Before the COVID-19 pandemic hit Texas, nutrition junior Dalia Nouraldeen would regularly visit her doctor to manage Crohn’s disease, a chronic illness that causes inflammation in her intestines. As her doctor showed lab testing results on a computer screen, the pair talked about how fatigue, stomach and joint pain affects her daily life.
Now, Nouraldeen receives her lab results over the phone and online. She says the experience is strange and causes miscommunication. These days, she finds herself talking more to nurses than her actual doctor, whom she has known for almost two years and usually keeps updated on her personal life and progress in school.
“If I’m with my doctor and they’re looking at me, I feel obligated to tell them everything that’s going on,” Nouraldeen said. “You feel a little bit closer, a little bit more comfortable talking to an actual person that’s standing right next to you than seeing them on screen.”
As the pandemic makes it difficult, if not impossible, for patients to receive treatment for their chronic illnesses, UT students are increasingly turning to telehealth, meaning they receive health care online and over the phone. Over the last month, UT Health Austin, the clinical practice of the Dell Medical School, has reported a dramatic increase in telehealth appointments, going from less than 25 appointments per day to 90-170.
The sudden switch to telehealth in the medical industry came with both advantages and disadvantages, said Elizabeth Jacobs, chief of primary care and associate chair for research in the Department of Internal Medicine at Dell Medical School. According to their website, most clinics at UT Health Austin are providing telehealth appointments, which are conducted through Zoom.
“If you can deliver health care to someone in their home, that’s really bringing value to them,” Jacobs said. “They're getting what they need and you’re not asking them to spend two hours of their day trying to get there.”
While Nouraldeen said the experience is impersonal, one benefit of telehealth has been increased accessibility. She said when she had a recent flare up, she was able to get help much more quickly than she would have in person.
“We went over my symptoms over the phone and decided that I needed to get blood work done and some other tests,” Nouraldeen said. “Normally, I would have to wait weeks to schedule an appointment in the first place just to go over my symptoms.”
Rose Monroe, a radio-television-film and advertising sophomore, has started relying on telehealth to monitor her hormone deficiency.
Monroe, who had her thyroid removed after experiencing thyroid cancer during her senior year of high school, said her recent doctor’s appointments have been much shorter than her in-person visits, where she could talk in more detail about her concerns.
“To me, doing Zoom and online stuff just isn’t the same as doing things in person,” Monroe said. “You miss that in-person touch.”
Monroe said her doctor also had thyroid cancer at a young age, so she felt very reassured by her success with the disease. She said they talk about their lives and tell jokes more during in-person appointments than telehealth appointments.
Nouraldeen said she feels like it’s easier to hide how she feels when she does not meet with her doctor in person.
“Sometimes I would go to appointments and (my doctor) could tell that I wasn’t well just by looking at me,” Nouraldeen said.
From a doctor’s perspective, Jacobs said another advantage of telehealth is an easy-to-use home monitoring system, which doesn't rely on constant phone calls. UT Health Austin has worked with Seattle-based company Sentinel Healthcare to develop an app to monitor people who have tested positive for COVID-19. The app displays patients’ symptoms on a dashboard health providers can access in order to monitor patients at home, Jacobs said.
Jacobs said her team has monitored symptoms for around 120 people, almost all of whom have been tested for COVID-19 at UT Health Austin. She said one patient was able to call the emergency room to prepare for their arrival, and another received IV fluids at home.
“If people download an app and log their symptoms at home, we can see what their symptoms are, are they getting worse, are there concerning things that we should give them a call for and help them manage their COVID at home,”Jacobs said.
Jacobs said the potential uses for this system go beyond care for COVID-19 patients: This kind of app could be used in the future with other chronic illnesses.
“It’s great because it empowers people,” Jacobs said. “They feel like someone is watching over them, because we are, and it reduces the amount of burden on the health care system.”
Nouraldeen said although she does not want telehealth to fully replace in-person health care, she could see it becoming a supplement to traditional health services.
“For something small that you just want to talk to your doctor about, telehealth … is a lot more convenient for people with a really active lifestyle, like a lot of students have,” Nouraldeen said.
Telehealth is also more accessible to patients in traditionally underserved communities, said Jacobs, who works with CommUnity Care, a system of clinics in Austin that serves patients who may not have insurance or struggle with language barriers. The rate of patients who show up to appointments there has increased by 20-30% to almost 100%, Jacobs said, based on her anecdotal experience.
Despite all of the advantages of telehealth, Jacobs acknowledged that technology isn’t the same as real, human interaction.
“There is nothing more powerful than a relationship between two people, and that is true in medicine as well,” Jacobs said. “I get to develop relationships with people that I've taken care of for years. There’s something about the in-person interaction.”