You wake up with a sore throat, and immediately your mind starts to rumble and twist: a post-nasal drip from allergies? Or COVID 19?
You’ve heard you really shouldn’t physically visit your doctor or clinic until symptoms demand it. But when is it time? And what should you do now?
First, don’t panic. Yes, this is a scary time, but late-spring colds and allergies are not new and they’re certainly not uncommon.
Our clinic for menopause, we’re opening up our telemedicine services to help women get medical attention for gynecological or primary care issues without taking the risk of going to their doctor’s office or clinic.
We talked to two of our telemed docs, Dr. Lisa Savage and Dr. Kristen Innes, about the services they offer, both during “normal” times, and now, during the COVID 19 crisis.
According to Dr. Innes, the Gennev doctors, who are all OB/GYNs, generally provide counseling on menopause and perimenopausal issues such as hot flashes, sleep pattern changes, mood and weight concerns, and so on.
Says Dr. Savage, “If you are concerned about an infection, I can discuss your symptoms and offer advice about whether an exam is needed; usually it is. While we sometimes advise or prescribe without an exam for an infection, the best management for infection includes exam and sometimes culture/tests to establish a diagnosis.” Dr. Innes agrees, adding: “It depends on symptoms; some vaginal infections are easier to treat based on common symptoms. Recurrent infections, lesions and other persistent issues need to be addressed in person with a gynecologist.”
If the problem is severe and urgent, of course, see a medical professional in person immediately. But if you’re just not sure the right next step, a consultation with a Gennev doctor is a good place to start.
Obviously, new conditions may well require an in-person visit, but, recurring prescriptions and conditions that don’t require a visit are perfect for telemedicine. Says Dr. Savage, “With telemedicine, I can prescribe menopause hormone replacement therapy and [other, non-hormonal] meds for menopause management, contraceptives, antibiotics/antifungals (rarely) and some other medications. Usually I limit prescriptions for non-gynecologic conditions to short-term refills of stable meds for chronic conditions in the event that a gyn patient is between primary care doctors or otherwise has a reason the prescriber is not available. I always want to be mindful of not fragmenting a patient’s care or stepping away my area of expertise.”
It’s actually pretty simple, says Dr. Innes. “When you have your visit, make sure to have your pharmacy information available. If a prescription is needed, we can call the medication in for you to the pharmacy.” We’ll also bill your insurance, as applicable.
In “normal” times, Gennev focuses mostly on menopause and the symptoms that can come with it. What does that look like? It’s all about listening to the woman, understanding her current situation and medical history, and tailoring treatment to her body and her needs. That can include medications, lifestyle modifications, naturopathic or alternative therapies, or the perfect blend of all the above.
Says Dr. Savage, “Helping women with menopause symptoms includes assessing whether symptoms are due to menopause/perimenopause, evaluating symptom severity, educating patients on what to expect and offering solutions, which may include medications in addition to holistic/lifestyle ways to manage any troublesome symptoms or changes.”
Dr. Innes agrees, adding, “There are some supplements that may be helpful in a percentage of women who take them. There are also non-hormonal and hormonal medications that may be helpful for some symptoms. There are many ways to individualize care depending on patients' wishes as well as medical and family history.”
Hand-in-hand, both of our doctors attest. Women get the most from Gennev when they access all our services, because doctors and coaches can help inform one another’s treatment of a patient, says Dr. Innes, via Gennev’s HealthFix program.
Dr. Savage: “Health coaches can be especially good and have the time available to review lifestyle/holistic management ideas, not only for menopause but for overall health in general. I always read the health coach’s notes if a patient I see has consulted one. I also remind patients about those recommendations and validate them during telemedicine appointments. Health coaches and physicians can learn from each other as well as both contribute to a patient’s overall experience.”
“Absolutely,” says Dr. Innes. Because Gennev is so concerned about privacy and security, we often exceed the required security measures.
“I conduct telemedicine appointments in my home study with the door closed, and document the appointment via technology that has all the safeguards one would expect for online medical services,” says Dr. Savage. Patients can be confident their privacy is being scrupulously protected.
By now, you might be curious what it’s like to have a telemedicine appointment. We asked our doctors to detail how typical (if anything about menopause can be called “typical”) appointments go.
“During a typical telemedicine appointment, the patient and I ‘connect’ via video chat, or sometimes on the telephone,” says Dr. Savage. “Before each appointment, I have reviewed the intake history a couple of times and read any prior notes, so I’m prepared and can make the most of our time. Preparing ahead of time also gets my diagnostic and therapeutic wheels turning, so I usually already have an idea how to help the patient before we meet. It’s very helpful if patients can be specific when filling out the intake form about what they are concerned about or hoping to achieve.
“When we start the video chat, I conduct the appointment the same way I would in my office. I clarify the history, solicit any additional information needed, listen to the patient describe what she is concerned about, then enter into a conversation about what can be offered to help. Just as in the office, I solicit any questions before concluding. Any prescriptions are then called in to the patient’s pharmacy.
“Our telemedicine visits are documented with notes about what we did and what follow-up is recommended. The patient receives an email with a summary.
“One thing I would add is that for my personal practice style, it is very helpful to have a 30-minute visit for a new patient. Even that goes by fast! I really enjoy a deeper dive and having more time to explain things and answer questions. Fifteen minutes is great for a follow-up. This is not to say that I can’t conduct a new patient visit with the 15-minute option, but having more time with a new patient is very helpful. One complaint that we doctors deserve is that we are ‘rushed’ in the office; being able to have dedicated time and undivided attention is very satisfying.”
It really pretty simple. The coronavirus is hugely taxing on our medical system, and particularly for women who are medically vulnerable or could spread the illness to vulnerable parents or others, going to the doctor is not a great idea unless the need is urgent.
Says Dr. Innes, “We are seeing more patients for concerns outside of menopause as it may be more difficult for patients to obtain in-person care.”
Many of Gennev’s doctors are offering primary care assistance; for others, expanded services includes a wider range of gynecological care. Dr. Savage: “’Expanded’ for me means being able to address gynecology concerns other than menopause, include contraceptive advice/management, menstrual problems, breast issues, etc. This includes helping patients determine when/whether an in-person exam is necessary for complete evaluation.”
Absolutely the doctors are qualified. As Dr. Innes says, “Many of us also provide some primary care in our regular practices, so we will provide some basic primary care as well.”
As to the question “Why expand?” it’s the same reason that underlies every decision at Gennev: to protect women’s health and safety. “Many patients may not have access to in person visits with their physicians due to the COVID 19 pandemic, or they may be uncomfortable leaving their home,” says Dr. Innes. “Telemedicine provides access to a physician in the comfort of a patient's home. Expanding our services makes it easier for more patients to receive care regarding their concerns or problems.”
This question is likely on nearly everyone’s mind. Tests can be hard to come by, and when you have hot flashes, it can be tricky to distinguish them from a fever.
According to Dr. Savage, “Any physician can help determine if your symptoms are consistent with Covid-19.” However, she adds, “To confirm a diagnosis, testing is needed.” If you’re concerned, a call with your doc or ours might be a good next step, but only a test can diagnose you for sure.
This is going to be a bit of a judgement call, say our doctors. But if you’re concerned and not feeling confident about your ability to gauge how severe your symptoms are, a telemedicine consult could perhaps put your mind at ease. However, if you are having any difficulty breathing, don’t wait. Seek professional medical help immediately.
Dr. Savage: “At this point in time, I would avoid the doctor’s office unless it’s something that absolutely needs an exam and is acute/urgent. Your annual exam can wait; a raging vaginal infection, extremely heavy bleeding, etc. cannot. Telemedicine can be especially helpful in cases of uncertainty. If you’re not sure about going in vs. waiting, consider a phone call with your local doctor’s office or a telemedicine consult.”
Finally, both say, stay home if you can. Limit your exposure to other people. Eat well, prioritize sleep, manage stress as best you can, and wash your hands.
Arrange a consult with a Gennev physician or health coach if you need help managing menopause symptoms – those don’t stop just because there’s a pandemic, and getting symptoms under control can alleviate stress, which can impact your immune system.
if you’re concerned about your health, or need non-urgent medical help, Gennev is here to help.
Just need some community support? Check our our Gennev forums. It's a great place to ask and answer questions and connect with others who understand exactly what you're going through!
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