need a phone consultation, most offices will make that accommodation.Get a pen and paper. At the end of most in-person visits, the doctor will give you a clinical summary of what’s been discussed. Since that isn’t possible with telehealth, be prepared to take notes.Write down all your questions. “Studies show that doctors tend to spend more time with patients and don’t interrupt as much when on telemedicine than in person, so take full advantage!” says Tharp.Have with you a list of medications and supplements (better yet, the actual pill bottles), a list of all your symptoms since you last spoke, and your insurance card.Get the right people around you. You may want a trusted person in the room with you to make sure you understand everything. Also, if you are not proficient with technology, have someone knowledgeable nearby who can jump in if there’s a glitch.
RELATED: How to Have an Effective Appointment With Your Rheumatologist
If You Do Need an In-Person Visit, What Safety Precautions Should You Expect?
Let’s say you need an injection, infusion or joint manipulation. How can you see your doctor in person safely? Most offices are following these Centers for Disease Control (CDC) precautions, says Domingues:
The doctor’s office will call you before the appointment to make sure you don’t have a fever or any other symptoms of COVID-19.When you get to the office, stay in your car and call the office to say you have arrived. They will ask you to remain there until they call you in.At the door to the office, a nurse will take your temperature before allowing you in.Wear a mask. The doctor and the health center employees should also be wearing masks.Only one patient is allowed in at a time.
RA Treatment Going Forward and the Future of Telemedicine
It looks like telemedicine is here to stay, but in what form and to what extent after the pandemic is over is still unclear. Phillips says, “It depends on whether some of the regulatory changes are left in place or not.” For the foreseeable future, enjoy not having to drive and then read endless out-of-date magazines in a waiting room!
