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The Covid-19 pandemic and technological advancement in healthcare delivery have introduced telemedicine in prenatal care. It might seem that telemedicine is here to stay and in a few years, will become a major approach in delivering health care to pregnant women.
With telemedicine, expecting mothers receive consistent and necessary care via videoconferencing, at-home monitoring, and consultation with remote specialists. These were said to improve health outcomes while allowing for less frequent antenatal visits.
However, certain challenges may affect the use and outcome of telemedicine to provide care to patients. Below are perceived barriers to telemedicine in prenatal care.
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Several factors affect the use and health outcomes of telemedicine. Patients and healthcare providers alike play a significant role in the provision and delivery. However, other non-human factors exist which may affect the successful outcome of virtual visits and at-home monitoring.
The following are perceived barriers to telemedicine in prenatal care:
Poor internet connection and slow speed result in loss of connection, poor audio and video quality, hence affecting the smooth interaction between patients and providers. Due to poor signal, online consultations can experience multiple interruptions leading to frustration, low patient satisfaction, and reduced use of the virtual approach to healthcare delivery.
In some cases, factors such as weather conditions, living in rural areas, and home interior can affect the network service in homes and workplaces, hence reducing the frequency, duration, and efficiency of virtual visits for healthcare delivery.
Lack of technological knowledge and skills is a challenge to the use and success of telemedicine in prenatal care. Unfamiliarity with communication technology is common to both patients and providers.
Healthcare providers who have little to no knowledge on how to use communication technology may not want to take up online consultations.
Likewise, patients may find it difficult to install and navigate the telemedicine software on their digital devices. In other cases, patients lack knowledge and training on how to use certain monitoring devices. Hence, they may find it difficult or impossible to interact and provide adequate information during online consultations.
The lack of certain equipment and instruments poses a challenge to the success of telemedicine in prenatal care. Some patients may not have certain instruments such as a fetoscope, weighing scale, sphygmomanometer, amongst others, resulting in non-availability of data to work with.
Consequently, this can lead to poor monitoring which may affect health outcomes of prenatal care via telemedicine.
While patients may enjoy convenience at home, they may be faced with discussing health concerns at the risk of being heard by family members and friends.
In-person visits provide the privacy of the doctor's office which may not be possible with audio and video calls from the homes of patients. This may affect the use of telemedicine in providing and accessing prenatal care.
In other cases, the patient may feel their conversations are being recorded and hence, lose trust in both the service and the healthcare provider.
Telemedicine switches up the order of the conventional hospital visit. The presence of family members, children, colleagues, and other persons may make engagement difficult. Activities in the background may cause distraction during virtual visits.
On the other hand, certain patients may feel disconnected due to a lack of social presence and physical contact with their healthcare provider. The online interaction may be alien to some patients and affect their ability to bond with their healthcare provider.
Nonverbal communication is as effective as verbal communication and in some cases, more. Virtual visits limit communication with body language and facial expressions. Healthcare providers can read these cues during in-person visits and act accordingly.
While telemedicine might be said to save cost, it does not come cheap. Patients may lack the financial ability to buy smartphones, airtime and data, and instruments and equipment.
Unfortunately, patients may not have insurance, or their insurance companies may not cover telemedicine healthcare services.
Healthcare providers are not left out as they also need airtime and data to call and interact with patients.
Telemedicine is a novel approach to access and delivery of prenatal care. Like the conventional in-person approach of care, it has its pros and cons.
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At My Virtual Physician, our team is committed to ensuring that patients get the best of health care as needed. We provide virtual care at any point in your pregnancy while you await your appointment with your local OB doctor. We are in network with many insurance health plans including Medicaid, Medicare, United HealthCare, and Blue Cross.
Every woman desires to have a healthy pregnancy and birth without complications. Prenatal care helps improve an expecting mother's chances of a healthy pregnancy and birth. In prenatal care, a pregnant woman visits a health care provider at intervals to assess and monitor her health and that of the growing baby.
Prenatal care, also known as antenatal care, is the health care a woman receives during pregnancy. Accessed by 4 million women every year, prenatal care is one of the most common preventive health services in the United States.
Prenatal care involves regular checkups with your healthcare provider and routine testing to ensure you are healthy throughout your pregnancy and have a complication-free birth and a healthy baby. During these appointments with your healthcare provider, you get to ask questions and report any complaints you may have. A doctor, nurse, or midwife provides answers to these questions, advice, and possible treatments for whatever complaint you report.
Appointments during prenatal care depend on the age of your pregnancy and your risk for complications.
Telemedicine is simply the use of technology to access and provide health care remotely. The Covid-19 pandemic made healthcare less accessible and unsafe for both healthcare providers and patients. However, with telemedicine, pregnant women and their families could access healthcare without being physically present. Information such as readings and test results could be exchanged via videoconferencing, voice calls, text messaging, and other formats on mobile devices and computers.
Hence, telemedicine has made healthcare more accessible, cost-effective, and convenient with patients receiving care from the comfort of their homes. Consequently, telemedicine has reduced the number of ER visits and the workload at hospitals.
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Although telemedicine is not new to the healthcare system, its use in prenatal care is low. In prenatal care, telemedicine provides an avenue for pregnant women to keep appointments and receive care via apps and other software on digital devices. These apps provide opportunities for home monitoring of vital signs including temperature and blood pressure, fetal heart rate, blood sugar, and weight amongst others. Besides having routine appointments with their general physician, pregnant women can book consultation sessions with specialists such as Obstetricians, Psychiatrists, Genetic Counselors, and Lactation Consultants.
With telemedicine, you can have your appointment from the comfort of your home. The physicians at My Virtual Physician are there when you have concerns, issues, and questions that do not require hands-on physical examination. Hence, we supplement the care you will receive from your local Obstetrician.
You can book an appointment or call for an appointment with our Obstetric and Gynecology specialists. To book your appointment, we will collect some data such as your name, address, and date of birth. You will be asked to specify the reason for your visit, your preferred day of the week, and your preferred time frame.
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During the video call, we will collect confidential medical, obstetric, and gynecology history. Privacy is very important and we adhere to all ethical rules binding that. We will ask you to agree or "consent" to the terms and conditions of the telemedicine visit.
During the video visit, we will ask you for other data such as vital signs including weight, temperature, and blood pressure. We will ask about medications you're using, allergies, diet and food cravings, complaints, and other important information. The data collected inform what action of care will be provided.
A visit to us helps you get your prenatal care started while you await your appointment with your local OB doctor. Your virtual physician can help to electronically order prenatal care labs and/or send an order to the nearest radiology facility for you to get an ultrasound.
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At My Virtual Physician, we are available to help guide you through your pregnancy and answer any questions that may arise. We are in network with many insurance health plans including Medicaid, Medicare, United HealthCare and Blue Cross.
Many women enjoy the feel of soft-shaven skin. But the red, itchy patches that come after can be a real pain. Razor bumps in sensitive areas like the bikini line are annoying. So how can men and women deal with razor bumps down there?
Razor bumps, technically called pseudofolliculitis barbae, are a common skin complaint. Fortunately, they are preventable to some degree. By protecting skin before, during, and after hair removal, men and women can minimize the effects of razor bumps.
If you're wondering how to save your skin, check out these tips to steer clear of painful razor bumps.
Razor bumps are an uncomfortable sign of skin irritation. For those who already have them, the first step is to keep them from getting worse.
A compress made with salt water can also help soothe the skin. Saltwater cleans and heals the skin by osmosis. To make a "saline soak" at home:
Consider adding a couple of drops of an essential oil, like tea tree oil, to the saline solution for more relief.
When bumps don't go away or become more painful, it may be best to see a doctor.
A physician can tell if the problem is razor bumps or may be something else. Some doctors use antibiotic gels, steroids, or retinoids to treat severe cases.
They say an ounce of prevention is worth a pound of cure. When it comes to razor bumps, it's very true.
Here's how you can lower your risk of getting razor bumps from shaving.
Find more tips on how to prevent razor bumps here.
Taking care of skin before, during, and after hair removal can go a long way in preventing razor bumps.
If you've tried to treat pseudofolliculitis barbae yourself but find the situation getting worse, it may be time to check with a doctor.
Are you looking for a doctor near you to treat your sensitive issues? My Virtual Physician has board-certified physicians who can address gynecological and primary care problems via video visits.
If you would like to talk with a board-certified doctor, you can schedule your appointment online now. My Virtual Physician offers health screening, lab tests, and counseling to meet all of your healthcare needs.
This past year tested many young businesses. Telemedicine is not new. But the My Virtual Physician (MVP) business model is. The virtual doctor practice offers the best in online doctor services as a direct-to-consumer multi-specialty provider licensed in multiple states. Regardless of 2020's challenges, the MVP virtual doctor team didn't slow down. They focused on their path to becoming the #1 online doctor and forged ahead.
Over the last 12 months, MVP worked hard to bring high-quality medical care into homes in 15 states. They now offer online pediatric, gynecologic, and primary healthcare services for patients of all ages. Plus, they provide same-day scheduling for online physician appointments, some in-network insurance benefits, and five-star customer service.
As the #1 online healthcare provider, MVP doctors get to know their patients. Quality care is emphasized, and they aim to provide the best patient satisfaction in telemedicine. Here’s what patients are saying about MVP's online doctors:
“I would give My Virtual Physician more stars if I could”
“Dr. Howard has the best personality and is very friendly.”
“The future of medical visits; what better way to social distance.”
“A+ would recommend to everyone.”
Since their launch, MVP has opened new offices and added service lines such as nutrition and diabetic care. The practice has partnered with more online doctors and added office staff. Just this Spring, MVP enhanced their patient portal for self-scheduling, and integrated a program to trend patient reviews.
This one year anniversary milestone is cause for celebration. It is exciting, and this is only the beginning. Despite any challenges that lie ahead for this medical practice, their progress shows that the future is very bright for My Virtual Physician.
Congratulations to Dr. Howard, Dr. Masghati, Dr. Ayyagari, and all of the My Virtual Physician Staff.
Starting a family is a goal for many couples. Unfortunately, one in ten couples may have some difficulty getting pregnant and require medical treatment. If you've been affected, you might be wondering about infertility: when is it time to see a doctor? My Virtual Physician has board certified physicians who specialize in infertility and are available for virtual doctor visits.
Infertility is a diagnosable medical condition in which a couple cannot conceive a pregnancy despite unprotected intercourse. It can be caused by many factors.
In women, most often, abnormal ovulation causes infertility. In men, usually problems with sperm cells, such as sperm count or function, cause difficulty conceiving.
Aside from these physiological causes, factors affecting a couple's fertility include their age, health status, and lifestyle factors such as stress, diet, or smoking.
According to the American College of Obstetricians and Gynecologists, women who are overweight, underweight, or exercise too much may have difficulty getting pregnant, and men who are heavy drinkers or smoke marijuana since these are known to lower sperm count and movement.
In some cases, doctors cannot determine the cause and refer to these cases as unexplained infertility.
Generally, it is time to consult your physician about getting pregnant if you are under the age of 35 and have been unable to conceive after one year of unprotected sex. Women over the age of 35 and those who have irregular menstrual cycles or have known abnormalities with their reproductive system, should talk with their doctor much sooner, after six months.
Infertility affects both people in the relationship. There is a 30% chance the infertility is related to male factors in a traditional couple, 30% related to female factors, and a 30% chance a combination of both factors. Therefore, anyone in the relationship may need to discuss options for starting a family. Here are some reasons to see a virtual doctor:
When you consult your physician about infertility, you can expect that they will begin your care with a complete history and physical exam. They may order blood testing, urinalysis, hormone tests, or other diagnostics to check for abnormalities. It may be necessary to have your partner undergo an exam and diagnostic testing also. Your physician may order an ultrasound or an X-ray as well.
After all of the tests, you will meet with your physician to discuss the results and go over treatment options and recommendations. After you decide on the treatment plan that is best for you, you will receive support and guidance in your process to get pregnant.
Medical treatment and new technologies can increase your chances of getting pregnant. One or both partners in a couple may undergo treatment.
Medications may be taken by mouth or injected. There are drug therapies for both men and women aimed at increasing egg production or sperm count. A list of medicines frequently prescribed for infertility treatment can be found here.
In some cases, blockages, scar tissue, or abnormal growths require surgical intervention. Procedures may be laparoscopic: meaning performed through small incisions in the abdomen for a minimally-invasive procedure.
Today, the two most common infertility treatments are intrauterine insemination (IUI) and in vitro fertilization (IVF).
IUI is a procedure during which a physician injects sperm into the uterus at the ovulation time. This method is least invasive and most cost-effective but has lower success rates. The estimated success rate is 10-20% for a single cycle of IUI, but additional rounds increase chances, and in three to six cycles, the success rate is up to 80%.
IVF is a complicated procedure requiring surgical retrieval of a woman's eggs, fertilization in a laboratory, and then transferring the fertilized eggs back into the uterus. Women under the age of 35 can expect a 50% success rate for IVF treatment, but this process requires intense testing and monitoring and can cost $20,000 to $50,000.
Starting a family can be challenging, and your physician may offer options to guide you through the process. Infertility is a medical condition that affects many couples, and there are treatments available.
Need to talk to a physician now? My Virtual Physician has Board-Certified OB/GYN's that are available for virtual doctor appointments and are able to answer any questions you have and guide you in the right direction. The online doctors at My Virtual Physician, not only address infertility and reproductive endocrinology, but also irregular periods and painful periods, and many more gynecological conditions.
If you still have questions or you would like to discuss your problem with our board-certified OB/GYN specialists, click below to schedule an appointment. My Virtual Physician treats conditions, including infertility, irregular periods, sexually transmitted infections, and more. If you have any suggestions for additional topics you want to read about, let us know! Don’t forget to check out our podcasts for more and follow us on social media.
Speaker 1:
The information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not a diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own health care professional about all topics address on Talk Tuesdays or for any other medical problem.
Speaker 1:
Welcome, everyone. Thank you for joining us today. My name is Stephanie and I'm part of the team here at My Virtual Physician. We are a direct to consumer multi-specialty telemedicine provider operating in multiple States. It is Talk Tuesday and we are continuing our weekly educational series to talk with our experts, explore some common healthcare concerns that we see and hopefully answer some questions you may have today. Our physician expert is dr. Coleman. She is a general surgeon, and today we are going to talk about breast cancer screening and breast cancer surgery. So thank you for joining us today. Thanks for having me. Yeah. And welcome
Speaker 2:
Back October was breast cancer awareness month. So we're going to be doing
Speaker 1:
Again a blog and an episode or two of Talk Tuesday on breast cancer screening. When would someone go in to get a mammogram or if they feel something or they have any history of breast cancer in their family, what's kind of the age range,
Speaker 2:
What to look for. Okay. So there's actually three organizations, probably more, but there's at least three organizations that have opinions on breast cancer screening, depending on which organization you listen to, it could be 40 years old, 45 years old or 50 years old, either way. Everyone agrees that by the age of 50, you should be getting a screening mammogram, most people, uh, and I believe most insurance companies go with the age of 40 breast cancer. Under the age of 40 is pretty rare. If, if you have
Speaker 1:
Breast cancer under the age of 40, usually it's associated
Speaker 2:
With some sort of genetic predisposition. There's the BRC mutation that predispose people to, to breast cancer at a younger age. But there's some other things that can, can run in families. Some other genetic diseases that predispose you at a younger age and typically cancer at a younger age is more aggressive and more advanced when it's found, because who in their thirties thinks that they're going to have breast cancer. So what we learned in residency was at the age of 40, you started getting your screening mammograms, and that's just, you have no symptoms. You have nothing going on. You're 40 years old. It's time to get a mammogram. Just like when you turn 50, you got to get a colonoscopy. It's just a way of life. Some people will come in. Well, I feel a mass I'm worried. And this also kind of depends on your age.
Speaker 2:
If you're younger, the chances of you having a mass that's breast cancer is pretty low. You, you may have these little hard nodules called fibroadenomas. They're pretty common in younger people and they grow and shrink in size with your menstrual cycle. And that's something that people usually will point out like, Oh, I noticed this, I know I was on my period last week and now I don't really feel it so much. And so that's, that's pretty common and we can actually do ultrasounds in clinic. I mean, not everyone, but if you're, if the clinic has an ultrasound, we can do an ultrasound because sometimes it's just breast cyst that can feel like a lump and they can hurt. And if it is a cyst, they can drain it in the office and, and hopefully give you some relief. So when you turn 40, get a mammogram, if you feel something that's concerning, you would need to go into your doctor, talk to them about getting an ultrasound or a mammogram.
Speaker 2:
And again, depending on your age, it may dictate what screening that they do. If you have a family history of breast cancer, then that would be something to coordinate with your doctor to get a screening done earlier. They usually recommend doing screening before 40, uh, it may be an MRI and mammogram alternating every six months starting at the age of 25 30. It just kind of depends on when your family member had breast cancer and what genetic mutation it is that you have. So I've had my screening mammogram and I got called back in for more images, do I have cancer? So not necessarily, this is something we actually deal with quite a lot. It really kind of depends on your age and your breast tissue density. It can be really hard to evaluate the breast tissue on a screening mammogram. If you have really dense breast tissue, there's actually, uh, States that have a requirement when they report on your mammogram, that they disclose to you that there are certain regions, depending on the density of your breasts, that they may not be able to see.
Speaker 2:
So they have to give you that information because then if you end up having breast cancer, but you've, you've had a screening mammogram, you know, why wasn't it caught well, and it, it can just really depend on the density of your arrests. So sometimes you'll get a call that you need to come back in and it's for a more formal or what we call a diagnostic mammogram. The difference in that is with a screening mammogram, you kind of just, you go into a facility, they do the mammogram and you go home. And in a couple of days, they either call you with the results or you go into your doctor's office and they give you the results, a diagnostic mammogram, you go into a facility, but the radiologist is, is physically there. And when they do the mammogram, they try and focus on that area that was questionable in your screening mammogram.
Speaker 2:
And so the radiologist can actually look at it in real-time and determine, okay, well, we need a different view here, or we need to zoom in here and take a better look at that so that you don't get called back in for even more. This is, I'm a little bit better idea of, of what they're looking at. And if it, if it is something that looks suspicious for cancer or not, some patients may actually end up needing an ultrasound to go with their mammogram or an MRI. It's all pretty personalized. So it all just depends on what your breast tissue looks like and what, what exactly it is, that's going on, what was seen, or if you're having symptoms and things like that. So it could just be that you have dense breast tissue, and it does not look abnormal when they do the more focused imaging, or could be something that, that is concerning for breast cancer. But being called back does not mean that you have cancer. You could, but they just need to get better pictures. Yeah.
Speaker 1:
Since so, after I got called in my mammogram showed an area concerning for breast cancer and I need a biopsy. Can you explain what that is?
Speaker 2:
Yeah. So when you need a biopsy, it doesn't necessarily mean that it's cancer again. So, so don't panic, but chances are, they saw something that are concerning and suspicious for cancer, and chances are it is, but I need a tissue sample to say for sure what it is. There's different types of breast cancer, there's DCIS, which maybe you've heard of, or there's invasive cancers by doing the biopsy. It gives you a little sample of tissue to be able to determine what type of cancer it is, what hormone receptors it has if it has any. And, and that helps you tailor your treatment, not only for surgery, but if you need chemo or other things, or even additional surgery, when you meet a bias, it can be done a couple of ways, the most common way, or at least the way that I'm used to it being done from when I was in residency is if you have a mask that can be felt if you came in because you had an that you found and you get a mammogram and they, they say, we need to biopsy.
Speaker 2:
If they can see it, then you can get a biopsy done with an ultrasound and you don't have to go through a mammogram again. If you can't see it on an ultrasound, then you got to get a mammogram again. So not, not super fun for everybody when they do it with under a mammogram, it's done by a radiologist typically, and it's called a stereotactic biopsy. So essentially you lay down on this table and you lay face down and there's, there's a little opening in the table. And the breast with the concerning area goes through this little hole in the table and kind of hangs blue so that the arm on this machine can get in the right position and orientation to access the delusion that the arm on the mammogram machine has a needle on it. And once the area is targeted, the needle goes in, they take a sample of the breast tissue that comes out, but there's also a clip that gets placed in the area that they biopsied.
Speaker 2:
So that on later imaging, you can say, okay, well, we already biopsy this area and everything was normal. Or this is where they had a biopsy before we don't see anything different. Or, you know, now there's something there that, that wasn't there before. And we need to re-investigate it. Sometimes you can't do the stereotactic biopsy and that's for reasons, you know, maybe you can't lay flat, maybe it's too uncomfortable, or you can't breathe. There are weight limitations. And depending on your age, I mean, it may just not be something that you're very capable of laying there because it's not, it's not a five-minute procedure. I mean, it's a 20-minute procedure or so. And it depends on where the lesion is. If it's really close to your chest wall, like the muscles underneath your breasts, they don't usually do the stereotactic biopsy. They can still do a biopsy under a mammogram. It's just done a little bit differently. This is all kind of targeted and oriented and one process. Whereas if they have to do it with, without the stereotactic part, it's done a little bit differently. Now there are some stereotactic biopsy machines where you can actually sit up. I don't know how many places have those. Like I don't, I'm not real familiar with how prevalent they are, but they do exist. So that maybe something that they could do.
Speaker 1:
Thank you so much, Dr. Coleman. I know it's a really hard topic to talk about. Cancer is always something that's a pretty scary word. I appreciate you joining us for Talk Tuesdays and telling us what we need to know about breast cancer screening for everyone else. This has been Talk Tuesdays with My Virtual Physician. You can schedule a consultation with one of our doctors by visiting our website: www.myvirtualphysician.com. We look forward to seeing you again, and we hope you have a great week.
Speaker 1 :
Information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not a diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics addressed on Talk Tuesdays or for any other medical things.
