House Calls

Parent on a telehealth call with a provider. The parent is holding the ipad and the sitting next to their daughter who has a thermometer in her mouth.

Prior to the pandemic, enacting wholesale changes to our country’s health care delivery system in the span of 12 months would have seemed impossible.

Yet, here we are. The COVID-19 pandemic has forced profound systemic and societal change, and some adaptations, like telehealth, may actually improve the delivery of health care in the long run, according to Rob DeMuro, MD, medical director for primary care at UVM Health Network – Elizabethtown Community Hospital.

Back in spring of 2020, preventive health care was largely put on hold as many routine appointments and procedures were postponed during the height of the pandemic’s first wave. Many providers who practice in small towns and have strong community ties, like Dr. DeMuro, worried that they might be missing opportunities to help friends and neighbors.

“I have lived and worked here for 20 years,” Dr. DeMuro says. “When you practice in a small town, you really get to know your patients, their relationships, their challenges. When you are used to seeing these people and then suddenly you don’t, you start to worry.”

Telehealth - health care by video or phone - quickly became the most accessible, highly-effective method to meet patients. “[Telehealth] allowed providers to maintain access to health care during this critical period,” says Todd Young, network director of Telehealth Services at UVM Health Network. “Without virtual care, a lot of health care would not have happened.” 

The numbers bear that out. In 2019, before the COVID-19 pandemic, the UVM Health Network conducted roughly 2,000 video visits. In 2020, that number jumped to nearly 210,000 video visits. Across the UVM Health Network, female patients and patients age 18 to 44 represent the largest adopters of video visits; the clinical areas that have experienced the greatest growth have been family medicine, neurology, oncology and mental health.

The Doctor Will See [Your Facial Expression] Now

“One thing I like about video visits, [as opposed to phone calls] is that they allow for body language,” says Dr. DeMuro, noting that body language can often communicate our health and our needs. Ironically, many of the important nuances we communicate via facial expressions – a nurse’s warm smile, a patient nervously chewing on their lip – become lost in an in-person visit in our masked world. “Being on camera allows us to see how our patients are reacting to our questions and behaving,” says Dr. DeMuro.

Dr. DeMuro cites an example of a patient who was recovering from a stroke. “There are nuances to a patient’s mobility and how they speak after a stroke, so it was important to actually see how this patient presented herself and how she was improving”. Video visits allowed that just as much as an in-person office visit would, he says. “Eventually I saw her in the office, and that office visit allowed me to see her walk down the hallway, but I found that the Zoom visits really didn’t leave out all that much.”

Often video visits are more efficient and convenient for patients than in-person appointments. No driving, parking or waiting in a reception area. “On video, the time is cut down tremendously and you’re waiting comfortably at home for that call,” says Dr. DeMuro. “And when you hang up – click, you’re done.”

Such benefits have caused patients to embrace telehealth more than might have been expected, Dr. DeMuro says. Patients reporting cold or sinus problems and urinary symptoms are often happy to be treated over the phone; physicians can review sugar control with diabetics just as easily in a video visit as in person. Telehealth is also a tremendous benefit for people who have limited mobility.

“I’m one of those physicians who believes a lot of office visits could be done via Zoom,” says Dr. DeMuro. “I’m pleased we’ve been able to do this for our patients.”