By Elaine Wyllie, MD

“Good morning!” My patient’s mother greeted me as our cameras and audio clicked in for the telehealth visit. “We’re so glad we didn’t have to brave that terrible snowstorm for our visit today!” She sat comfortably at her kitchen table with her son, who was enjoying a bowl of breakfast cereal.

During the next 40 minutes we had a detailed conversation about the test results from her son’s recent hospitalization and the plan for a brain surgery that would hopefully stop the boy’s epileptic seizures. As I started to share my screen to show the MRI, the boy’s father suddenly popped into view, saying: “Good morning, doc! Mind if I join in?”

We were together in their home, where they were most comfortable, collaborating on their child’s healthcare with minimal disruption to their daily routine. After decades of consulting with patients and families in clinic rooms on a large medical campus, I was finally making house calls.

A new closeness with patients

A surprising effect of the COVID-19 pandemic was that it brought me closer to my patients. The shift to telehealth visits allowed families to remain safely at home while receiving the care they needed, but it also presented greater opportunities than I ever imagined for increased understanding and rapport between doctors and patients.

When our patients engage in a telehealth visit, they invite us into their homes and share their lives with us. We are more likely to meet siblings, grandparents and beloved pets. Many patients also share their hobbies. On one occasion I was given a tour of my patient’s vast collection of horror movie masks and memorabilia, which he and his mother had curated over many years. When families travel to my clinic for the visits, I miss these opportunities to know them more fully.

One morning, during a visit focused on the management of her son’s seizures, my patient’s mother invited me to say hello to him and redirected the camera. I knew that he had disabilities and was technology-enabled, but when his father cheerfully greeted me while filling his gastrostomy tube, he gave me an impactful glimpse into their day-to-day life and their total dedication to their child’s care.

A more level playing field

Telehealth visits put patients and doctors on a more level playing field. For patients, they eliminate the challenges of missing work and school, traveling long distances, finding a parking space and waiting in a busy reception area. We both show up within minutes of our appointed time and take off from there. 

Telehealth visits allow us to meet anywhere. A college student connects from his dorm room 15 minutes after waking up following a long night at the library. A mother and teacher join the visit together with the child at her elementary school. A child on the autism spectrum happily builds intricate Lego^® constructions in the living room while his mother and I talk at length. A family checks in from a remote rural area in another state. One memorable visit had a background soundtrack of lapping waves, and when I asked about it, the mother reversed the camera and showed me the ocean view from her hotel at Myrtle Beach.

By lowering barriers to doctor-patient conversation, telehealth visits can help improve adherence to the medical plan. Telemedicine also provides a tool to reduce no-show appointments. If a patient has difficulty logging on to the visit at the expected time, we can reach out with a video call using another platform to ensure continuity of care.

Benefits for practitioners too

The practical benefits of telehealth visits for patients are obvious, including reduced out-of-pocket expense, greater convenience and increased access regardless of distance. Less apparent, until the pandemic, were the many rewards for the practitioner. Being invited into our patients’ homes is a privilege that can renew and uplift us. In moments when burnout threatens to sap our energy, virtual visits can reinvigorate us. We cannot go back to the days when doctors routinely visited patients physically in their homes, but we can recreate that experience virtually.

Let the house calls continue

How do patients perceive telehealth visits? Research performed during the COVID-19 pandemic has documented that patients’ satisfaction with telemedicine is high.^1-6 In a survey from the COVID-19 Healthcare Coalition capturing the opinions of 2,007 patients across the United States,¹ 79% said that they were satisfied with their telehealth visit, 83% felt patient-physician communication was strong and 83% reported good overall visit quality. The high satisfaction scores were consistent across age ranges and insurance types, and they applied regardless of whether patients lived in an urban, suburban or rural location.

Many patients expect to access virtual care post-pandemic, and it is likely that this form of care delivery will be part of the “new normal”. Healthcare delivery on site at a medical center will always be important, but in 2020 the potential of telemedicine became a reality. This is good news for physicians and patients alike. It is exciting to be a doctor who makes house calls.

References

1. The COVID-19 Healthcare Coalition Telehealth Impact Study Work Group. Telehealth Impact: Patient Survey Analysis. https://c19hcc.org/telehealth/patient-survey-analysis/. Updated April 11, 2021.
2. Rose S, Hurwitz HM, Mercer MB, et al. Patient experience in virtual visits hinges on technology and the patient-clinician relationship: a large survey study with open-ended questions. J Med Internet Res. 2021;23(6):e18488.
3. Orrange S, Patel A, Mack WJ, Cassetta J. Patient satisfaction and trust in telemedicine during the COVID-19 pandemic: retrospective observational study. JMIR Hum Factors. 2021;8(2):e28589.
4. Ramaswamy A, Yu M, Drangsholt S, et al. Patient satisfaction with telemedicine during the COVID-19 pandemic: retrospective cohort study. J Med Internet Res. 2020;22(9):e20786.
5. Phenicie R, Wright RA, Holzberg H. Patient satisfaction with telehealth during COVID-19: experience in a rural county on the United States-Mexico border. Telemed J E Health. 2021;27(8):859-865.
6. Bhuva S, Lankford C, Patel N, Haddas R. Implementation and patient satisfaction of telemedicine in spine physical medicine and rehabilitation patients during the COVID-19 shutdown. Am J Phys Med Rehabil. 2020;99(12):1079-1085.

Dr. Wyllie is Professor of Neurology, Cleveland Clinic Lerner College of Medicine, and a pediatric and adult epileptologist in Cleveland Clinic’s Charles Shor Epilepsy Center.

This article was one of four award-winning submissions for the inaugural “Acts of Rejuvenation and Renewal” annual lecture series event hosted by Cleveland Clinic’s Center for Bioethics on May 19, 2022.