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Everything you need to know about virtual doctor appointments, plus when you really should see an MD in person.

What Exactly Is Telemedicine—and How Does It Work? | Health.com

Nearly half of US doctors now report treating patients via telemedicine (also known as telehealth), according to a recent survey by Merritt Hawkins in collaboration with The Physicians Foundation. Telemedicine isn’t actually a new thing; doctors have been offering telephone consultations for decades. But the COVID-19 era has brought telemedicine to the forefront of health care. Until there’s a proven treatment or vaccine for the new coronavirus, getting medical advice, checking out symptoms, or going for a checkup remotely might be a reality for many of us. Here’s what doctors who practice telehealth want you to know about it.

What is telemedicine? 

Telehealth is simpler than it sounds. Basically, you get a consultation or an appointment with your doctor over the phone or via an online video platform like Skype, FaceTime, or Zoom. Think of it as a “virtual visit” with your health care provider. 

Before COVID-19, New York City-based gynecologist Rebecca C. Brightman, MD, assistant clinical professor of obstetrics, gynecology and reproductive medicine at the Icahn School of Medicine at Mount Sinai, offered phone consults to patients. But since the outbreak, she’s offered both consultations and appointments via phone or webcam. “I offer both to my patients—it’s up to them whether they want the face-to-face interaction,” she tells Health. 

Orthodontist Heather Kunen, DDS, co-founder of dental practice Beam Street, in New York City, is another doctor who has embraced telehealth. “Prior to the COVID-19 pandemic, my office had been considering incorporating virtual Invisalign consultations as part of our list of services,” she tells Health. “The lockdown/stay-at-home orders motivated us to officially implement the virtual service using Zoom.”

Most health care providers are pretty flexible when it comes to digital platforms. “Using FaceTime is a simple option for those with an iPhone, and Skype works great as well,” pediatric urologist Jay Levy, MD, who is a medical director at Aeroflow Healthcare, tells Health. “Many providers also offer an electronic medical record system, like Doxy.me, where patients can check in online and connect with their doctor.” 

Various health care platforms are available to connect patients remotely with the right medical providers, such as Walgreens Find Care, which also offers a virtual pharmacy to those who need to have their prescriptions filled and delivered. 

What do I need to do telemedicine appointments?

If you’re happy with a phone consultation, all you need is a phone. If you’d prefer a face-to-face consultation, you’ll need a smartphone, tablet, or a computer with a webcam. To ensure a positive, productive telemedicine experience, Dr. Levy says the most important thing is to check your WiFi is working properly. “One of the biggest issues is an appointment being sidetracked or ultimately cancelled due to poor WiFi connectivity,” he says. 

Just as you have a private, quiet space when you meet with your health care provider in their office, it’s a good idea to do the same at home. Dr. Levy suggests a well-lit space where you’re not likely to be disturbed. On that note, it’s a good idea to let others in your home know ahead of time that you’ll be unavailable during your appointment time frame. 

Any other preparation, such as checking your weight or your temperature, really depends on the specific health questions you have. To give your doctor an accurate health history, take note of any symptoms and their duration, Kevin Ban, MD, chief medical officer at Walgreens, tells Health. 

Do all insurance companies cover it?

Not necessarily. “As telehealth has become even more critical to help address medical needs during the coronavirus outbreak, the government, health plans, and providers have begun instituting new policies and technological advances to make it more accessible to patients across the nation,” says Dr. Ban. For instance, the federal government recently passed legislation expanding the availability of services provided through telehealth under Medicare. 

When you call the doctor’s office to make or confirm an appointment date and time, staff will verify your insurance, make any necessary updates and, if applicable, take payment for your co-pay over the phone, Dr. Levy says. Still, play it safe by asking your health care provider or their office staff about coverage before you schedule an appointment, or what the total cost will be. 

What happens during a telemedicine appointment?

During a telehealth consultation, Dr. Brightman asks her patients questions about their medical history and current symptoms to decide the best course of treatment. She never asks a patient to disrobe, but they can send her a photo (without any identifiers) if they are concerned about a visible finding. “This can help me make a diagnosis and work out whether or not it can be treated remotely or requires an office visit. “Typically, nobody else is present when I host a telemedicine visit,” she adds. 

If she decides that a patient needs an exam, she encourages them to come to the office, where all precautions have been taken regarding social distancing, hand hygiene, and personal protective equipment (PPE) where appropriate. 

Dr. Kunen starts a Zoom consultation by asking her patient what their chief concern is. She then examines their teeth and analyzes their bite before providing a diagnosis. “I explain the Invisalign product and process to the patient and answer any questions they may have,” she says. After the consultation, the practice’s treatment coordinator contacts the patient to discuss financials and the next steps. 

Can my partner or friend listen in for support?

It’s absolutely fine if you want your partner, family member, or roommate to be present during your telehealth appointment. “I have had several telemedicine appointments with young teens who have wanted their moms present during the visit,” says Dr. Brightman. “Having a family member present can also be helpful when it comes to obtaining a family history or reviewing a course of treatment.” 

Dr. Kunen always encourages her patients to invite a friend or family member to be present. “I want consultations to be fun and comfortable, whether they’re done in person or virtually,” she says. 

When should I stick with an IRL visit?

“Telemedicine can support many acute care needs and illnesses, but it’s not appropriate in some circumstances,” says Dr. Ban. “For example, patients can’t undergo procedures or receive imaging tests remotely.” And telemedicine is never a replacement for an in-person appointment for patients who are extremely ill and require urgent medical attention, or who have symptoms that could indicate a serious and urgent issue. 

Dr. Brightman has performed consultations via telemedicine for the management of menopausal symptoms and painful periods and family planning, as well as to treat urinary tract and other infections. Some obstetrics visits can also be done virtually, with women checking their blood pressure and weight at home. But Dr. Brightman says there are times when an in-office visit is necessary, such as abnormally heavy bleeding and STI screening. 

When it comes to dentistry, almost all procedures will require an in-person visit at some stage to let the dentist complete any physical work that needs to be done. While minor emergencies like a broken bracket or a popped-out wire can often be resolved temporarily at home via virtual guidance by an orthodontist, detailed clinical observation and specific diagnosis must be done in person, says Dr. Kunen. 

What are the drawbacks?

While telemedicine offers face-to-face interaction with health care providers—which is crucial at a time like this, when needs are critically high due to the COVID-19 pandemic—it’s important to remember that it does have limitations. 

“Physicians are able to rely on patients to take their temperature, however things such as blood pressure and lab work all rely on nursing staff,” says Dr. Levy. “It’s also impossible to recreate the hands-on element of a standard office visit. Without the ability for the doctor to touch or feel the patient, it is sometimes more difficult to determine what the actual issue is.” 

Dr. Kunen agrees that telemedicine may be somewhat limited in terms of what can be accomplished, but she believes it’s “a wonderful adjunct to modern practice.” And during this unprecedented time, when many people may not be able to (or want to) go to an in-person visit, a virtual one is a great alternative in many cases. “Going forward, I think telehealth will remain an important component to all medical practices,” she says.

Source: https://www.health.com/mind-body/what-is-telemedicine-telehealth

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Magnesium is an essential mineral that keeps our bodies running smoothly. Normal serum (blood) magnesium levels are defined as 0.75 to 0.95 mmol/L, with anything below this range indicating potential deficiency known as hypomagnesemia. While only 2% of the population is reported as having hypomagnesemia, some health professionals say that the condition is severely under-diagnosed since magnesium levels are usually only tested when they get dangerously low.

If you’re concerned about your magnesium levels, here are the most common symptoms of a deficiency, how to test your levels, and what to do about it.

Signs of a magnesium deficiency. 

Magnesium deficiency can be hard to diagnose, but if you suffer chronically from two or more of these symptoms, it’s a clue that further testing might be needed.Article continues below

Fatigue

Fatigue and exhaustion are generalized symptoms. You may attribute your tiredness to stress, poor sleep, or a host of other reasons and not realize just how much nutrition is playing a role. According to research on chronic fatigue syndrome, magnesium provides nutritional support to combat fatigue.* This is because magnesium is required for the production of energy.* If the body has inadequate access to magnesium, then energy production suffers, leaving you prone to fatigue.*

Chronic inflammation

Although inflammation is a necessary part of immune function and wound healing, chronic inflammation underlies many major diseases like heart disease and diabetes. Inflammation can feel like hot and swollen localized areas on the body, generalized aches and pains, overall feeling lousy or tired, or show up as an inflammatory diagnosis. 

Magnesium plays a key role in managing the body’s normal inflammatory response.* When magnesium intake is low, inflammatory biomarkers such as high-sensitivity c-reactive protein (hs-CRP), interleukin-6, and fibrinogen are significantly affected.* In fact, a large study of a Nordic diet providing magnesium-rich foods, such as whole grains and vegetables, reduced the pro-inflammatory protein known as Interleukin-1.

Blood sugar spikes and prediabetes

Although blood sugar (glucose) levels are no doubt heavily influenced by what you eat and how much energy you expend, surprisingly they are also influenced by magnesium levels. This is because magnesium assists the body in glucose and insulin metabolism.* 

A large six-year study found that low serum magnesium levels were associated with insulin resistance and risk of prediabetes.* In addition, it found that common variations in magnesium-regulating genes that cause low serum magnesium were associated with increased risk for diabetes.*  Unfortunately, the onset of diabetes might compound the problem because it increases urinary magnesium excretion.

Restless leg syndrome and leg cramps

Although the mechanisms aren’t well understood, there is anecdotal and some limited published evidence that low magnesium levels can cause restless leg syndrome (RLS). 

Magnesium supplementation has been found to help manage symptoms of RLS, leg cramps, and even periodic limb movement disorders.* Magnesium might be most beneficial in muscle cramps related to pregnancy;* however, more research is needed.

Stress and mood swings

More than 40 million Americans’ quality of life is affected by their daily struggles with social stress, fear, and apprehension. Maintaining normal magnesium levels could help manage stress due to magnesium’s beneficial interaction with the brain.* 

Magnesium is important for the regulation of the “feel-good” neurotransmitters dopamine and serotonin as well as the stress response.* In other words, low brain magnesium means serotonin levels are reduced, which can present as mood swings.* Studies back this up, showing that low levels of magnesium intake are associated with mood disorders.*

Migraines and headaches

Migraines are the sixth-most disabling illness worldwide, causing hours and days of recurring pain, sensitivity to light and sound, and even nausea and vomiting. A large body of evidence has found that magnesium, whether administered orally or via IV, can be an effective and inexpensive option for providing nutritional support in the management of migraines.*

Although the mechanisms aren’t fully understood, it is known that maintaining a normal magnesium level helps preserve the electrical function of brain neurons.*

Irregular heartbeat or rhythm

Magnesium is a mineral and electrolyte that the body requires to maintain normal nerve and electrical impulses of the heart.* Heart flutters, elevated or slow heart rate, and a “racing” heartbeat are all signs of a possible magnesium deficiency.* 

In addition, reduced magnesium intake, as well as low serum levels, have been shown to have an adverse effect on multiple aspects of cardiovascular health.* According to a meta-analysis, an extra 100 mg of magnesium a day in the diet was associated with cardiovascular health.*

How to test your magnesium levels.

If you are concerned about your magnesium levels, there are several lab tests you can discuss with your health care provider. A serum magnesium blood test can be obtained with a quick and simple blood draw, although it can be a poor indicator of magnesium levels because 99% of magnesium resides within your cells and tissue.

Urinary magnesium excretion, obtained via a 24-hour urine collection, might be a more accurate assessment tool, but it can be cumbersome. A magnesium retention (or “loading”) test is also more reliable than blood testing but requires measurement of bone magnesium after an oral or IV magnesium dose.

While you’ll need formal testing to know if you’re clinically deficient, you can also add more magnesium-rich foods to your diet or try a magnesium supplement to see if your symptoms improve.

How to get sufficient magnesium.

Several foods contain magnesium, especially dark leafy greens, nuts, seeds, legumes, and whole grains. To get the 350 mg of magnesium per day that the NIH recommends, you also might want to consider talking to your doctor about taking a magnesium supplement. There are several different forms of supplemental magnesium, but the glycinate, citrate, chloride, lactate, and aspartate forms are best absorbed by the body, though some of them are associated with issues like bloating and diarrhea. Magnesium glycinate is less likely to cause side effects and has the added benefit of promoting deeper and more restorative sleep and early research shows it also might help with stress relief.*

The bottom line.

Magnesium is an important mineral that protects our organs, DNA and cell integrity, helps our bodies produce energy, helps maintain the body’s normal inflammatory responses, and supports normal blood pressure and blood sugar levels.*  

Despite several delicious and easy-to-eat foods that supply ample magnesium, like nuts, seeds, beans, dark leafy greens, and whole grains, supplementation may be ideal.

If you suffer chronically from any of the symptoms listed above, then magnesium supplementation could be beneficial.* Aim to consume 300 to 420 mg of magnesium per day from a combination of food and supplements, or more for a diagnosed deficiency.

Source: https://www.mindbodygreen.com/articles/magnesium-deficiency-signs-and-symptoms-to-look-out-for?mbg_mcid=777:5ebf1f435e720f2cea758b25:ot:5c22b3f39799ec3cc6aecb97:1&mbg_hash=57103be3843e0e1cb6615f5efa797221&utm_source=mbg&utm_medium=email&utm_campaign=daily_v2_20200516

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Take these steps to stay healthy if you have to make a doctor’s appointment right now.

The country is gradually emerging from lockdown, with almost every state rolling out phased reopening plans for schools, entertainment venues, and non-essential retailers. But what about a doctor’s office, hospital, or outpatient facility for non-coronavirus care? When are they reopening, and is it risky to go right now?

Teenage girl in a medical examination room after having her blood pressured and heart rate checked. doctor-visit-pandemic-risks , pandemic, covid-19 , doctor-visit, doctor-appointment ,

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During stay-at-home orders, many doctors closed their offices or outpatient spaces entirely, or they only offered telemedicine appointments. Meanwhile, hospitals have been focusing on providing lifesaving care to COVID-19 patients and other emergency cases. As a result, non-emergency treatment, such as elective surgeries and general checkups, have been postponed. 

Doctor’s offices and hospitals have always been thought of as safe places. But it’s totally understandable to feel apprehensive about getting health care right now. Here’s what experts want you to know about going back to your doctor, ER, or outpatient facility for non-COVID-19 visits and treatment. 

When will my doctor reopen for non-coronavirus patients?

It depends on where you live and what kind of appointment you need. If you’re waiting to schedule elective surgery, whether that goes ahead depends on your state government. “We’re not moving ahead with elective surgeries until we are given authorization from the governor and Department of Health to do so,” Andrew Rubin, senior vice president for clinical affairs and ambulatory care at NYU Langone Health, tells Health. “Right now, most cases that are moving forward are those that qualify as urgent or medically necessary.” 

Rubin says that some of the urgent or medically necessary procedures NYU Langone Health is now doing were delayed at the start of the pandemic as long as 90 days, including certain cancer procedures and surgeries, neurologic testing and treatment, and cardiac prosecutes and surgeries. 

Typically, your local county health authority, in consultation with your state, will give guidance to facilities about when and how to reopen. “The ‘when to open’ will rest with the authorities, along with recommended or regulatory mandated guidelines, and the the ‘how we will open’ will be nuanced by the physicians and facility providers,” former hospital CEO, health care advisor, and biomedical ethicist Michael Hunn tells Health.

After restricting their practice to emergency care, Diagnostic and Interventional Spinal Care (DISC) in Newport Beach, California, has now returned to general surgical procedures to treat urgent cases as well as people in severe pain. “Over the coming weeks, we will return to full-spectrum pain management as well,” Robert S. Bray, Jr., MD, DISC founding director, tells Health. 

NYC-based gynecologist Rebecca C. Brightman, MD, assistant clinical professor of obstetrics, gynecology, and reproductive medicine at the Icahn School of Medicine at Mount Sinai, opened up her private practice to patients for non-urgent matters and routine visits on May 11. “We’re following guidelines outlined by the American College of Obstetricians and Gynecologists (ACOG), New York State, and the Department of ob-gyn at the Mount Sinai Healthcare system,” Dr. Brightman tells Health. 

“Some physicians aren’t ready to see patients, and a lot of that has to do with the type of medicine they practice,” adds Dr. Brightman. “If I wasn’t comfortable about seeing my patients, I wouldn’t.” 

What precautions are health care providers taking to keep patients safe?

Health care providers might be gradually getting back to normal in some parts of the country, but new procedures are in place to help reduce the risk of spreading the coronavirus. At NYU Langone Health, all providers, staff, and patients are screened for COVID-19 symptoms at the entrance of the facility, including a temperature check with a “no-touch” thermometer. All patients are required to wear a mask or face covering, and social distancing measures are enforced in waiting areas, says Rubin.  

Extensive protective and preventive measures are also in place at DISC. All employees are tested on a weekly basis at minimum, and “every patient is tested several days before their surgical procedure to assure that no COVID cases are entered into the facility,” says Dr. Bray.  

Everyone in Dr. Brightman’s office is practicing social distancing, sanitizing, and wearing masks. “We are also screening all patients, employees, physicians, couriers, and anyone else who enters the office with a questionnaire, plus we are recording their temperature,” she says“If the screening is abnormal, they won’t be allowed into the office.” Appointments are scheduled in a way that minimizes the number of patients in the waiting room at any given time. 

What can patients do to lower their risk at a doctor’s office or hospital?

Ahead of your appointment, health care staff should let you know what specific precautions you’re expected to take to reduce the spread of COVID-19. Hunn says patients and visitors should take their temperature and wash their hands before they leave the house, wear a mask in the car on the way, wear gloves when necessary, and avoid touching their faces, especially their nose or eyes. 

“Only show up when you need to and not early,” advises Hunn. “Use doors that automatically open. Try not to touch surfaces. Protect others by remaining six feet apart. Be consistent, and don’t let anyone near you who is not doing the same.” Expect to wear a mask inside the doctor’s office or health care facility as well, including during your appointment.

Can patients bring someone with them for support?

Many people might be keen to take a friend or family member with them to a doctor’s appointment or hospital visit. But many hospitals and practices are limiting the number of visitors to maintain safety standards. 

“Currently, adults may not be accompanied to their appointment unless our staff determines it is medically necessary, and children may be accompanied by two adult caretakers,” says Rubin, of NYU Langone. But this is an evolving situation, so he advises checking the current visitor policies before your appointment, and calling your doctor’s office with questions if needed.  

When will my doctor’s office return to normal?

More than ever, patients want to feel safe in their health care facility, and their physicians want safe environments in which to practice. Depending on how the COVID-19 pandemic plays out—only time will tell whether there will be a second wave of the virus, and we’re still many months, if not longer, away from a vaccine—the new protocol could become the norm. 

“Both patients and surgeons are now looking to more ‘safe’ environments like ambulatory surgery centers and outpatient clinics that can tightly control their environments and their infection control procedures,” says Hunn. 

DISC is one example of the ambulatory surgery center model that can care for patients in a non-COVID environment. “This type of facility in a closed environment provides a very safe available option,” says Dr. Bray. “We have the capability of overnight stay, 24-hour nursing, and all necessary follow-up. And we are going to maintain our limited visiting and limited outside-world contact until this crisis is adequately resolved.”

Bottom line: Like just about everything these days, going to your doctor or another medical setting as the country opens up incurs some risk. But if you have a true medical need, it’s important that you get care and treatment. “Some patients with heart attacks, strokes and sports or orthopedic injuries have avoided getting the proper care, which has caused significant harm and long-term negative effects to their health,” says Hunn.

If you’re not in a high-risk group for the coronavirus and take all the necessary precautions before and during your visit, you can rest assured that your health care provider will be doing everything they can to keep you safe and healthy. 

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it’s possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

Source: https://www.health.com/condition/infectious-diseases/coronavirus/is-it-safe-to-go-to-the-doctors-office

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