Vermonters turned to telemedicine during the pandemic. Now some providers — and teenaged patients — prefer it
The early months of the pandemic saw a dramatic increase in Vermonters using telemedicine services. A year and a half later, doctors still rely on telemedicine, but a number of health care providers — and teenaged patients — say in some situations, it's actually preferred.
VPR's Mitch Wertlieb spoke with VPR's senior political correspondent Bob Kinzel about the continuing use of telehealth services, the issues that have emerged as benefits for patients and doctors, and what problems have been discovered. Their conversation has been edited and condensed for clarity.
Mitch Wertlieb: Help us put this growth of telemedicine services into perspective. How much have they grown since the start of the pandemic in the winter of 2020?
Bob Kinzel: Mitch, the growth has been really amazing. In February of 2020, just before the pandemic really hit, there were 427 claims for telemedicine at Blue Cross Blue Shield of Vermont for that month.
In February of this year, there were 29,000. I talked to Dr. Joshua Plavin, vice president and chief medical officer at Blue Cross Blue Shield of Vermont, about this increase.
He said he was initially surprised to learn that about two-thirds of the claims were for mental health services.
"You can provide the bulk of care effectively in mental health, on a telehealth visit, audio/visual," Plavin said. "Rather than in medical, where there is sometimes a need for an exam, et cetera, procedures, whatnot."
So Mitch, over the last 16 months, the use of telemedicine services has remained quite high, though not quite as high as its peak in 2020. But it's clear that it's remained a critical part of the state's overall health care system.
"I have gone from seeing it as a emergency measure, to us in the middle of a crisis, to [telemedicine] being just a normal part of my medical practice."
How have doctors responded to the growing use of these telemedicine services?
It really depends on the doctor and the services that they provide.
I think it's really important to note that telemedicine is not for everybody. It's not for every doctor, it's not for every patient, it really depends on the circumstances.
I had a chance to talk with Dr. Anna Hankins, who is a pediatrician in central Vermont. When the pandemic started, she said she was a skeptic about telemedicine, but now, she's an advocate.
"I have gone from seeing it as a emergency measure, to us in the middle of a crisis, to [telemedicine] being just a normal part of my medical practice," she said.
Dr. Hankins says there are definitely circumstances when she needs to see a patient in person, but she's learning that there are cases that can be dealt with effectively using telemedicine services.
What about the major benefits of these services, though? Why has she become such an advocate for them?
You know, she told me that these virtual visits with children allow her to see a side of the child's life that usually is not revealed in office visit.
"But when I see her in her bedroom, I can see that she has painted every wall in the bedroom, and I can say, 'Wow, who painted that?' 'Oh, I did.' 'Well, show it to me!' And I've gotten tours of bedrooms to see the artwork, to see the design," Hankins said. "Teenagers are really proud of their bedrooms, and they want me to see that. And it gives me a chance to find out things about them that I just don't find out about if they're in the office."
Dr. Hankins told me that sometimes her appointments are a 10 to 15 minute checkup visit with a patient, and that telemedicine is a very practical way to do this.
Well, that's one side of the coin, but the other really important part of this relationship, of course, is the patient. You had a chance to talk with some of Dr. Hankins' patients about this use of telemedicine. What did you learn from them?
It was fascinating. I learned a lot by talking to them. And many thanks to George and Edith for sharing their experiences with me.
George told me that in some cases, it can actually be easier to discuss a difficult issue in a virtual appointment than it is in person.
“Being in person and being in the same space and talking about stuff that is really close to home, oftentimes causes stress for both people," George said. "And I'm not saying, necessarily, that her office isn’t a comfortable space. It's just different than being in your own home.”
There's also a convenience factor with these virtual visits. For instance, Edith told me that it's been possible for her to schedule a virtual checking appointment with Dr. Hankins, between school and a sports practice.
"I've been able to do it like, on my computer, and have that quick appointment," Edith said. "So that's been a benefit."
And in talking with Edith, it became very clear to me that this COVID pandemic has been a very difficult and stressful time for a lot of people. Certainly, we've heard that it's been tough for older Vermonters who have had to deal with isolation, it's been really tough for parents trying to balance working at home and making sure their kids keep up with remote learning.
"Being in person and being in the same space and talking about stuff that is really close to home, oftentimes causes stress for both people ... It's just different than being in your own home.”
And as Edith reminded me, it's been a stressful period for many teenagers as well.
“I've basically missed the first year and a half or so of, like, being a normal teenager, due to COVID," Edith said. "And it's just stressful all around, because I want to hang out with people, but at the same time, I don't want to have to worry about, have they been following mask mandates? Have they been doing what they're supposed to? Am I safe to, like, be around them, without having to worry about maintaining social distance?”
So, while a pandemic has made life more difficult for many people, telemedicine seems to have evolved as a pretty effective way to deal with some of these issues.
Bob, we're obviously not using their last names for privacy reasons, but thanks again to George and Edith for speaking with you about these issues.
We’ve discussed some of the benefits of telemedicine, but is there a downside, or some other issues that need to be addressed?
Definitely, Mitch, First, I think we really need to remember that telemedicine is not for everyone. There are going to be circumstances where it's very important for a patient to see a doctor in person, and in some cases, there's absolutely no substitute for that office visit.
Second, telemedicine also assumes that the patient has access to high speed broadband services. And we know that's not the case in many parts of the state.
Dr. Hankins says a poor connection can result in a really frustrating experience for everybody involved.
“It keeps pausing, it keeps slowing down. I'm talking and it turns out that on their end, I'm frozen," Hankins said. "And then by the time they tell me that I've just spent three minutes giving the best explanation of asthma management I've ever given, and now I have to repeat it again. So that doesn't work.”
And Mitch, I think one of the lessons of the pandemic has been the critical importance of having universal access to high-speed broadband throughout the entire state of Vermont.
What do you think about the long-term use of these services? Is telemedicine here to stay?
I think it's definitely here to stay, I think the outlook is very good. Dr. Plavin from Blue Cross also teaches at the Dartmouth Medical School. He told me that the use of telemedicine services has now become part of the curriculum at Dartmouth.
“We're just introducing it, formally, into training," Plavin said. "So, for that to percolate up for the entire system will take time."
I'm not sure that there are a lot of positive things that have come out of this pandemic, but the use of telemedicine, in appropriate circumstances, might be one of them.