Telehealth for seniors: pros, cons, and how to use it

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Rajay Seudath.

CARMENN MILES
Hello, and thank you so much for joining us. I'm Carmenn Miles, your host today alongside veteran co-host Dr. Rajay Seudath on the award winning Docs in a Pod presented by WellMed. Each week we come to you with a wide range of health and wellness topics, especially those that impact our seniors. Our goal is to share practical information on how we can all live healthier, happier lives and better manage chronic conditions. We've got a great topic for you today, so thank you again for joining us. My co-host today is Dr. Rajay Seudath, who is absolutely no stranger to Docs in a Pod. He's a Tampa, Florida native. Dr. Seudath is a board certified family medicine and currently he is lead physician at the university location for Optum. Dr. Seudath is enthusiastic about primary care, keeping health literacy in the forefront. He's always guiding his patients to meet their health care goals. He's a very passionate about teaching, and that's just one of the many reasons we love having you on our show. Hello, Dr. Seudath, how are you doing today?

DR. RAJAY SEUDATH
I'm doing good. So thankful to be here joining you guys. Thank you for having me on.

CARMENN MILES
Thanks for being here. Let's take a moment to welcome our guest today. Johnathan Rhoads is a board certified physicianÕs assistant in family medicine at WellMed at Mesquite. He completed his training at UT southwestern and is passionate about providing comprehensive, patient centered care and building long term relationships with the patients and families he serves. Outside of work, he loves to spend time with his family and friends, and he enjoys staying active by playing pickleball, running, and traveling with his fiancŽ. Welcome back to the show, Johnathan. I interviewed you at your clinic last summer, and I don't recall you being engaged at that time. Am I wrong?

JOHNATHAN RHOADS
You're correct. I was not. This is recent as of this past December. So, thank you for having me again.

CARMENN MILES
Absolutely. Well, congratulations to you and your fiancŽ. Do you have a date set or are you enjoying traveling in the engagement period?

JOHNATHAN RHOADS
Always enjoying traveling so we don't have a date set at the moment.

CARMENN MILES
Very good. There's no need to rush. All right, we're going to jump in. To today's subject, it is health care and talking about telehealth. Healthcare is changing, and one of the biggest changes in recent years is something called telehealth. Today we're going to discuss the benefits of telehealth and how to use it. Before we jump right into it, Johnathan, please explain to the listeners what we mean when we say telehealth.

JOHNATHAN RHOADS
Telehealth is a virtual office visit done through either your computer or your smartphone device that allows the provider and patient to be present via audio and video communication to complete a visit. This has many pros and cons, and as you have said before, we'll kind of talk about those things today.

CARMENN MILES
Very good. Dr. Seudath, are you using telehealth in your area or any people under your guidance using telehealth as well?

DR. RAJAY SEUDATH
Yes. Telehealth has been a big shift in medicine. On my zoom here I'm nice and young, but I lived through the COVID days back when we couldn't see people in person, so we had to do telehealth. So, that was kind of the driving force that made things go to telehealth. During that time, it was an absolutely necessity. After COVID kind of went away and we kind of got back to the swing of things, people said, no, I don't want to come in anymore. I like having these telehealth visits. I like that I can stay at my home. I can upload documents, or you can see me or I can do it from my car. I can do it on my lunch break. I don't necessarily have to leave my location and spend 15 or 30 minutes getting to and from this visit. So, it has really come a long way than what it used to be. Whereas telehealth was really only for kind of emergencies or special situations. People who were bedbound or someone in the ICU who needed to talk to a psychiatrist, and there's only one psychiatrist for three hospitals. Then we would utilize telehealth. But I think it's become much more ubiquitous, especially with the change in technology. So, I think that's great.

CARMENN MILES
Fantastic. Let's take a moment to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. I'm your host, Carmenn Miles. Our podcast is available wherever you listen to podcasts. We're also available on the radio and several Texas and Florida markets. My co-host today is Dr. Rajay Seudath, along with our guest, physician assistant Johnathan Rhoads. Today we are discussing the benefits and even some drawbacks of using telehealth. So, you mentioned that telehealth was kind of birthed during the pandemic. There were some great things that came out of the horrible pandemic, and telehealth is probably one of those. But I imagine you have some folks that once the pandemic was over, maybe didn't want to come back to the office. Telehealth should not really replace the in-person visits, am I correct? Should there be a balance between the two?

JOHNATHAN RHOADS
I think that's definitely important to not replace it as we do see, it can improve the access to care and it can reach people in rural areas, maybe homebound patients. But at the same time, it is important for hands on patient centered care. We rely so much on the properties of our physical exam as well as certain tasks and things that we do here in the clinic, and that's really important for planning the patient's overall care. So, I think that's very important to have a balance between the two.

CARMENN MILES
We're just delving into the pros of telehealth, especially for our seniors. One of the major advantages I can think of is just the convenience. Some of our seniors have issues getting to a clinic, finding a parking space or even sitting in a waiting room. But let's talk about some of the pros that we see that have come out of telehealth medicine.

DR. RAJAY SEUDATH
I would say it's a lot easier for people to keep follow up and keep a regular pace of seeing their doctors if they have a chronic disease. So, for some of my patients, I see them as regularly as even once a week if they're having the exacerbation of their disease. So, if they're really sick and they can't come in, but we need to know how they're doing, are they getting better and better or are they getting worse? That telehealth visit can really help to bridge that gap. So, I think that's one of the ways that it's been effective, and that's one of the pros. It allows people who are sick to still be seen and to still have their clinical status effectively evaluated by their provider, but they don't have to necessarily come in. So, I think that's one of the things that it's been a very good boon for our patient populations.

CARMENN MILES
Would you say it's easier to get a telehealth visit versus an in-person visit? Is there a certain period of time within your day and your schedule that allows for telehealth, or is there a difference at all versus in-person and telehealth and the access to care?

JOHNATHAN RHOADS
For me, I have a block on my schedule for one telemedicine visit per day just to kind of open that up to acute visits or people that I may need to follow up with relatively quickly. As Dr. Seudath said, this is great for managing chronic conditions that may need a quick follow up. Maybe a COPD exacerbation, or maybe you're having uncontrolled blood pressure here in the clinic and we want to follow up with you in a week or two to see how you're doing at home. These are great areas where we can just say, hey, we can see you virtually, as opposed to you having to come into the clinic. As you said before, there's transportation insecurities. People are busy nowadays, so they have tons of things going on, so the convenience of their home or wherever they may be. I've seen people whenever they're driving in their car and they want to connect, and I say, okay, let's pull over first and then we'll finish the rest of the visit. But yeah, it's important. I have a block on my schedule every day, and it can be used for telemedicine, or it can be simply used for an acute visit when needed.

DR. RAJAY SEUDATH
I think one of the things, to go back to your question, Carmenn, was, are there specific times that we have specifically? I think that's a provider preference. One of the things that I've noticed is for the patients where I used to only see them in the mornings or in the late afternoon because their caregiver was only available at that time. They had to come in right before work, or they had to get off work two hours early around the 3:00 or 4:00 spot to try and get them here. With the telehealth, it seems like they're able to have visits at other times because they're not dependent on that caregiver to be there for that visit, so to speak. I find that that's been helpful in getting more time slots available for that particular person.

CARMENN MILES
Yeah, that would definitely open up their availability. Good point. I imagine seniors living in rural or underserved areas, they can easily connect with health care providers and specialists via telehealth versus living in a rural area and not necessarily having the transportation. I think we touched on it, but what about reduced exposure to illness? I know when I'm sick, the last place I want to be is at the doctor's office, but I imagine that's a pro as well. Reducing exposure to illness and reducing exposing other people to our illness. Right?

DR. RAJAY SEUDATH
That's true. Although I will scold you. I will scold you as I scold my patients. When you are sick, that is when I want to see you. I want you in my office when you're sick. The doctor loves you when you're sick. I'm glad to see you when you're healthy, but when you're sick is what I love you, so I need you to be here when you see. All of our listeners need to know that. Your doctor, your physician's assistant, your provider, your nurse practitioner, anybody on your health care team. When you're sick, we want to see you.

CARMENN MILES
I understand. Do you want to add to that, Johnathan?

JOHNATHAN RHOADS
Yeah. I definitely agree. We definitely want to see you. We have protocols in place for whenever you come in to decrease the risk of exposure to our other patients. So, after there's someone second one of these rooms, we close that room down for a certain amount of time afterwards and disinfect it. But, yeah, if someone isn't able to come in, that would definitely improve that access to care as well. So, definitely benefits on both sides of that spectrum.

CARMENN MILES
For sure. Let's pause and just take a quick break. Please stay with us as we continue this great discussion on telehealth. This is Docs in a Pod presented by WellMed.

AD
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CARMENN MILES
We're back on Docs in a Pod. I'm your host Carmenn Miles in the chair alongside co-host Dr. Rajay Seudath. Along with us is physician's assistant, Johnathan Rhoads. Today we are discussing the great benefits of telehealth medicine. I imagine with the convenience of telehealth, being able to visit with your doctor basically virtually, we get a little bit complacent, but there may be some limitations when it comes to telehealth. Let's talk about some of the drawbacks of this approach.

JOHNATHAN RHOADS
There are many pros that we just discuss, but some of the conÕs kind of make this difficult. One of the biggest cons I see with telehealth is the barrier with technology, especially in our older population, I see multiple times that they just have difficulty understanding how to connect, which device may be suitable for them to be able to connect to this platform that we use here at WellMed, and just relying on other people to help them do this process. So, a lot of the times, we kind of counteract this con in the clinic. So, if we know someone may in the future want to have a telemedicine visit, or maybe we're going to follow up with them in a week, we have some of the staff teach them how to use it. So, that's always an option. But we definitely see from time to time that we may have to call the patient and walk them through the steps in the moment, telling them, okay, you're going to click here, you're going to activate your camera and your microphone, because a lot of these things are just unknown to someone that doesn't use technology regularly, and especially for these types of purposes.

DR. RAJAY SEUDATH
Yes, I agree. Some of our patients they told me, I would have a rotary phone if I could still use it. Let alone a smartphone. Typically, I'll try to ask them, okay, for the next visit, it's going to be a telehealth. We're going to be using your phone. Is there a grandson or a granddaughter who might be able to help you? Is there someone who is young and grew up with the internet available to guide you through this ordeal? And usually after about the first or second time, they can do it on their own. So, that's one of the nice things. As they become more accustomed to using the technology, it becomes a lot easier.

CARMENN MILES
There's the convenience factor, but I'm curious to know, do you do any of the seniors feel that maybe the downside to telehealth is that it may feel a little bit impersonal for some of our seniors who prefer maybe face-to-face interaction?

JOHNATHAN RHOADS
I would say a lot of them prefer to come in person, and it's kind of unfortunate when they do have those barriers that are there as far as transportation and maybe not able to come in at the necessary times that we have available for them. It does kind of lack that personable feeling to be able to connect with them on a different level to be there present with them in the room and kind of read the room a little bit better and to see how they are. It kind of goes into being able to touch the patient and to listen to their heart and lungs. In addition to that, we depend so much on our physical exam components, not only listening to the heart and lungs, but just how the patient looks. So, it's not always the greatest picture on their camera lens. We can see how everything's going, and to see how they're acting in general. So, it does have some limitations and that aspect as well.

DR. RAJAY SEUDATH
One of the things I just wanted to add on that you were saying about the limitations of the platform of telehealth in general. You're right. Being there in person for certain types of issues, certain types of problems. For instance, I wouldn't want to tell somebody if they had a cancer diagnosis over telehealth, right? I would want to be there in person with them, talking with them, showing them any sort of testing information, but just being there, like you said, Johnathan, to be present for that. Oftentimes, it's not necessarily the treatment that you're offering the patient. It's really being there with them to go through that journey together. Oftentimes, that's what a patient wants. It's funny, we talk about how the telehealth exam doesn't allow us to do a physical exam. It's important, not only for diagnostic purposes, but one of my patients just last week, they transferred from another practice, and they said, that guy never touched me once. What kind of doctor was he? Patients understand that. They feel that part of treating them, part of understanding their disease is, you should listen to my heart. You should feel my pulse. I'm paying you to be a health care provider. Go and provide some health care. I don't know there's any data on this, but I'm wondering what the health grades, the satisfaction scores, may be higher or lesser if we're looking at only telehealth visits versus only in-person visits. I wonder if there's a difference for that. I haven't looked into any of that data or any studies regarding that. My guess is there should be some difference because you get that kind of full art of medicine experience when you're in-person.

CARMENN MILES
One thing that you both touched on is the limitations when it comes to the physical exam. I'm just sitting here thinking, yeah, of course, the first thing that happens when I visit the doctors is they're checking my blood pressure, my oxygen levels, all of these things. So, when you're addressing a patient via telemedicine, how does that work? You have some of that high blood pressure, for example, you need to check their blood pressure. Are you making sure that they're monitoring that at home? What's your approach in that case?

JOHNATHAN RHOADS
Yeah. The telemedicine platform allows the patients to self-report certain vitals. However, it's only as good as the vitals that the patient knows how to check and has the ability to check. So, the absence of a blood pressure cuff at home is not going to be very helpful when it comes to monitoring blood pressure. Someone with the upper respiratory symptoms, it may not be beneficial if they have shortness of breath and they're not able to check the pulse oximeter because tells us how well you're breathing and how much oxygen is present in your blood. So, those things can definitely be limiting as well. I think it's important also to counsel our patients on the accuracy on how to measure blood pressure properly and things, so that way whenever they're checking it on their own at home in that setting, that they're getting accurate readings to self-report to us. So, that's just one component of education whenever it comes to telemedicine and telling your patient, okay, in this case, I need you to do this, and if you don't have this available, maybe go to the pharmacy later and check there. You try to find ways around it if you can, but sometimes it's just not able to be done.

DR. RAJAY SEUDATH
Right. I think you touched on this, Carmenn, but what are the things that need a physical exam? What are the things don't necessarily need to a physical exam. I kind of think that any of the regular follow up visits like going over test results, we're going over your chronic conditions, everything's pretty good. Maybe we're doing some counseling. You've had some relationship issues, or you're going through a difficult time, so we're doing some mental health counseling. Those kinds of things are very good for telehealth, because we're not necessarily relying too much on our physical examination. But, again, Johnathan, as he put it, you're having an acute problem. A right now problem, and we're thinking about what medicines should we give. Well, if we're using our physical exam to figure out what medicine we should give, we can give that medicine in clinic. So, it's kind of nice for you to be here for us to give you the medicine or to give you the breathing treatment, or to send you for an X-ray or to do those kinds of things. I often think that if we're having a right now problem, I want to do everything we can to get the patient in, because oftentimes if we don't see the person in the flesh, in the clinic, they might worsen and end up in the hospital. So, I always feel that any time we can keep a person out of the hospital, that's always a victory. Not to knock our hospital folks, but the hospital is where all the bad bacteria are. That's where all the bad germs are. So, hospital associated infection, pneumonias, urinary tract infections, diarrhea infections, C-diff, COVID, influenza. All of those things live in the hospital, so any time we can keep you away from the hospital by having you come into clinic by doing our acute visits, by treating you when you're sick here in our clinic, that is always beneficial to patients. I think when it comes to feeling bad, I want you in office. I want to see you.

CARMENN MILES
Johnathan, I'm wondering if you've been able to gauge whether patients are more transparent and forthcoming with their health concerns via telehealth or are they more transparent and forthcoming in person? Have you been able to get to that either of you?

JOHNATHAN RHOADS
Yeah, I think I have been able to. I ask certain questions in the clinic, and I feel like patients are more open with you whenever you're there present with them face to face as opposed to them through the screen. I will often find that family members come into the clinic and they also prevent the patient from telling something that's not accurate. So, I can glance over and the other person with the patient accompanying them or not their head yes or no to confirm or deny. But we don't have that same ability when we're seeing someone through the screen and they're not always forthcoming, as you said.

DR. RAJAY SEUDATH
Oh, that's so perfect. I often tell people, yeah, I want you to bring your second brain when you come next time. The spouse or the son. One of the jokes I often say to patients is they're like, yeah, I like it when they come because there's your version, my version, and then the truth. They typically point to the third person, and everybody gets a kick out of that one because it's true. They keep you accountable. I like seeing husband and wife teams because the wife is eating sweets when she's got diabetes. The husband is eating bacon when he has hypertension, and they tell on each other, and that's the best.

CARMENN MILES
Very good. As we're winding down, anything else you want to add as a pro or con that our listeners should know?

DR. RAJAY SEUDATH
Well, I would say for our patients, for our listeners, try to be prepared for your telehealth visit. Just like in person, if you could make a list of your issues, if you can leave a list of the things that are you want to talk about, that will be extra helpful because we have our agenda, we have our artillery we want to talk about, but we want to make sure that your voice is heard and the things that you want to talk about. So, have those written down beforehand. It will make it a lot easier and smoother.

CARMENN MILES
Fantastic. It sounds like telehealth overall can be a viable option for many of our seniors, and the best approach is often a combination of telehealth, telemedicine, and in-person care based on an individual's needs and their comfort levels. Thank you, gentlemen, for joining me today, and thank you to our listeners. As always, talk with your health care provider about whether telemedicine is right for you. We thank you for joining us for another episode of Docs in a Pod, presented by WellMed. Until next time, stay well.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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