Should telemedicine be the future of healthcare?
In the wake of the pandemic, it appears that it will be. As more people became afraid to leave their homes, more and more physician visits were conducted via video calls. The market research firm Forrester predicts that virtual physician visits in the United States will exceed 1 billion in 2020. The telemedicine market is projected to grow from $46 billion in 2019 to $175 billion by 2026. Nearly half of U.S. physicians, 48%, are now treating patients via telemedicine, up from 18% in 2018.
“To me, it has been a welcome change,” said Dr. Comilla Sasson, a professor of emergency medicine at the University of Colorado. “I think what we are doing is bringing more care to people in their homes, and then, we are more appropriately able to triage them.”
But not all physicians are on board.
“Telemedicine is not medicine, in my opinion,” said Dr. Juliette Madrigal-Dersch, a primary care physician in Marble Falls, Texas. “There is so much to a doctor-patient interaction that builds a relationship. And when you are just on a video call, there is so much that you can’t see or pick up from the patient.”
Telemedicine, increasingly referred to as “telehealth,” is the practice of caring for patients remotely, often via video call but also with texts and phone calls. Physicians can offer diagnoses and possible treatments without the patient having to schedule an office visit. If the problem is more serious, the patient can be directed to the appropriate place to seek treatment.
The quality of telemedicine is the subject of considerable debate.
A 2016 study from the Agency for Healthcare Research and Quality suggested that telemedicine could be effective in treating people with chronic conditions and for psychotherapy. Other research, though, has found that telemedicine leads to an overuse of antibiotics. A study published in the Journal of the American Medical Association, in which medical students posed as patients with skin conditions, found that telemedicine physicians repeatedly missed major diagnoses.
That is something that concerns Madrigal-Dersch.
“You can’t see rashes well on a computer screen,” she said. “You can’t tell. Is the rash raised? Does it feel like sandpaper when you touch it? Is it hot? You can’t discern that on a screen.”
Sasson says that in her experience, dermatology cases are among the most amenable to telemedicine.
“Those are often things you can deal with via a video chat and with photos of the rash,” she said. “You don’t need to have the patient travel 30 minutes to your office for what is often a one- to two-minute visit.”
The convenience of telemedicine is something that patients appreciate. A survey from Massachusetts General Hospital found that about 4 out of 5 patients said that scheduling a telemedicine follow-up visit was easier than scheduling a follow-up visit to a clinic. And the majority of patients didn’t think the quality suffered, with 62% saying that the quality of the telemedicine visit was the same as an in-person visit and 21% saying it was better.
Madrigal-Dersch claims that an area in which telemedicine has inferior quality is in providing the privacy that some patients need to confide in their physicians.
“Another problem is wives who are in abusive situations. Sometimes, the abuser is close at hand, and the wife can’t say anything,” she said. “The same holds true for the teenagers I treat. Sometimes, I’ll ask them questions, and they’ll reply that they can’t tell me because their mom is right outside the door.”
“I would argue that a woman in an abusive situation would be able to get care sooner because she is not afraid of the cost of an ER visit,” Sasson replied. “There are less barriers to her getting care than if she only had the option of the ER.”
Sasson also emphasizes that telemedicine could greatly increase access for patients since it is cheaper than other types of care. A study of Jefferson Health in Philadelphia found that a telemedicine visit saved the patient between $19 and $121. The biggest savings came from avoiding emergency room visits, which can save from $309 to $1,500 per visit.
Yet such savings may prove illusory. The reduction in ER costs may be offset by the increased utilization of telemedicine. A RAND investigation of the California Public Employees’ Retirement System found that 88% of telemedicine consults were new visits and not a replacement for more expensive care. But the Jefferson Health study found that new utilization accounted for only 16% of the cases.
Not surprisingly, Sasson and Madrigal-Dersch differ in their outlooks for telemedicine.
“I think we are giving patients options, and I think the best way to deliver care is to give patients more ways to access that care,” Sasson said. “That way, they are not always going to the ER because they don’t know where else to go.”
“I think we are going to have a lot more people having diagnoses missed and morbidity and mortality much higher than expected,” said Madrigal-Dersch.
