Studies have shown, for example, that automated blood-pressure measurements taken when a patient is sitting alone in a quiet place are more accurate. People with white-coat hypertension regularly experience higher blood pressure in clinical settings as a result of anxiety or fear. At-home tests, Fendrick said, can better capture a person’s usual blood pressure.
Along the same lines, some patients seem to perform better on telehealth cognitive tests for dementia, Julia Loewenthal, a geriatrician at Boston’s Brigham and Women’s Hospital, told me. In-office exams can be exhausting, nerve-racking ordeals that sap memory and attention; at home, patients are more relaxed and clearer-minded. “It reduces test anxiety,” Loewenthal said.
A virtual house call can also improve the quality of treatments. Christina Dierkes, a 37-year-old from Columbus, Ohio, usually dreads the end of an intense therapy session. “You bare your soul to this person,” she told me, “and then you’re running into somebody in the elevator and sitting in the car crying and driving home.” Since March, she’s connected with her therapist over the phone, from safe within her pandemic cocoon. “I was at home, in my own space, in sweatpants. It made it easier to imagine I was talking to myself or someone I feel really safe with,” she said.
This advantage is, to some degree, subjective. David Bober, a 51-year-old in Maryland, struggles to find a quiet spot at home where he won’t be overheard or interrupted during psychiatry sessions and is ready to return to in-person therapy. “I’d be happy to sit 12 feet away, on the other side of the room, wearing a mask,” he says. And having to verbalize bodily concerns to a doctor who can’t touch or examine a patient up close can be a source of discomfort. Jon Johns, a 54-year-old in eastern Ohio, had his annual physical—it went well—over videoconference in April. “But what if I was in pain or something was wrong?” he says. “I would be anxious about how well I was describing my symptoms.”
Whatever might be missing from the patient’s descriptions, doctors can glean information through telemedicine that they wouldn’t otherwise have access to. And this might be the true magic of the virtual house call.
The family doctor Carman Ciervo, for example, can’t check a pulse or administer a vaccine through a screen. But over video, Ciervo, a primary care physician for Jefferson Health, in Philadelphia, goes over the prescriptions in his patients’ medicine cabinet one by one. He gauges nutrition by peeking inside fridges. In summertime, Ciervo asks to see thermostats to make sure they’re on and functional. If a patient has mobility issues, he monitors the video’s background for railings or potential tripping hazards.