The thyroid gland might be small, but any changes to its function can pack a huge wallop on how you feel every day. During January’s national Thyroid Awareness Month, pay attention to any possible symptoms that could indicate problems in you or any of your patients.
According to the American Thyroid Association (ATA), some of the more common diseases of this small gland include an overactive thyroid (hyperthyroidism), an underactive thyroid (hypothyroidism), and even thyroid cancer. Symptoms of these endocrine diseases can overlap with each other and can be mistaken for many other conditions.
Symptoms of hypothyroidism are frequently dismissed by patients. As a nurse, your patients may complain about being excessively tired or lacking energy or even that they have a worsening mood. They may have noticed their hair is thinning or falling out or seems especially brittle. Hypothyroidism can cause people to gain weight and to feel cold in temperatures that were previously comfortable. Often, people will attribute these symptoms to stress, a particularly busy time, or seasonal changes.
It might seem that symptoms of hyperthyroidism would be the polar opposite of having hypothyroidism, but that’s not always the case. Because hyperthyroidism can speed up the metabolism, patients might also pass off symptoms like a racing heart, more-than-normal sweating, or mood changes to job stress, lots of activity, or even an increased fitness routine. But they can also experience the fatigue and hair loss that hypothyroidism presents. Some patients may notice more prominent eyes (Graves’ disease) or even feel their thyroid gland itself is enlarged.
According to the American Cancer Society, rates of this cancer have increased in the last decade in young adults (3 percent increase annually) and adolescents (4 percent increase annually), and even those who have had no prior thyroid problems can have thyroid cancer. This highly treatable cancer often presents as a lump in the neck rather than with symptoms like those of hyperthyroidism or hypothyroidism, and even blood tests don’t show anything abnormal.
If any of your patients mention these symptoms, a blood test may be in order. According to the ATA, a simple lab test will check thyroid hormone levels. If the levels of thyroxine (T4) or triiodothyronine (T3) or of the thyroid-stimulating hormone (TSH) are too high or too low, follow up will help determine next steps of medication, treatment, and referral to a specialist. If you or they notice any kind of lump in the thyroid gland, follow up tests are necessary to check for cancer.
Thyroid problems are fairly common and approximately 20 million Americans have some kind of thyroid disease. Listen to your patients as they describe any physical, cognitive, or emotional changes they have experienced to help detect any changes in the early stages.
The contributions of a nurse in today’s crisis – stricken society are countless, especially in the midst of this pandemic. For that reason, thorough explanation of the nurses’ role is imperative for greater appreciation. Nurses have well known responsibilities including but not limited to recording medical history, vital signs and symptoms, patient advocacy, monitoring patient health and administering medications and/or treatments. Nurses collaborate with members of the interdisciplinary team for better patient outcomes and educate patients and their families about the management of illnesses. In academic settings, we educate aspiring nurses and propel them to achieve their goals in the midst of challenging life circumstances. As they say, nurses wear many hats, and as a result, nurses are burning out.
A nurse must advocate for patients beyond the health care environment while utilizing a holistic care approach; a patient may be admitted to a hospital or other health care setting for a particular ailment. However, the nurse must question this patient’s ability to care for themselves on their own, and if incapable, ensure that adequate support is in place upon discharge. Nurses also care for patients’ families. Often times, difficult conversations must occur and nurses are challenged to interact with those on the receiving end. Nurses are usually the first to notice irregularities due to the first phase of the nursing process – assessment. Nurses are the punching bags for the frustration of others on a daily basis. While nurses ought to possess qualities of resiliency, they are also human, and if empathic in nature, easily carry the stress of others on their shoulders. Hence, while taking work load, work environment, and coping mechanisms into consideration, nurses are at increased risk for burnout.
Burnout is defined as a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. It has many physiological effects. In a recent study conducted by Salvagioni et al (2017), burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. Specific to nurses, in a 2019 study, 14.4% were found to be unengaged with their work, 41% of those respondents reporting feelings of burnout. Due to the physical and emotional demands of the job, nurses ought to be cognizant of the warning signs of burnout (anxiousness, chronic fatigue, insomnia, and frequent illness) because they are putting their health in jeopardy. Please take into account that these statistics are not reflective of the impact COVID-19 has had in the nursing industry. Therefore, in 2019 – 2020, these statistical figures are presumed to be more alarming.
In September 2018, I recall being transported by an ambulance from a clinical setting to the hospital. Runs of atrial fibrillation and ventricular tachycardia flooded the heart monitor as I struggled to maintain my strength, oxygenation and my life. “Look! You can show these rhythms to your students!” said the EMT as life threatening rhythms printed from the monitor. My usually jovial self immediately thought, “Did he really have to say that and could this get any worse?”
At the time, I was a nursing education supervisor for a technical school. The program grew exponentially and I was expected to supervise both day and evening programs. This not only meant overseeing and executing the curriculum’s development and application, but also subbing for instructors as necessary, which was quite often. I was a single mother in need of more support. My divorce was recently finalized. Ageism and racism were also my contenders in the work environment. I was challenged when giving direction to a group of women, my staff, who were older and looked different from me. I was expected to provide hope for my students who had lost hope in themselves due to extenuating life circumstances. Inadvertently, I experienced the warning signs of burnout such as anxiousness and chronic fatigue, but ignored them, leading to my experience in September 2018.
In the year of 2019, I went on a quest to find a work environment that was more holistic and welcoming. The familiar saying, “Nurses eat their young” resonated within me. My mental health suffered as I experienced feelings of being unappreciated and belittled. Nonetheless, in the midst of all of this rain, the sun did shine again. I decided to return to my home district as a school nurse, which gave me an opportunity to give back to my community and encouraged healing for my broken soul.
As a survivor of burnout and the consequences that came with it, I feel the need to bring awareness to the fact that nurses need to be nursed. So, who nurses the nurse? If possible, nurses must nurse themselves by doing the following:
Evaluate Your Own Personal Life.
Ask yourself, have I recently experienced life changing events and have I taken enough time to ride life’s emotional rollercoaster? Trying to balance work and these emotions can lead to a very bumpy ride (burnout). One may need to request time off from work or even take a leave of absence. Taking these actions does not mean that you are weak. It just means that you are taking a step closer to healing.
Identify Sources of Support.
As John Donne said, “No man is an island. No man stands alone.” It is impossible to navigate through these difficult times in solitude, so finding a trusted confidant is important. It may be a family member or a close friend. For some, it may involve getting help from a licensed therapist. Once having adequate support systems, you will come to the realization that you are not alone. This notion generates healing thoughts and behaviors.
Ask For Help.
Nurses have a tendency to practice autonomy and often forget about asking for help. We always give but do not want to receive.
Diet and Exercise.
You are what you eat, therefore in order to promote feelings of wellness, we need to eat foods and participate in activities that support wellness. Overall, one should base their diet on whole grains, increase fruit and vegetable consumption, and reduce fat, salt, and sugar intake. We should also aim for 30 minutes of moderate physical activity daily.
Watch Your Water Intake.
Men and women need approximately 3 liters of fluid daily, however water requirements vary depending on weight. As it pertains to burnout, water can help maximize physical performance. Water also significantly affects energy levels and brain function.
Make Time For Hobbies.
Do not forget about your interests. Make time for these activities. It could be as simple as listening to music or watching an interesting TV show. I’ve always loved dancing. Since my experience in 2018, I joined a ballroom dancing/social community.
Practice Mindfulness Meditation.
This is the practice of actually being present in the moment which in turn trains you to become more mindful throughout the day, particularly during stressful situations. There are an abundance of mindfulness meditation exercises that can be found on the internet. I do these exercises daily.
Get Enough Sleep.
We need at least seven to nine hours of sleep daily to function at our best. If you are having a hard time achieving this, talk to your doctor. You can consider non-pharmacological methods such as teas and lavender oils. According to the National Sleep Foundation, obtaining healthy sleep is important for both physical and mental health, improving productivity, and overall quality of life.
Watch Your Appearance.
If you think you look good, chances are you will feel good too. Participate in practices that enhance positive feelings about personal appearance. Do a facial. Get your eyebrows waxed and your hair done. Do you!
The above recommendations highlight the importance of self-care. I urge each and every nurse to take part in such practices before it is too late. The disease processes that result from lack of self-care are probable, but preventable. So before you become dependent on a caretaker due to illness, remain independent by being your own best nurse.
Special Thanks: Desmond & Lillieth Gayle; The Wong Family; Nayomi Walton, PhD, RN; Therelza Ellington, RN; Anisa Cole, LCSW; Bloomfield Public Schools
In the spring of 2020, the coronavirus pandemic first gripped the world by the throat and its deadly menace continues to unfurl with renewed ferocity. In the United States, medical and scientific experts issued a series of early recommendations to slow or halt the spread of the virus that causes the disease COVID-19. Such public health measures are clearly warranted. As of this writing, over 285,000 Americans have perished from COVID-19 and the infection numbers are soaring across much of the country. Recommendations to combat the virus spread include handwashing, covering the face when coughing and sneezing, wearing a mask when in public spaces, and social distancing. The most challenging anti-virus measure was the lockdown or stay-at-home orders issued by state and local governments. In many communities, people rushed out to stock up on food, water, and household supplies before they began sheltering in place. The lockdown preparations and implementation clearly highlighted the pervasive and persistent inequalities impacting every aspect of American life that are attributable to social determinants of health (SDH). The World Health Organization defines SDH as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.” During the current public health crisis one key question for researchers, policymakers, and clinical providers alike to ask is: Which populations in the U.S. are most likely to experience adverse effects from SDH?
As an academic nurse researcher with expertise in health disparities, I closely monitored news about how the spring lockdowns were impacting various population groups. I paid special attention to the dramatically different experiences of white-collar employees, many of whom had the privilege of safely sheltering in place while working from home, and front-line essential workers who had no such option. This later group, often employed in grocery stores, meat-packing plants, bus stations, and other crowded environments, had higher risk of exposure to the coronavirus. Many of these essential workers are people of color and the devastating consequence of this reality was all too predictable. According to the U.S. Centers for Disease Control and Prevention, communities of color have experienced considerably higher rates of infection, severe illness, and death from COVID-19. This population includes approximately 100,000 individuals, largely African American, with sickle cell disease (SCD), an inherited red blood disorder. The major symptom of this disease is persistent, disabling pain, including excruciating episodes known as a pain crisis. SCD is a lifelong illness with a life expectancy of 48 years for women and 42 years for men.
With a primary research focus on pain management disparities experienced by SCD patients, I worry how coronavirus-related stressors are exacerbating the considerable pain already endured by these individuals. My research indicates that systematic stressors such as healthcare injustice—defined as unfair treatment an individual receives from important medical figures such as healthcare providers — predicts increased pain in patients with SCD. They are particularly vulnerable at this time because the coronavirus pandemic can magnify the negative SDH already experienced due to their race and disease trajectory.
I am concerned about how SCD patients are coping with today’s magnified societal stressors, particularly when trying to avoid a stress-related pain crisis that would require hospitalization and potential exposure to the coronavirus. Given the comprised hematologic profile of patients with SCD, which reduces oxygen circulation, these individuals are at elevated risk for both COVID-19 severity and mortality. Statistics from early in the pandemic document this grim reality. A recent study found that between March and May 2020, 178 infected individuals were entered into the SCD-coronavirus disease case registry. Of these, 122 (69%) were hospitalized and 13 (7%) died. (These hospitalization and death rates are much higher than for infected individuals in the general population.) Healthy stress management techniques that decrease emotion-triggered pain crises could greatly improve the well-being of SCD patients and potentially reduce their hospitalizations and deaths. Healthcare professionals can play a key role in encouraging patients to consistently utilize non-drug coping strategies to complement medication regimens for pain management.
Our research team found that patients with SCD who experienced healthcare injustice from nurses reacted to this psychological stressor by isolating themselves. Meanwhile, those who experienced healthcare injustice from doctors reacted by both isolating and pain catastrophizing. These negative coping strategies are associated with poor health outcomes. For example, pain catastrophizing corresponds to lower health-related quality of life for patients with SCD. On a more positive note, patients who experience healthcare justice also cope with prayer and hopeful thinking. These healthy strategies have long been endorsed within African American communities, where deep spiritual beliefs and regular religious practices have helped them deal with the harsh realities of slavery and the systemic racial discrimination and injustice that sadly remains a powerful force in American culture.
Another coping strategy for SCD patients dealing with stress and pain is guided relaxation. This can include deep breathing and counting backwards from 10 to 1 while focusing on a specific spot within an object. This technique has been shown to effectively reduce stress and pain for adults with SCD. Another recent study found that music therapy also reduces pain and improves mood. It is important that these vulnerable patients know there are a number evidence-based drug-free strategies they can utilize during this unprecedented and pressure-filled coronavirus pandemic.
Unfortunately, SCD patients in the United States, like other citizens the world over, cannot individually control the course of the pandemic and the havoc it is wrecking. However, these patients do wield tremendous control over how they choose to cope with coronavirus-related stressors that can intensify their SCD pain. In addition to the non-drug options described above, individuals can explore and try other safe coping strategies to better manage their physical and emotional health challenges. It is vital that patients are proactive on an ongoing basis to reduce their stress and pain and improve their overall well-being as the world awaits better coronavirus treatments and an effective vaccine.
NEW YORK, Dec. 8, 2020 /PRNewswire/ — The National Black Nurses Association (NBNA) is excited to announce the launch of two new major campaigns for its members under its new wellness initiative, NBNA Resilient Nurse Resource™. RETHINK, launched yesterday, was created to build awareness around the importance of vaccinations, with a focus on influenza and pneumococcal. The goal of RETHINK is to debunk common myths surrounding vaccines and to inform Black nurses and the Black community on the benefits of vaccinations. The website features an interactive ‘Test Your Flu IQ’ quiz to test participants knowledge and understanding on the flu and vaccines. There is also a flu and pneumococcal vaccination locator to assist with identifying providers in nearby serving areas. Anyone interested in learning more about vaccines can visit www.nbnaRETHINK.com.
On December 15, 2020, the NBNA will also launch its mental wellness campaign, RE:SET. This new initiative offers members FREE counseling services, education webinars, wellness podcasts and more, to aid them in maintaining their mental wellness throughout the current COVID-19 crisis. The free counseling services are only available for existing and new NBNA members, and their families.
Unfortunately, there is a stigma in the Black community surrounding mental health. This, in addition to the lack of providers from diverse racial/ethnic backgrounds and culturally competent providers, contributes to only one-in-three African Americans receiving mental health treatment.
To provide the best patient care, nurses must be able to reset and recharge from the daily pressures and renew their resilience and strength. Creating tools for renewal and increased resilience is especially important as nurses have a high prevalence of anxiety and depression. With this comprehensive resource, NBNA members will receive holistic tools and resources designed to give nurses the boost they need to promote mental wellness and wellbeing.
“We know how difficult this year has been for nurses everywhere, especially Black nurses who are faced with both the pandemic and the current racial uprising,” states Dr. Martha A. Dawson, NBNA President. “It is crucial that we protect our nurses’ physical and mental wellbeing during such an unprecedented time in our country. With RE:SET we are able to provide them with the tools necessary to recover from the daily stresses of exhausting working conditions and challenges. It is essentially PPE for their mental and emotional health, which will help to impact their physical health.”
RE:SET provides NBNA members and their families with easily accessible options for mental wellness – including:
- RE:SET Support Line: Available 24 hours a day, 365 days a year, members who need in-the-moment support, are connected with licensed clinicians for no-cost, confidential guidance and resources.
- Free, Confidential Counseling: The RE:SET program provides up to five free sessions with experienced and licensed clinicians. This service removes the cost, access and privacy hassles of getting professional emotional support when NBNA members face a problem or situation that is difficult to resolve.
- Text Coach®: Also known as ‘text therapy’ is available to NBNA members via mobile phone or desktop computer to help with non-acute concerns. Licensed clinicians will help nurses and their families boost emotional fitness and wellbeing by exchanging text messages, voice notes, tip sheets, videos and resource links.
To learn more about the RE:SET FREE tools and other resources, visit, www.nbna.org on December 15th.
To become a member of the National Black Nurses Association and to gain access to the FREE counseling services, visit www.nbna.org.
About National Black Nurses Association (NBNA)
Founded in 1971, the National Black Nurses Association (NBNA) is a professional organization representing 308,000 African American registered nurses, licensed vocational/practical nurses, and nursing students in 108 chapters and 34 states. The NBNA mission is “to serve as the voice for Black nurses and diverse populations ensuring equal access to professional development, promoting educational opportunities and improving health.” NBNA chapters offer voluntary hours providing health education and screenings to community residents in collaboration with community-based partners, including faith-based organizations, civic, fraternal, hospitals, and schools of nursing. For more information, visit nbna.org. #NBNAResilient
NBNA Marketing and Communications Manager
As the coronavirus pandemic reaches new heights across the country and hospitalizations rise, nurses are facing extreme and unprecedented demands. A recent study from the Journal of Occupational Health found that the coronavirus pandemic has significantly impacted the mental health of health care workers, especially frontline staff.
The heightened risk of exposure, coupled with inexperienced nurses providing care in fields where they have limited experience and veteran nurses feeling severe burnout, has caused many nurses to quit and move to outpatient clinics or home care.
As a result, hospital systems are turning to short-term travel nurses to fill the gaps in care as they continue to rely heavily on their nursing staff to manage the increase in hospitalizations due to COVID-19. These temporary nurses often struggle to feel connected to the resident nurses which can result in miscommunication and lapses in effective patient care.
These rapidly changing circumstances have put hospital systems in a tough place. Many are focusing all their energy on dealing with the crisis at hand, rather than addressing the deteriorating mental and emotional health of their nursing staff.
To protect one of their most valuable resources–their nursing staff–it’s crucial for hospital systems to think proactively about building resilience among their nursing teams and leaders. In my work with Innovative Connections, we we’ve been able to help nursing leaders at Baptist Health in Montgomery, Alabama, do just that.
In May 2020, it was clear to Gretchen Estill, MSN, RN, CNML, Chief Nursing Officer at Baptist Medical Center East (BMCE), that her nursing leadership team was emotionally exhausted from the nonstop care needed to handle COVID-19 hospitalizations.
“We had a multifaceted challenge,” Estill said. “This strong group of leaders were beginning to run on empty as we realized that this was not a transient pandemic. We are a very relational group, and we were missing the ability to get together in person and debrief.”
Meanwhile, at Prattville Baptist Hospital (PBH), chief nursing officer Meg Spires, RN, MSN, recognized a similar pattern of fatigue and frustration among her team of clinical leaders. Her close-knit leadership team still felt a strong commitment to their mission of putting patients first, providing passionate care, and pursuing perfection. However, the challenges from the pandemic made this mission seem impossible to carry out.
Although investing time in team development and resilience work during a pandemic may have seemed counterintuitive, these nursing executives at Baptist Health understood their teams needed emotional and psychological support to make it through the ongoing challenges of COVID-19.
Nursing teams participated in weekly team coaching sessions facilitated by Innovative Connections, a management firm in Fort Collins, Colorado, via videoconference. Nurses were able to discuss mindfulness, dealing with grief, changing their perspectives and building resiliency.
At the end of each training we give them a mindfulness practice to help ground them during their work. We had nurses dedicate the 20 seconds they wash their hands multiple times each day to practice mindfulness. Instead of adding one more thing to their non-stop schedules, we were able to incorporate this self-care practice into something they already have to do throughout the day.
“This resilience training is a necessary investment before and especially during a crisis,” Laurie Cure, CEO of Innovative Connections said. “If a team has been working to build trust, they are better positioned to show up and do their job when a crisis hits.”
Initial feedback found that the nursing team was grateful to have an opportunity to connect as a group in a designated place to debrief about how they were doing mentally and emotionally with their teammates. Many enjoyed the chance to unplug and understand how others on their team were coping to focus on their collective contributions and strengths during such a stressful time.
“I’ve heard repeatedly from my leaders that they’re extremely appreciative that we, as an organization, cared enough about them and their emotional health to invest in them,” Spires said.
Dedicating the time for resilience and team building during the demands of the COVID-19 pandemic may have seemed counterintuitive at first. However, the awareness that these key team members gained from having protected time to rejuvenate and support one another was invaluable. Pursuing this intervention has contributed to increased efficiency and connectivity for these nursing teams.
“The team had to acknowledge that we have to take care of ourselves before we can take care of others,” Spires said. “We focus on our physical health, but we don’t pay as much attention to our emotional or mental health. We can’t do justice to our patients or our team members if we’re not emotionally healthy.”
Due to the ongoing coronavirus pandemic, telehealth visits conducted via video calls are becoming more common than ever, and more insurance companies are covering them, too. The annual physical you once had in a doctor’s office may now be taking place over your webcam instead. You may be wondering how you can make the most of your telehealth appointment and make it easier for your nurse, doctor or other professional in cotton scrubs. Here are seven things that you can do to improve the experience on both sides.
1. Know what you want to talk about.
Just as with an in-person visit, you should come to your telehealth appointment prepared to discuss your health concerns. Make a list of everything that you want to cover, and prioritize them from most to least important. If you’ve been exhibiting symptoms, track them in the weeks leading up to the appointment and keep a log of them so you can note any trends over time. Have your notes with you, as well as a working pen or another way to jot down things during the appointment. This will maximize your appointment time and help your doctor or nurse treat you more efficiently.
2. Test the telehealth service beforehand.
If you’ve never had a telehealth appointment before, download the software or create an account and log in before your appointment begins. You won’t be able to actually video chat your provider until the appointment starts, but you can familiarize yourself with the platform and make sure that your camera is working. Depending on what service your provider uses, you might also be able to message your providers, schedule an appointment without having to call and more. If you have any trouble with the platform, contact tech support and try to get it resolved before the day of the appointment.
3. Get a strong internet connection.
Video calls require a strong internet connection, so run a speed test to ensure that your internet connection can support your video call without dropping. If your internet connection is weak, you might need to ask other people in your household to refrain from streaming videos and other activities that take up bandwidth when you’re in your telehealth appointment. If your Wifi is still weak and you’re the only person on it, you might need to look into upgrading your plan, getting a better router or installing a signal booster to extend the range of the Wifi.
4. Choose a quiet room.
Selecting the right room is equally important to having a good internet connection. Choose a quiet space with a door that can close so you won’t be interrupted. If you have pets, put them in their kennels or a separate room for the duration of the call. Let your partners, roommates, and children know that you’ll be on a call and that they shouldn’t interrupt you. Make sure that the room is clean, double-check that the background behind you is plain and professional (a blank wall is fine) and confirm that you have good lighting so your provider will be able to see you clearly.
5. Log in early.
Don’t wait until the last minute to log into the platform in case you have any unforeseen technical difficulties. Five to 10 minutes before your appointment is supposed to start, get set up in your room and go ahead and log in. There may be a virtual waiting room where you can chill. If not, you can just sit on the platform. Try not to get distracted by social media or other websites. You don’t want to miss the start of your appointment! If you have any medical devices your provider will need to look at, set those out on the table so you can easily access them during the appointment.
6. Volunteer to offer feedback.
Many health care providers have only recently installed telehealth platforms, and may still be working out the kinks. You may receive a survey after your appointment asking you how the telehealth visit went. If you’d like to help your providers improve the platforms, be sure to fill that out and let them know how it went from the patient side. If they aren’t sending out a survey, you can suggest the idea to them, or offer to provide more informal feedback via email or another way. After all, the whole point of health care is to improve patient outcomes–so as the patient, your opinion matters.
7. Know when you need an in-person visit.
Telehealth is a great technology, and it offers many advantages over in-person visits. However, sometimes you simply need to see a medical professional in person. An emergency is an emergency, so if you have sudden chest pain, weakness on one side of the face or body, or sudden difficulty breathing, you need to go to the emergency room or call 911 immediately. Your doctor may also prescribe some in-person visits, such as bloodwork and other tests, that cannot be conducted virtually. Use common sense and schedule an appointment in the office when it can’t be taken care of virtually.
A nurse can’t listen to your lungs with their stethoscope via a telehealth visit, but there are many positive aspects of virtual appointments. Telehealth keeps both providers and patients safe from a contagion, and increases access to care for patients who have trouble leaving the house for one reason or another. If you’re new to telehealth, or just looking to have a good experience during your next appointment, follow the seven tips outlined here. Your provider will appreciate all the prep work that you did and you’ll be way more likely to have a positive telehealth appointment.