The new normal: Providers, patients embrace virtual care as a first option

It’s official. Michigan Medicine has adopted virtual methods, such as video visits, as a first-line option for clinical care. It will become the new normal as the organization continues to flatten the COVID-19 curve and move toward recovery.

“Despite this dramatic and immediate impact on how we deliver health care, providers and patients have been surprisingly adaptive and supportive of the change to virtual care,” said Rakesh Patel, M.D., associate professor of orthopaedic surgery.

Orthopaedics is one of the service lines taking the lead on virtual care. And, as Patel said: “It’s been refreshing to see how flexible everyone has become.”

Pandemic inspires new way of thinking

The surge in virtual care within orthopaedics may seem surprising considering the personal attention patients often receive from providers during an exam, including observing the patient’s range of motion while walking, sitting, standing, bending and even climbing stairs. But according to Patel, COVID-19 has pushed his profession to think differently about how they care for patients. 

“I’m all for asking the questions, ‘Why do things the same way for years, when so much more is possible today? Why diagnose patients in the same way when we now have advanced imaging and other functional tests which provide a much better analysis of our patient’s condition?’” said Patel, who conducted more than 100 virtual exams well before the coronavirus was even a blip on anyone’s radar. 

“Currently, we perform manual muscle strength testing on a 0-5 scale that was originally developed in the 1940s. The grading scale can vary, based on either the patient’s and/or provider’s perspective. Therefore, the standard physical exam may not be the best tool to assess a patient’s functional status,” Patel said. “An online assessment can help eliminate any reliability issues by performing a more objective physical exam.”

Before COVID-19, Patel used video visits for follow-up exams, but had already set his sights on evolving the initial patient exam.

He collaborated with the Mayo Clinic, Walter Reed National Military Medical Center and the University of Wisconsin to develop a virtual physical exam, which is now being used by Patel and other orthopaedic providers to examine new patients. 

While Patel recognizes that in-person interaction is necessary to solidify a patient/provider relationship, he believes a lot can be accomplished online or by phone.

“You can filter a lot of information before meeting in-person,” he said. “We can still develop a good treatment plan with fewer touch points and unnecessary visits.  

“People have been resistant because it seems less personal but based on our interactions, we find that people from home are more relaxed and not on edge compared to when they are seen in a sterile hospital environment by doctors dressed in white coats.”

A game changer

A recent report by PricewaterhouseCoopers (PwC) Health Research Insights (HRI) seems to prove that out. Among the patients surveyed who used telehealth for the first time during the pandemic, 88 percent said they would use it again.

Carter Beil, a patient of Patel’s, agreed.

“The benefits of a virtual visit with my doctor heavily outweigh the challenges,” Beil said. “I don’t have to drive into the office, find parking, figure out what floor and where the check-in desk is before I wait in the lobby.

“I think a face-to-face meeting is important for more serious conversations, but for routine follow-ups, a virtual visit feels no different than an office visit,” Beil added. “In my case, respect, confidentiality and professionalism were all still maintained and I was thrilled to be able to utilize the technology. I believe if the technology brings a more pleasant experience, while saving time, stress and cost, it has the potential to be a ‘game-changing’ addition to Michigan Medicine’s repertoire of care choices.”

For primary care providers, the option to use video visits already is a game changer for patients who can’t otherwise visit their doctors. 

“Overall, the video visits have been very successful,” said Jill Schneiderhan, M.D., assistant professor of family medicine. “Most people are extremely grateful this option exists under these unusual circumstances. I have a few patients who struggled with getting to the office for appointments and this has been a great way to provide care for those patients. 

“I definitely appreciate being able to reach out to patients and discuss how they are doing,” Schneiderhan added. “Without virtual care, many of them would not address their medical concerns or issues they may be worried about. It gives both the doctor and patient peace of mind knowing any medical concerns or challenges are getting the proper attention.”  

Like Patel, she sees a future role for virtual care: “We simply have to figure out how to integrate it back into our tool box.”

Global implications

Virtual care is not only a great addition for Michigan Medicine patients, but it can make an enormous impact on rural communities.

“Consider areas such as the Upper Peninsula, where patients can’t easily visit the local hospital,” Patel said. “Or even globally, I have visited rural villages in India and Nepal. They have no access to health care, but they do have WI-FI and smart phones. I see children with deformities that are treatable here. It is avoidable.

“With technology, we can do there what we are able to do here for our patients. It’s a way to make a difference both here and across the globe.”

Virtual Care resources are available to help faculty and staff navigate and understand E-Visits, Video Visits, and the other modes of virtual delivery. Please visit the Virtual Care internal website for more information.