Rural Telehealth – Part 2 of 2

Welcome to the Talking Total Farmer Health podcast from AgriSafe Network. At AgriSafe, we work to protect the people that feed the world by supporting the health and safety professionals, ensuring access to preventative services for farm families and the agriculture community.

Hey listeners - we left off last episode talking with Mr. Randy McKinney about what exactly constitutes telehealth. And in today’s episode, we’re going to wrap up that conversation. If somehow you missed the first part, go back and listen now! I promise we’ll be right here waiting once you’ve caught up… And if you’re still here, well, then let’s begin!

I know that it can be daunting to try something new for the first time, those unknowns that can cause hesitation. Talking to your doctor or healthcare provider just on a video or phone call is vastly different than sitting in the exam room with them. But regardless of whether it’s your first time in a telehealth visit, or whether you are a telehealth pro, we have tips for how to make the most out of your visit! As well as tips for finding a telehealth provider. But first, Randy has a story that he wants to share about why he’s so passionate about rural telehealth.

So in my younger years, it's been over 50 years now. one of my first jobs as a teenager was working at the local funeral home in our town. And I can remember so many times going out, especially to remote areas where where people lived in very rural areas…

And I can remember going out to to numerous homes out in the rural areas and to to perhaps go out to make a first call for the funeral home. And the the spouse, and it was a wife at the times that I remember would be crying and just talking to us about how it was it that her husband had been having chest pains for weeks, 2 to 3 weeks, and that she'd been trying to get him to go in and to get seen about; to see what it was that was causing it. And he wouldn't do it. She couldn't get him to do it. So, you know, just one of the things that I've just taken with me since my childhood is the fact that if something happens and you're having chest pains or you have a a massive headache like you've never had before, get to the telephone, tell somebody to call, ensure that first responders are on their way.

Today, we've got something available in most rural areas that we didn't have 50 years ago, and that's the helicopter that can medevac us out to the major medical centers. Even if we have an aortic aneurysm, which is essentially a blood vessel in the chest that has either burst or is getting ready to burst. And but we have to dial that phone. We have to make that first step. And if we don't do that, it can cost us our lives. And so we want to do what it takes to take care for our of ourselves. Certainly, you know, if we're worrying about, well, I've got to get the watering done in the morning or I've got to I've got to be sure that the fields are plowed in the morning. One thing thing's for sure that if you're not there to to take care of that, if you're not alive, you're not going to be able to take care of that crop, nor next year's crop. So I just encourage each of you to, if you have something like that, that that feels critical. It probably is. It's better to to get help than to not.

Absolutely, Randy. Your story definitely hits close to home, and I’m sure many of our lsiteners will be nodding their heads in agreement, that they too have experienced something similar – maybe they know someone who has had a relatable experience. Thank you for sharing that, Randy. You know, it is so easy to get wrapped up in the work that needs to be done, to lose sight of taking care of our health first. But you’re right – if we put off our healthcare too long, or in a critical instance, we won’t be there anyway to get the work done.

So, okay, so for those folks who are thinking, you know, maybe telehealth is a route I'd like to go. Any advice for people wanting to find a new telehealth provider?

Well, absolutely. First, if you contact your provider, many providers since, uh, since Covid or have a telehealth platform available. But if if your provider does not and you'd like to have a telehealth visit, there are a couple of options. One is to contact, of course, another provider or contact your nearest community health center or federally qualified health center in your area. Most health centers have telehealth platforms already that they're operating off of. These community health centers have often received special funding to improve your access to them and to the communities that they serve. So most of them will will have one. But there is another alternative, also. Many of our insurance plans have providers who will provide a telehealth visit. Often these are at no cost. And when I say no cost, I mean no deductible and no co-pay…

And you may have to call your benefit specialist, the 800 number on your insurance card, to find out if that's available. But more often than not, it is available today by insurance company.

Yeah, that's great too, because of course, when we think about farmers and ranchers and all the costs that they have just to operate a successful farm business, and then you think about the life, their lifestyle and their living needs, costs. If there's a discount, absolutely. I'm sure that they would certainly take advantage of it in that 800 number on those insurance cards can also give you a wealth of information. So. So use it. Are there any differences in using insurance or any special payment options such as grants or discounts for people living in rural areas when it comes to telehealth?

There are none that I know of, uh, right off of the top of my head. But where the real value of using telehealth is at is in getting primary care faster. So that, of course, we have deductibles and co-pays oftentimes. The less treatment that we have to have, the earlier that we catch disease progress, the less that's going to cost us in co-pays and deductibles in the long run. So I think that's how we save money. It's just by insuring ourselves, making the promise to ourselves that we're going to give ourselves the best possible primary care and that we're going to get it as soon as we can rather than waiting later to get it.

I hear you. I hear you. You're speaking to the choir a little bit because getting these farmers and ranchers to get into a clinic, that means they'd have to leave their their place of business, their farm or ranch, and they'll put it off because, you know, it might get better tomorrow. I just don't have time right now to to tend to to what my body needs or my mental health needs. So are there any other tips you want to share? Some resources for our folks?

Well, just one. Given what we've already talked about, I would suggest that that if you're out there, you're in a rural area, you're an agricultural worker or you're a teacher, a school teacher, it doesn't matter. I would suggest that if you're a little maybe uncomfortable with having a telehealth visit, that you go ahead and schedule one, give it a good faith. Try, as I said earlier. And one of the things that might help you to overcome some discomfort is calling your clinic and asking them if they could do a test run with you over their telehealth platform before your visit to be sure that you can connect to them.

I think that would go a long way in making us more comfortable. And and then the other thing that I want us to remember is patience, is that there are certain guidelines around federal laws and the dispensing of controlled substances. There are laws in place that require an in-person visit, in some cases before dispensing a controlled substance. So if your provider, your doctor, your mental health provider or even a dentist for pain, if he was to tell you, well, I cannot give you this particular substance for pain without an in-person visit, first, please understand why that that is federal law for certain drugs and medications.

Yeah, absolutely. Again, those federal laws are put in place for our health and safety, as you know. And so it's yeah, it's good information to keep that in mind as we think about opioid misuse and the misuse of of many medications. So what should people have ready with them for their telehealth service or their visit?

Well, if you're going to have a telehealth visit with a with a, let's say, a mental health provider, really there's nothing that you need to do other than ensure that you're in a quiet place with minimal interruptions. Remember that conversations with your medical or behavioral health providers might need to be private. So if you're anticipate discussing sensitive topics, you might want to find a private location in your home or even in your car or at a trusted friend's home. One of the things for any type of telehealth visit, we need to try to turn off all of the noise makers that are in our environment. This may include televisions or radios, cooling units or ceiling fans. Also, if we have children that need care, we need to ensure that that they're placed in somebody's care during our telehealth visit. And of course, many of us have pets and in rural areas, that's almost one of our hallmarks to have a pet, a cat, a dog, birds. But we need to be sure that they're safe and they're in a place where they would not disturb our visit. And one of the things that I would suggest, if possible, if the patient as a patient, if we could sit in front of a solid-colored background rather than in front of cluttered colored backgrounds for clearest video.

Also, we should try to stay away from windows or other light sources that are behind us. We need to try to to make sure that light is in front of us more than behind us. Our providers need to get as clear a look at us as they can. And of course, if we're using a smartphone, we'd want to have some kind of a bracket or something that we could set it on on our table or a desk in front of us so that it's not moving around. Uh, this is not usually a concern if we're using a laptop computer because we have a camera generally that's mounted, but it would also be advisable to have a good bright flashlight available with charged batteries in case there's some type of lesion or a spot, a mold or something on your a area of your body that you want to show your doctor. And he may ask you to adjust the light so that he or she can see it better. And if you're in a situation where it might be difficult for you to to do this for yourself, if you're comfortable, you may want to have a trusted friend or relative with you, uh, perhaps a spouse to help you to adjust the camera or the screen so that you can see so that the provider can see you and so that you have the ability to focus on what you need to tell your provider.

And also, if we know that we may have to remove a partial article of clothing or let's say we have a a lesion or a spot on the upper part of our arm, for example, we want to be sure that we're wearing loose clothing so that we can easily pull that up and the provider can see it…

That’s very true, great advice so far. Now, is there anything specific our listeners should have on hand for their appointment?

Um, one of the things we need to do is be sure that we have everything written down that we need to tell our doctor, our medical provider. And I say, Doctor, this could be a nurse practitioner, it could be a physician assistant. But we need to be sure that we make the most of our medical visit just like we do when we're in that office. We only may have ten minutes, so we have to make the most of it. We want to be sure that we have a list of our current medications. We should include any prescriptions that we have, any supplements, vitamins, anything that we're taking they need to know about. And of course need to be sure that we have our allergies listed, especially if it's a first visit….

And if we're using our smartphones, we need to be sure that they are fully charged before we start our visit. And we need to also expect that our provider may want to make an emergency plan with us. Let's say I'm talking to my provider about the fact that I may be having chest pains or a bad pain in my head that may be symptomatic of a stroke or of a heart attack. And let's say something did happen and I became unconscious during that visit. My provider would need to know how to get help to me, how to get first responders to me. So if I'm the provider and I see that my patient has passed out. If I dial 911, I'm going to get the first responders in my county or parish and not the ones in the county or parish necessarily where the patient is at. So with that, I might expect my provider to to ask me for my exact location, my exact physical address that I'm at now, because there's always a presumption that the patient may have moved to another location other than their home to have the visit.

So if something happens, we want our provider to know how to get help to us. So they might ask us what county we're in or parish they might ask us for the for the seven digit number of the the law enforcement agency or the first responder agency. If we know that and it's available, we would certainly want to have that for them so that they could make a call to the appropriate agencies to assist us if something should occur. And last but not least, of course, you would need to have your identification copy of your driver's license or other ID as well as your Medicare, Medicaid or other insurance cards. Remember, this is a medical visit and we need to be able to provide the same information as we would provide if we walked in the door of a clinic and and had a medical visit. And the first thing they'll ask you for every time you go in almost is your ID and your your insurance card. So those are things that we need to to be sure that we we have handy during our telehealth visit.

Those are some great tips. Some of those things I hadn't even thought about, like the emergency plan. Right. And how 911 works. Well, this has been more than enlightening. Randy, is there anything else that you'd like to add to the conversation?

I don't think so, other than just encouraging people to do their best to get the best Internet connection that you can in your home, so or on your telephone so that you can have a telehealth visit that is meaningful and that can help you to improve your health, or at least to keep you at the health status that you are at currently so that you can continue serving people by by working, especially in agriculture. A lot of times we don't think about the agricultural workers and how how they contribute to our well-being, not only our mental well-being, but our physical well-being. We have to get proper nutrients in life or we're going to get sick. So we you know, we understand the value of the agricultural worker and what it means to us and what the farm and rural America means to all of the rest of us, whether we are rural or in a metropolitan area. And we're grateful for your service. And we want to be sure that you get the best healthcare possible. And we just want to encourage you to take whatever steps you need to take and know that telehealth is one viable option. And by all means, if you're just not going to do a telehealth visit, that's okay to get to your doctor and take care of yourself as best you can.

What a great way to close. Thank you, Randy. Thank you very much for your time. And we look forward maybe to some future visits as telehealth continues to evolve and we evolve with it.

Absolutely. And again, Linda, thank you for having me. I'm blessed for this opportunity.

Oh, you're more than welcome.

Okay folks, that’s it for today. Thank you again for tuning in to another episode. Be sure to subscribe to this podcast to hear more from AgriSafe on the health and safety issues impacting agricultural workers. If you’d like to suggest topics, or have a story you’d like to share, contact us by email at INFO AT AGRISAFE DOT ORG, and title your email “T T F H Podcast.” You can also get our attention by using the hashtag "T T F H pod" on Twitter! To see more from AgriSafe, including webinars and our newsletter, visit w w w dot agrisafe dot org.

This episode was created by AgriSafe Network, directed by Laura Siegel, hosted Linda Emanuel, edited by Matt McKenney for ProPodcastingServices.com, with special guest Randy McKinney.