Telemedicine Made Me a Better, More Confident Patient

Two selfies I posted to Instagram in the last several years confirm roughly when the splotch appeared. A portrait snapped in 2016 shows nothing but an expanse of white cheek, but in January 2018, there it is: a little patch of color between my jawline and my ear alongside a caption joking about how people sometimes ask me where I got my nose job. Punchline: I’ll never tell. Reality: I was born with this nose. I was also born with a family history of skin cancer.

The picture at right, taken in 2018, shows a spot that wasn’t there in 2016 (left)
(Credit: Jill Duffy)

In February 2020, the splotch looked bigger and pinker, and I decided to go to the dermatologist as soon as I wrapped up a two-week vacation. The next thing I knew, it was March 2020, and that routine dermatology appointment I was hoping for was out of the question. My job at that time, I realized, was to convince a doctor over a video call that I needed to see a specialist in person and have the spot biopsied despite the brand-new COVID-19 crisis.

The good news was that many physician’s offices and hospitals had gotten on board with telehealth practically overnight. Virtual appointments are great, maybe even ideal, for medical advice and treatment for run-of-the-mill rashes, children with pink eye, and other nonurgent issues. But they’re not at all helpful if you need preventative or ongoing cancer treatments, which were being postponed(Opens in a new window) in light of the coronavirus. The message at the time was, “Don’t come in if you don’t have to.” Seeing a doctor online became the preferred method for nonurgent care, but those of us with more pressing needs felt stuck and unsure how long to delay.

So I set up an online appointment to lobby for an in-person appointment. Though I worried about my first telehealth experience, in the end, it radically and forever changed the way I advocate for myself as a medical patient. It might have been one of the best healthcare experiences I’ve had. The reason? I’d been working remotely for the previous five years, which meant I was highly skilled at bringing my most professional and confident self to video calls. I’m comfortable and self-assured whenever I sit in front of a computer and webcam because that’s what I do at work. And putting myself into that same place, only this time as a patient, made for a markedly different experience from any interaction I’d had with doctors before.

In-Person vs. Online Health Appointments

Not only was I professionally experienced at taking video calls, but all that experience happened since I’ve been an adult. As a medical patient, my experiences go back to childhood. Those two identities—adult professional and child patient—couldn’t be more different.

Like a lot of people in the US, I grew up without health insurance. I had parents who said of every fever, cold, and broken toe, “You’ll get better.” Each passing day with an illness or injury my mother would ask, “Do you feel better today?” (never, “How are you feeling?” because the right answer would be to improve a little each day). The underlying message felt like, “If you get worse, you might have to go to the doctor, and no one can afford that.”

And perhaps like a lot of people, I was also trained as a kid to placate people in positions of authority by giving them the “right” answers. So even as an adult, when I go to a traditional doctor’s office, I revert to a juvenile mental state. I can’t help it. My amygdala kicks in and tells me I should be seen and not heard, that I should cause the least amount of problems, get out of there quickly, and not waste anyone’s time. How can you advocate for yourself as a patient when you feel like a child trying not to get into trouble?

It was worst of all at the dermatologist for regular skin checks. A nurse or physician’s assistant would prep me first by having me undress and lie face up on a table, draped with a paper sheet. Only then did the doctor come in and ask me about any concerns I had. It’s pretty hard to project poise and determination when you’re nearly naked on a table.

The Video Call That Changed My Relationship to Healthcare

The day of the telehealth appointment, I gave myself a pep talk first. That’s not unusual for me. Sometimes I rehearse what I need to say before a video call or at least think about what I want the outcome to be. Often on calls, I’m the one who drives the conversation. I ask the questions. I decide what I need to get out of it. So that’s the attitude I had going in. 

Because of COVID-19, I anticipated an uphill battle of trying to convince someone to see me in person and biopsy this thing on my face. I knew I’d have to make a good case. 

The doctor logged on early and sent me a text prompting me to do the same. Not for nothing, it was the first time I’d had a dermatology appointment with my clothes on. It was also the first time I spoke with a doctor about my health while in front of my computer, the place where I feel the most competent.

A young man in scrubs blipped into view. Judging by his background, I was fairly certain he was at home. He told me he had read the summary that I entered into the secure medical portal and looked at the pictures I uploaded. “Great,” I said, taking charge. “Let me quickly reiterate it so we’re sure we’re on the same page.” I took him through my bullet points: my family history, how I usually get a skin check once a year and am very familiar with biopsies, and some other logistical issues that complicate my availability. “So I want a biopsy sooner than later.”

We didn’t discuss it much more than that. He put me on hold, conferred with another doctor, and returned a few minutes later to say someone would call me to schedule the appointment. I can’t be sure whether or how much my ability to be direct and advocate for myself influenced the outcome, but the whole process was efficient and felt good.

The Unexpected Long-Term Benefits of Telehealth

Proponents of online healthcare have been pushing to expand it for decades. They’ve talked about how it would cut costs and improve healthcare for low-income and rural communities in particular. But I’ve never heard anyone raise the point that it could benefit someone like me, a person with a complicated history that affects how I behave in an examination room.

As for that spot on my cheek, I did get a biopsy, and a diagnosis, and Mohs surgery(Opens in a new window) to remove it. The surgeon and all the staff were excellent, even in person.

It’s frustrating that it took a global pandemic to kickstart telemedicine in earnest, but I’m glad it did. It’s changed my role as a patient and my ability to speak up for myself. I even think I’m starting to take the lessons I’ve learned about my different identities and bring more of my professional adult self into the physical doctor’s office. After all, I’m good at my job, I know how to plan ahead, I think about the outcomes that I want, and I drive the conversation. Maybe it’s not such a big leap to bring those same skills to my role as a patient.