Let’s start with the big question I hear at least once a day:
“Doc, can I do this as a video visit, or do I need to come in?”
It’s a fair question. Online urgent care—especially since the pandemic—has become the go-to option for patients in Lewisville and across the Dallas-Fort Worth area. And I get it. No one wants to drive across town when they’re feeling miserable, especially in 105-degree August heat or in the middle of cedar fever season.
But here’s the truth: virtual care can do a lot more than most folks think… but also less than they sometimes hope.
Let me walk you through what we can treat online, what usually requires an in-person exam, and a few tricky in-between cases where my answer is: “It depends.”
UTIs: Yes, Virtual Care Works
If you’re a woman in your 20s to 60s who’s had a few UTIs before, you probably already know the symptoms: burning, frequency, urgency, a nagging pressure in the bladder. The usual story.
For uncomplicated cases like these, I often treat via telehealth. We review symptoms, history, and—if applicable—recent culture results. I prescribe a short course of antibiotics like nitrofurantoin or TMP-SMX. Sometimes I add phenazopyridine for bladder discomfort (just warn patients it turns urine orange).
When I don’t treat online:
- A man with UTI symptoms (we need to rule out prostatitis)
- A woman with flank pain and fever (may be progressing to pyelonephritis)
- Recurrent infections (we need labs and a deeper workup)
I remember one patient, a 34-year-old teacher, who had her third UTI in two months. She had been treated virtually by another provider each time. Turned out she had a resistant strain that needed culture-based therapy. We saw her in person, sent a urine culture, and got her on the right track.
So yes, virtual care works—if we stay thoughtful.
Skin Rashes: Usually, But Not Always
Rashes are tricky. Sometimes a photo tells me everything I need to know.
Take the classic case of poison ivy. Raised, linear streaks, itching like crazy. That’s an easy telehealth diagnosis. Same goes for contact dermatitis, mild eczema, even shingles (especially if caught early).
But here’s where it gets murky:
- Diffuse rashes in kids (especially with fever)
- Drug eruptions
- Petechiae or purpura (non-blanching spots can be serious)
In those cases, I want eyes on the patient. Lighting matters. So does palpation, which I obviously can’t do over Zoom.
Just last spring, we had a local college student with what looked like hives on video. She thought it was stress. But something felt off. She looked pale. I asked a few more questions. Turned out she’d taken Bactrim for a UTI the week prior. We brought her in. She had an early Stevens-Johnson Syndrome. A teachable moment, and I’m glad we caught it in time.
Chest Pain: Probably Not (But Let’s Talk About It)
This is the one that surprises patients.
A lot of people think, “If it’s mild chest pain, I’ll just ask the doc online.”
Here’s the problem: chest pain is too high-risk for virtual-only evaluation.
I had a 58-year-old patient last month—former smoker, high blood pressure, slightly overweight—tell me he was having a “tight feeling” in his chest after meals. He figured it was heartburn. Could be. But also, could be angina.
Can I tell that definitively over video? Nope.
What I can do is this:
- Ask the right questions
- Assess risk factors
- Help you decide if this is an ER visit or an urgent same-day clinic trip
In this case, I sent him to the ER. Turned out he had a 90% LAD blockage. Classic “widowmaker.” We got lucky. That’s not a call I make lightly.
So no, virtual care isn’t the place for chest pain.
Seasonal Stuff: Absolutely
This is one of the most common use cases we see here in North Texas. Seasonal allergies. Sinus infections. Mild asthma flares. Sore throats without fever.
Cedar fever is a real thing in Lewisville. It hits hard between December and February, and folks are miserable. I can usually manage those with a combo of antihistamines, nasal steroids, and sometimes a Medrol dose pack.
Pro tip I always share: change your pillowcases weekly during allergy season. You’d be surprised how many allergens stick around.
What I Hear From Patients (and What I Tell Them)
“Can you just prescribe something to get me through the weekend?”
If it’s a sinus infection, maybe. If it’s shortness of breath? I need more than just your word. Safety first.
“My kid has a fever but seems okay otherwise. Do I need to bring them in?”
Depends on age and behavior. If they’re under 2 months, absolutely yes. If they’re 6 and bouncing around with 101°? Maybe not.
“Is it okay to treat strep without a test if I have all the symptoms?”
Sometimes, but I prefer to test in person—especially in kids. We can arrange a drive-up swab if needed.
“I had COVID a few days ago, now I’m wheezing. Can you help online?”
If you’ve had asthma before, maybe. If this is new? Better to be seen.
Our Approach at Health Express Clinics
At our Lewisville location, we try to keep virtual visits safe, simple, and smart.
We’ll never tell you “just do a video” if you really need an EKG or hands-on exam. That’s not how we practice. But we also won’t make you drive in for a garden-variety UTI or allergies unless something’s off.
What I’ve found is this: most patients don’t mind being told “come in” if they know you took the time to hear them first.
One Last Thing: A New Guideline Worth Noting
There was a recent update from the CDC on outpatient antibiotic stewardship. They’re recommending more restraint with empiric antibiotics for things like sinusitis and bronchitis—especially when viral. I agree. We’re seeing resistance patterns shift, even here in DFW.
In practice, I try to counsel patients a bit more during virtual visits. I might say:
“I get why you want antibiotics. But based on your symptoms, this still looks viral. Let’s treat the inflammation and revisit in 48 hours.”
Patients usually understand. Education goes a long way.
Final Thought
Virtual care is a tool—not a magic wand.
It works incredibly well for common infections, mild flares, and medication refills. But it has limits. As your doctor, my job is to help you figure out where that line is.
If you’re not sure whether a video visit is right for your issue, reach out. We’ll talk it through and point you in the right direction—whether that’s online or in person.
Reviewed by Harveer Parmar, MD, Family Medicine, Health Express Clinics, Lewisville, TX.