By Julian Peskin, MD, MBA
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Full disclosure: I love virtual visits.
Contrary to what some may think, sometimes I find them more intimate than an office visit. I get to see the patients in their homes, and share in their surprise when the cat jumps up on the table or a small child runs by wearing nothing but a diaper. Patients love them too – it can be difficult to juggle the demands of work or find childcare, and then sit in traffic and fight for a parking space for an appointment that might last 15 minutes. I’ve even done virtual visits for patients who were in Sydney, Australia, Chicago and on the beach in California.
One of the reasons virtual visits work well in obstetrics is that we have the opportunity to develop relationships with women over the 9-12 months they are in our care. This means our patients have time to get to know and trust us, and we are able to pick up on subtle cues or changes online just as we are in the office.
I have had the opportunity to complete about 160 pregnancies using a hybrid model of office-based and virtual care. In this article, I explain my process, including when and how virtual obstetrics visits are scheduled, and what takes place during the visit itself.
Plant the seed early
When I see patients at their first visits, I plant the seed of what a virtual visit entails. I say to them: “Virtual visits are a little like FaceTime. Throughout the course of your pregnancy, you’ll see me maybe 13 or 14 times. Rather than taking time away from work, or finding childcare, and driving all this way, we can usually convert two or three visits into virtual visits.”
Schedule multiple visits at one time
With my patients, I average about three virtual visits per pregnancy, built around the instances in which I know an office visit will be required, for laboratory testing or imaging, for example. Generally speaking, these virtual visits take place in weeks 22, 26 and 32. If I decide virtual visits are appropriate, patients will leave my office after their 16-week visit with a Doppler ultrasound device and a blood pressure cuff, and they go directly to the front desk to schedule their virtual visits all at once.
Set aside blocks of virtual time
I like to block portions of my clinic schedule for virtual visits. This simplifies the scheduling process. It also keep me on-time — it can be very difficult to squeeze virtual visits into the middle of a clinic day. The waiting room is one significant difference between in-office and virtual care: if you are running behind in the office, patients see that your waiting room is full. They know you are in the office and your support staff can offer reassurance. Online, however, a patient doesn’t really see anything until the appointment begins. They might wait a few minutes past their appointment time and then drop off.
Develop hybrid options and stay agile
Virtual visits are not appropriate for all patients. Patients whose pregnancies are complicated by hypertension, multiples, or who are at high-risk for preterm labor should be managed in the office. Additionally, anxious patients don’t do well with virtual visits, in my experience. If any of these complications arise, I’m honest with my patients. For anxious patients, I might say: “I know we spoke about virtual visits, but am I correct you’ll feel more comfortable coming to the office?”
For other patients, I might swap out more than three office visits. For example, I had a patient who relocated to Dayton, Ohio during her second pregnancy. I’ve been able to conduct nine of her prenatal visits virtually rather than having her drive some 400-miles round trip.
Provide the same care you would if the patient were in the office
The care I provide virtually should be identical to the care I provide in the office – there is no trade-off between convenience and the quality of patient care.
Patients are instructed to measure their weight and blood pressure and listen to the heart beat before each appointment. I ask some preliminary questions, such as: “Is baby moving? Do you have any complaints? Are you bleeding?” Then I ask my patient to give me the weight, blood pressure and heart beat metrics. Otherwise, I manage the visit just as I would a face-to-face visit. We discuss upcoming tests and scans, any birth plans, and whether then have a pediatrician lined up.
As we look to expand our offerings to increase access and convenience for our patients, it is important to keep patient safety in mind. We would love to be able to offer virtual obstetrics visits to women on bedrest for complications, for example, but the technology just isn’t there yet. So for now, in obstetrics, we stick to the lower risk patients.
We are beginning to offer virtual postpartum visits – a convenience that new mothers seem to embrace. Additionally, we use our virtual health platform to complete preoperative education and postoperative gynecology visits for minor surgical procedures, such as biopsies or dilation and curettage. We have also hired a full-time virtual Nurse Practitioner for lower-acuity gynecologic concerns.