Updated: May 26
Receiving cancer care is hard. Receiving it during a pandemic is even harder.
I’m deeply sorry that you’re experiencing additional stress during these unprecedented times.
I am confident that I can help though. My goal here is to lighten some of the load by helping you prepare for your cancer care in ways that you may not be considering.
This is the third in a series of posts, each addressing questions regarding cancer care in the time of Covid-19.
We discussed precautions and preparatory actions in posts #1 and #2. We'll now shift to what most patients need to optimize --how to effectively "see" your oncologist on the internet!
#3: How will telehealth change my care? How do I maximize its effectiveness? (This post).
There's that saying: "the future is already here, you just don't know it yet." Telehealth is a great example of that; it didn't magically arrive two weeks after Covid did. We're just being forced to use it for the first time--and actually, it ain't all bad.
Let’s talk telehealth.
Telehealth: The New Normal For Many Of Us
Telehealth appointments are doctors’ appointments that are conducted via phone, or ideally, via internet-based video.
These high-tech appointments have been around for a couple of decades, but have struggled to achieve wide adoption for various reasons.
Now, all of a sudden, a huge number of doctors’ appointments are taking place via teleconference. According to the Lancet, there has been a “ten-fold increase” in telehealth over the last few weeks. It’s arguably the biggest healthcare transformation we’ve seen since the advent of the Affordable Care Act.
We can expect that these appointments will continue to take place for the foreseeable future, and they will likely continue long after a Covid vaccine comes. So let’s dive into this—it’s our new normal.
Does Insurance Cover This?
The first thing you might be wondering is whether or not a telehealth appointment is going to be covered by insurance.
Several weeks ago, CMS (the Center for Medicare and Medicaid Services—I have no clue why there’s just one “M” in the acronym) instituted an emergency measure that allowed 80 new services to go forth via teleconference; there are now 193 total services that are covered. Most private insurers quickly followed suit with coverage of their own. (That’s typical; they often follow CMS’s decisions).
Nevertheless, there may be some insurance companies who are not covering these appointments, so it is wise to check if your appointment will be covered before you see your doctor—especially if you are a part of a PPO.
How Do I Have Productive, Normal Appointments Using Telehealth?
Telehealth, as you might have already experienced, is considerably different than a regular appointment.
The enormous plus side is that you get to stay home, out of Covid's destructive path.
The down sides are numerous. The nurse can’t weigh you. The nurse can’t measure your blood pressure, temperature or oxygen saturation.
Moreover, the doctor can’t listen to your heart or feel your lymph nodes to assess the presence or disappearance of “local metastases” (cancer spread that’s close to the original tumor).
Some of these issues can be alleviated though. You probably own a scale and a thermometer—and you should be prepared for the appointment with your weight and temperature recorded.
That’s a great start. But there is more you can do to help your doctor make these appointments a little more normal.
You can buy an easy-to-use sphygmomanometer (that’s the blood pressure cuff that doubles as a great tongue twister for your grandkids).
Digital pulse oximeters are available too. (That’s the device they put on your finger tip to measure blood oxygenation. That tells us how efficiently your red blood cells are delivering oxygen to your other cells).
Digital stethoscopes (that allow your doc to listen to your heartbeat) that interface with smart phones are also available.
[Note: I do not make royalties from any products that I’ve linked to.]
If you’re willing and able to buy these products and feel confident using them, ask your doctors if that will allow you to stay at home for more appointments before you make the investment.
If you do buy them, be sure to remind your doctors at the beginning of the appointment that you have this information. It will be invaluable to them, I assure you.
Compensating For One More Telehealth Downside
One of the challenges that patients have during telehealth appointments is that they often have a difficult time remembering and describing their symptoms. For that, I strongly recommend the use of a Symptom Diary.
A symptom diary is fairly straightforward as you can see in the example. On the left column, you have possible symptoms you may be experiencing. On the top you have days of the week. Print out a new one every week and record what symptoms you have on what days.
Even if you are going in for regular face-to-face appointments, this diary is still beneficial. (You can download and print a free symptom diary here, It’s more comprehensive than the one depicted. My list of provided symptoms could never be complete, however, so you’ll fill in the bottom several rows with other symptoms that come up for you).
What Do I Need To Do Before My First Telehealth Appointment?
If you are going to have a telehealth appointment, are you prepared?
You may have to do one or more of the following to prepare:
1) Download video software that your doctor’s office has sent to you. It should come with instructions on how to download it and how to test your microphone and video capability.
2) Verify that you have a strong internet connection.
3) Close all unnecessary apps and re-start your computer just before your appointment. Your computer will be able to “think” faster if you do this.
4) Have access to a phone and your doctor’s telephone number in case you are unable to participate.
If you don’t feel comfortable setting up the technology, who can do it for you?
There are a lot of nice people out there who understand computers quite well. If you need help, can you get it from a church volunteer or one of the neighbors’ kids? (It’s best to try to do this over the phone, of course, so you don’t expose yourself to the virus. If that doesn't work and you have them inside your home adhere to all the guidelines we discussed in this series' first post. Everyone should be wearing masks, keeping their distance and of course, disinfect the computer after the kid is done helping).
What If I Have To Have A Live, Face-To-Face Appointment?
For most cancer patients there will inevitably be times that your doctor requires you to come in. There are certain examinations that you must be present for.
The catch is that it’s possible that they won’t allow your loved one or caregiver to come in with you anymore. That person likely attended appointments with you in the past not only to support you emotionally, but also to be a second set of ears to interpret (and remember) what the doctor said. They may have even taken notes for you to allow you to focus a little more.
It's remarkably common for cancer patients to be stressed out during their appointments. When we get stressed, we don't always form memories as clearly as we normally would.
So what can you do now that your loved one can't be there with you?
Hopefully, you can record audio or video of the appointment with a smart phone. If you don’t have one or don’t know how to do that, call ahead to your doctor’s assistant and see if they can set that up for you. It may be very simple for them to record the appointment and email it to you, your loved one or your caregiver.
In the next post, we’ll talk about some good news. Covid includes a few silver linings for cancer patients and this next post will lift your spirits! To receive an email notification of that blog’s arrival, scroll down and subscribe.
Please check out our free resources page. We have catalogued all kinds of good stuff for cancer patients.
If you think you need help navigating your cancer care, check out the 5 Ways To Hire Us.
I believe you will find my knowledge useful and I'm willing to put my money where my mouth is. We have a new product called the Confidence Call. You send me $1. (Our insurance requires that you pay something). Then you’ll get on a conference call with a few different patients and I will answer your questions. Afterwards, you can tip us if our responses helped you. Click on the link above for details.