Telehealth was forced into mainstream primary care during the pandemic and has stayed because — for the right kind of visit — it works very well. Used correctly, it saves you a commute, gets you seen faster, and keeps you out of waiting rooms. Used wrongly, it produces missed diagnoses, repeat visits, and a frustrated patient.
What telehealth is great for
- Medication refills and adjustments. If you are stable on a blood pressure pill or a statin and just need a renewal plus a check-in conversation, you don't need to come in.
- Lab review. Once labs are back in the patient portal, a 15-minute video call to walk through what they mean is faster and more useful than reading the numbers cold.
- Follow-ups on previously-evaluated complaints. If we have already examined you for that knee pain or migraine, a follow-up to titrate the treatment plan rarely needs hands-on contact.
- Mental health check-ins. Therapy and psychiatric follow-ups translate to video extraordinarily well — many patients find it less stigmatizing than walking into a clinic.
- Minor acute issues with a visible component. Pink eye, a rash, a tick bite. We can see it, recommend a treatment, and call in the prescription.
What telehealth is bad at
- Abdominal pain. The abdominal exam — pressing on specific points, listening for bowel sounds, checking for guarding — is one of the most diagnostically useful exams in medicine, and there is no video substitute.
- Chest pain. Anything that could be cardiac needs in-person evaluation with an EKG. Don't try to triage chest pain over video.
- Pediatric sick visits in young children. Fever in an infant, ear pain, sore throat — we need to look in their ears, throat, and chest.
- Anything that might require a pelvic, breast, or genitourinary exam. Telehealth gets us 30% of the way; the rest needs to be in person.
- First-visit comprehensive physicals. The initial head-to-toe matters. Subsequent annual visits can sometimes be hybrid (labs in clinic, video for the conversation).
The hidden cost of "convenient" telehealth platforms
The standalone video-only platforms that sell you a 10-minute visit with a random clinician for $79 are useful for narrowly-scoped problems (a UTI script, for instance). They are not a replacement for primary care. The clinician has no record of you, no continuity, and no incentive to see you again. They will write the prescription you asked for and move on. That is fine for a yeast infection. It is dangerous for fatigue, recurrent headaches, or a new mole.
How we think about it at Linden
For established patients, our default is to offer the visit modality that fits the question. If you call about a refill, we will offer a video slot the same day. If you call with abdominal pain, we will get you in. If you aren't sure, the front desk will ask three or four questions and tell you which way to go — no charge to ask.
Most telehealth visits are billed exactly the same as in-person under current insurance rules, so cost rarely drives the choice. Convenience and clinical fit do.