Virtual Visits With Your Doctor – Pants Optional!

For a transcript of the video, see below:

 

Steve:

Hello Nation! I’m here with my good friend and colleague, Jeremy Pettus.

Today we’re going to talk about virtual diabetes visits. It’s certainly going on now with all this quarantine stuff, which is a good thing, and it may be a thing of the future because as we’re going to describe, it may work out pretty well.

Jeremy:

Yep, and I’m coming to you live all the way on the other side of the TCOYD office. I can’t see or hear Steve except through this computer. So, Steve, really quick, you mentioned why we’re doing this. You know there’s this need for social distancing right now, very important to limit the spread of the virus. We’re trying to keep the clinics and the hospitals free of patients so they can free up space in case we’re really overwhelmed by needing to see people rapidly. So, this is becoming the way of the future, and you know it’s something we’ve been doing with diabetes for a long time. So, lets’ talk about some of the positives and negatives of doing these virtual visits. What are some of the positives?

Steve:

Some of the positives are, it’s so convenient for everybody. You don’t have to get in your car, you don’t have to wait in line, you don’t have to check in. Diabetes is a condition where we really don’t need to see you face to face, in a clinic, we don’t do too many things on a physical exam for people with diabetes. So, I just think it’s convenient for everybody, hassle free, and may lead to better care.

Jeremy:

Great, you know, and we love you, patients, but sometimes we just don’t need to see you. And what are some other advantages? I’m wearing my jammies right now, I’ve got my Optimus Prime transformer shirt on, I’ve got my fuzzy pants, so I’m feeling pretty comfy here on the other side of the TCOYD office.

Steve:

And I drink a lot of diet iced tea, so…

Jeremy:

Yeah exactly, and what I am drinking in here? I don’t know, is it Diet Coke, is it bourbon, is it a nicely mixed Moscow mule? Who knows? Only me. The other thing, Steve, you can hide your snacks from your provider. I’ve got a big thing of M&Ms back here you had no idea; I’ll be snacking on those all day long…

Steve:

Jeremy, you took those from my office…

Jeremy:

I know, I know, so that’s one of the negatives. What are some of the other negatives, Steve? What’s a disadvantage of not coming in person?

Steve:

There’s not too many negatives actually. I do think the human interaction is important. You can do your visit with a video cam like this like Zoom. It’s great because you can at least see people’s expressions. Putting your hands on somebody and maybe doing a part of a physical that’s needed – I do think that’s important, but this is pretty close.

Jeremy:

Yeah, I would say one thing “negative” is that it’s on the patient to really come prepared. They can be used to just showing up, you hand over your meter, you hand over your pump, it just gets downloaded. You need to make sure that all that information, all your labs are ready before you get seen, that you somehow get all your CGM information to the clinic if you’re on a CGM, send in your meter download. So, it’s going to take some work on your part to get that information to the clinic however they get it, because without that information it becomes a wasted visit.

Steve:

And just to add on to that as we’re talking now about preparing for the visit, if you can, get your weight, and if you have a home blood pressure cuff, take your temperature, and as Jeremy said, get all your information together. Get it from the laboratory if you go to Quest, or wherever you get your blood from, and have all that information ready. And, have your three (or less) important questions and issues you want to discuss.

Jeremy:

And that goes really for any visit, but especially these virtual visits which can be back to back to back. Take a minute and sit down, write down your top three things you want to talk about (not top 12) and the more focused you can be, the more that you can get out of that visit. So, prepare in that way. Super important.

Steve:

And as Jeremy always says, focus on THAT visit. Just because it’s a video or a telephone call doesn’t mean you have all day. It’s not like talking to your ex mother in law. These care givers, just like us, we’ve got them lined up just because we want to make sure we take care of everybody. What else, Jeremy?

Jeremy:

Well with that in mind, it’s worth talking about how these visits actually happen. To your point, the way our system works is: I’m on my phone, I see my patient’s schedule just like I normally would, and as soon as the patient has logged in on their side, I get a  little text and I just click, “join the visit”. But I’m still on my visit schedule, so I’m trying to still do my work to stay on time so it’s important for patients to be respectful of that.

Steve:

And believe it or not, it’s going to go just like if you were sitting in the exam room with your caregiver. They’re both basically the same. You say hello, he or she asks how you’re doing, you get focused in on the most important issues, because time is of the essence. And you try to review the data that you’ve collected. Even if you have to hold up a meter result or any kind of download, if you can’t email it or send it in, just have it there in front of you. You can read off the values.

Jeremy:

And these can be kind of fun. When your patient pops up you never quite know where they are. They might be in their car or their office, so it’s kind of fun to see them in their natural habitat. And to your point there too, Steve, be prepared if things do go wrong, the video feed gets cut off sometimes, CGMs aren’t downloaded – be able to just talk through your issues with your blood sugars or whatever in case this kind of technology goes awry.

Steve:

And that’s important. It’s kind of like Murphy’s Law. You should have seen me yesterday trying to get the system going. But I’m better now. Well that’s basically it, one last thing. If you have a foot ulcer or a skin rash, you can actually try to get that close to the camera and believe it or not, they can get a lot of information just by taking a quick look and then they can decide what to do from that.

Jeremy:

And we can actually take pictures of that and it gets saved to the medical record, so that’s really nice.

Steve:

Yeah, put it on Facebook, things like that.

Jeremy:

So, prepare for your visit. The actual visit is pretty much the same except you can’t be physically touched, and then the after visit, there are a couple things that are a little bit different, and I think it really comes down to two things: one is how you get the information summarized to you after a visit. Typically, a lot of times the clinics will print that information out for you and physically hand it to you when you leave. They can’t do that for you when you’re at home. So, make sure there’s some way the visits get wrapped up and emailed to you or sent to you electronically for you to review at home. So that’s one. Two, the process for making a follow up visit might be a little bit different. You can’t just wander out to the nurse’s area after your visit and chat with them about your next appointment. You might need to do that electronically or with a follow up phone call. So, make sure when that visit ends, you have your next appointment, and you know how to make it, That’s very important.

Steve:

And make sure you have a list of your prescriptions that you need refilled, for sure. Well that’s it, folks, that’s your virtual visit with Doctors Pettus and Edelman. So long for now, Nation.

Jeremy:

Ok, so great job, Steve.  Just, alright, just turn it off…

Steve:

Ok, just turn it off, and I’ll catch you later, ok…

Jeremy:

Oh, oh Steve, Steve! Your camera is still on bud, and why don’t you have pants on? That’s ridiculous!

 

Checklist for Virtual Visits:
  1. Have all of your data available (CGM downloaded, weight, temp, blood pressure if you can)
  2. Have a list of any prescriptions you need refilled
  3. Have your top 3 topics/issues ready to discuss
  4. Make sure you receive a summary of the visit for your review/records
  5. Know how to make any necessary follow up appointments
  6. Turn your camera off before you stand up, if you opted NOT to wear pants 🙂

 

15 Comments
  1. Avatar

    One of your longest Vids good job both of you and cute shorts Steve.

  2. Avatar

    Thank you. I have been doing telehealth for almost two weeks. Please address a telephonic visit with patients (primarily seniors) that do not have a smartphone or computer.

    • Avatar

      Hi Joyce,
      Thank you for bringing this up. If someone doesn’t have a smart phone or computer, they will receive an appointment time with a call-in number from their provider, and they will have the same meeting via phone as they would with a video visit. If they have a foot ulcer or some type of physical concern, they would need to be seen in person, but everything else would remain the same.

  3. Avatar

    Great idea! Medicare will not approve my diabetic consumable supplies unless I schedule quarterly doctor appointments. For my controlled condition, I do not need 4 office visits a year so if my doctor approves, this virtual meeting suits me just fine! The only concern I have is the A1C draw. Are disinfectant labs available these days to ensure adequate coronavirus safety conditions for all? Thank you!

  4. Avatar

    Very helpful. I am preparing for my first visit to UCSD Endo dept in late April. Hopefully this madness will be behind us, but this got me thinking about needing to get labs done ahead of time in order to make the most of our appointment.

  5. Avatar

    I Loved the video.
    Thanks so much for the laughs.

  6. Hi Dr. Edelman
    This question I know is off subject somewhat, but where is your clinic located at the San Diego V A medical center? And what is the direct phone number to that clinic? Thank you in advance

  7. Avatar

    Do you bill insurance the same as before?

    • If it’s a video conference it’s close to the same. If it’s just telephone call, than it’s much less.

  8. Avatar

    Hi guys, For people without a bank account, who may not be fully insured or have any health insurance at all, how can they pay for tele-health visits? When an appointment can only be by a land line phone, could a bill be sent by mail? Is there any pre-appointment help getting registered, downloading the health care system’s app, learning what the price points per type of virtual visit are? Thank you TCOYD for always providing so much of what you do and say online for free.

    • Hi Jean,
      Each institution is different when it comes to how they bill etc. At UCSD there are ways to pay any way the patient can, and I would call the administration office of the system you go to. A friend could pay with his or her credit card and you could pay them back with cash. A bill could be sent for sure. There is a lot of help available to get people set up, now that so many institutions have gone to virtual visits. Good luck and email me if you need more help. Steve@TCOYD.org

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