The doctor will video chat with you now: Perspectives on telehealth

How often do you leave your house without your phone? Let me guess – rarely, if ever. Among the many advantages that the internet has been able to provide, one of these is almost instantaneous access to information. You forget the name of the actress who made a cameo in your favorite show? You have the encyclopedia and more at your fingertips – Google it! You need directions to the new grocery store in town? Open Apple maps to find the fastest route. You’re at home sick with the flu and don’t feel like driving to your doctor’s office for an appointment? Have a telehealth visit instead.

Telehealth, often referred to as telemedicine, has given patients the ability to connect with a clinician without an in-person office visit. Patients can use their phone, computer, tablet or device to conduct a live video or audio chat with their doctor. In the past few years, telehealth has been marketed as a public health tool, especially with the start of the COVID-19 pandemic. The idea that you can still reach and contact your physician without exposing the public to your contagious germs is appealing to many patients.

The prevalence of telehealth

According to data from the National Health Interview Survey from the CDC, over 37% of adults used telemedicine in 2021. Telehealth is revolutionizing the world of medicine and combatting many of the issues that people face when receiving care – most notably, it’s easier. Don’t have enough PTO to take time off work during the day to leave and go see your doctor? Use your phone to speak with them live during your lunch break. Don’t have time to drive to the doctor’s office in between juggling children, work or the daily stresses of normal life? Use your computer to video chat with them.

There are a multitude of reasons that telehealth is advantageous, such as improved access to care and overall accessibility to doctors and health information. However, telemedicine is not without pitfalls. Telehealth can be a double-edged sword. While it may be easier for patients, is it also easier for doctors?

From day one of medical school, professors teach their students that one of, if not the, most important parts of making an accurate diagnosis lies in your physical exam. There is something to be said for laying your hands on the abdomen of a patient who is presenting with nausea and vomiting. Not only does it aide in your clinical decision-making, but it also contributes to the sacred doctor-patient relationship. Your patient is coming to you in a time of need, and human touch can go a long way in building a better rapport with the patient – helping them feel like their needs are genuinely being addressed.

Unfortunately, telehealth essentially eliminates this aspect of medicine and typically limits doctors to what they can see on the screen. While on a live video chat, you can visibly see that your patient is coughing, but you can’t listen to their lungs to identify if there may be other underlying disease processes. You can’t listen to their heart and diagnose an asymptomatic murmur. This undoubtedly could make doctors concerned that they may have missed something or made the wrong diagnosis. Not to mention that not everyone has access to the internet – let alone reliable internet. In this sense, telehealth can be somewhat exclusionary, especially to those of lower socioeconomic status.

The disadvantages of prescribing through a screen

A qualitative study on primary care physician perspectives of telemedicine during the COVID-19 pandemic published in The Journal of the American Board of Family Medicine in 2021 found that several of the physicians they interviewed mentioned that a lack of a physical exam could result in their overprescribing of antibiotics. This led them to sometimes feel more inclined to use an antibiotic in order to err on the side of caution in treating a patient’s condition.

Many of the physicians noted that the physical exam generally improves patient satisfaction. While it may not be necessary for every single visit, it is important for a doctor’s connection with their patients.

On the flip side, some of the physicians also acknowledged the advantages of telehealth and said they believe some visits are well-suited for the platform. These include visits focused on counseling. Doctors noted that the time they would have spent on a required physical exam in the office could instead be spent on longer discussions with the patient. They also found it easier to perform medication adjustments via telehealth. Chronic conditions such as hypertension or diabetes may require constant tweaking of medication dosages, which can quickly and efficiently be done without needing to be in person.

The world we live in is ever-evolving – what is popular or trending today may be different by the time we wake up tomorrow. Telehealth got its substantial rise in popularity during the pandemic and has continued on an upward ascent. It’s changed the way in which health care is delivered and received, both for patients and doctors. But remember, though telemedicine might be easier, that doesn’t necessarily mean that it’s better.

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