Maggie McKay (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. When it comes to virtual care, how much do you know about it?

Today we're going to learn more with family medicine physician Dr. Anitha Lokesh. Thank you so much for being here, Doctor.

Dr. Anitha Lokesh: You are welcome. I'm glad to be here today.

Host: So let's just start off with, could you please explain what virtual care encompasses and how it's evolved over the past few years?

Dr. Anitha Lokesh: Yeah, so virtual care is a combination of different kinds of care. It's like telephone visits and video visits, which pretty much I think was available before but just became more user friendly or convenient once the pandemic hit. So interestingly, during the pandemic there was like 50% of care was provided through virtual care, and now about maybe a little more than 10%, we're still seeing virtual care being there. So I think majority of those are video visits and then maybe some telephone visits.

Host: What are some of the major benefits you've seen with virtual care, both for patients and healthcare providers?

Dr. Anitha Lokesh: Yeah, I mean there's several benefits for both. Maybe starting with the patient. I think the number one benefit is the convenience. So you can do a visit like during your lunch hour or at home or at work, or when you're out of town or out of state and you have a problem, that's the convenience for the patient.

And then for the provider, I think it's again, like, say you have an opening in your schedule, but you have like 15 minutes and there's a cancellation and you want to discuss like a lab result or imaging result. And that's a good time to kind of fit that video visit in so you can discuss with the patient so you can proceed with the next step instead of waiting for an in-person appointment.

And then the other added benefit is like say a provider is sick. During COVID we did do this lot where we we had the quarantine, so we were staying home for so many days. So we did video visits from home at that time. So that way, we didn't have to be there in person, but that helped out as far as a provider.

And then I know some providers these days, like especially Telepsychiatry, they work from home and so, they do a lot of video visits from what I hear.

Host: So even with these benefits, virtual care can't completely replace in-person visits. Can you share some examples where in-person care is an absolute must.

Dr. Anitha Lokesh: Yeah, I mean, absolutely I don't think it can ever replace in-person care, but, there is a place for it. So, the in-person care, I mean, if it's something related to skin problems or, say a urinary tract infection or a GYN problem. I mean, we definitely cannot do virtual visits, obviously.

So, those are some examples where a patient has like a, an actual problem that you have to touch and feel, and you have to see the person in the office. So there is some restrictions to virtual visits.

Host: And what advice do you have for patients when they're trying to decide between an in-person or a virtual appointment? Are there clear guidelines or is it more case by case?

Dr. Anitha Lokesh: I think it's more case by case, so there's no real clear guidelines. But the best way to do it would be to call the doctor's office and say, this is what's going on. Is it possible to do a video visit and then let us make that decision? Like yesterday I had this patient who was having a hospital follow up and it was really difficult for her to get here and her husband to, move her here and transport her.

So, they contacted me and I said, yeah, absolutely we can switch it to a video visit. So that worked out great because we went over all her medications and she could address her concerns. And that was convenient for her and that really worked out. But I think it's a case by case basis.

Host: That's a good point. Transportation is a big deal for people, especially elderly. Not everyone lives with someone or has access to Uber or whatnot, so I can imagine for those people, like you said, virtual is great. Have you encountered any challenges in diagnosing or treating patients virtually that would've been easier in person?

Dr. Anitha Lokesh: Yeah, I have, I do have younger adults in my practice, fortunately compared to my colleagues. So, they're either in college or they're outside somewhere and they, like an ankle sprain or a rash. They've tried to do video visits, but a lot of times I'm going to have to say, I really need you to come in to be seen because, I'm not able to see that very clearly.

So those are the instances when, and, or even like an eye problem, they'll try to come closer to the camera, but unfortunately it's not the same till you actually look at them and examine them. So, those are the instances I've said, you know, I, I mean, we tried, but I really think you need to come in person.

Host: Dr. Lokesh from a patient safety and quality of care perspective, what are the risks of relying too heavily on virtual care?

Dr. Anitha Lokesh: So yeah, for instance, abdominal pain, that's one I would say is a really not a safe one to do a virtual visit for because I mean, you really need to be seen and examined before you can do that. So, the other thing is the HIPAA part. I mean, if they're out and about, like at work, I mean, they should be in a safe place where no one else is there if they don't want other people to hear what they're saying. Same thing with psychiatry. They have to be in a safe place where what we discuss is in a confidential environment. So, those are certain safety things that I can think of as far as patients. Yeah.

Host: How do you think the healthcare systems strike the right balance between offering virtual convenience and ensuring essential in-person care isn't overlooked?

Dr. Anitha Lokesh: So, I think these visits have to compliment each other, so I'm thinking, the virtual visits is going to compliment in-person care. That's how I would put it, because there's so many advantages to virtual visits, like I said, especially like hospital follow-ups or avoiding an ER visit, like say someone is having something acute going on and they want to try and be seen, but they're calling at the last minute. We can't work them in in-person, but at least we can talk to them and find out all their symptoms and say, okay, you need to head out to the ER or we can see you tomorrow, kind of thing. The other thing is, the ease of scheduling.

I think like a lot of times, if we have cancellations, they can kind of fit those patients in there and say a patient wants to be seen so that they can get approval for like whatever, like their work, they need some things get done for their work and a form filled out. Then those are the things we can sometimes do a quick video visit and go over a form like an FMLA form for instance, or any kind of like form for work or school.

Sometimes instead of having the patient come in to discuss it, we can do it over the video visit. And then, mostly I think psychiatry, I mean medications and follow up on medications. I think that plays a big role.

Host: And looking ahead, what role do you see virtual care playing in the future of medicine, especially in complimenting, not replacing in-person care?

Dr. Anitha Lokesh: I think it is here to stay. I mean, like I said, we may not be doing as many virtual visits like before, but I think we have all realized that both physicians and the patients have realized how convenient this can be to address like medical problems. I mean, especially if someone's traveling or out of state.

 I do have some patients out of state and that has been very useful for that. So I think people are realizing that this is something that will help actually improve healthcare and improve quality of healthcare where people can ask questions and actually take better care of themselves instead of waiting to see a doctor in-person.

 I feel like it will only improve healthcare going forward, but again, it has its niche, so you have to be really careful which ones you can do video visits and which patients you cannot.

Host: Exactly, and you make a good point about people traveling or out of town or they moved and they want to keep their doctor. Thank you so much for sharing your expertise today. This has been so informative and helpful. We appreciate your time.

Dr. Anitha Lokesh: Oh, you're welcome. I was glad to share this and I still do video visits, like I said yesterday, I had one that we did all of a sudden, and it worked out great. And I have another patient, that lives in Stewart, Virginia, that we had to do an urgent video visit and that saved her from getting into like acute renal failure, because we were able to do that video visit and she could go immediately to an ER and get treated. So that was definitely a useful tool.

Host: Definitely, thank goodness. Again, that's Dr. Anitha Lokesh. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org.

And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Meaningful Medicine, a Novant Health podcast.