The Pros and Cons of Telemedicine

Telemedicine is all over the news right now, due to the COVID-19 pandemic which has dramatically increased its use. But even before this outbreak, telemedicine filled a need for many patients, including those who were geographically isolated, too sick to travel, or without transportation. There are countless other reasons that make traveling to the doctor difficult, or even impossible. With telemedicine, your appointment is “virtual”, taking place over a phone or computer. But before you have a virtual appointment, it’s important to consider the pros and cons of telemedicine.

What exactly is telemedicine?

Telehealth is the broad term for all healthcare services that use telecommunications, including telephone alerts regarding disease outbreaks. Telemedicine, a subset of telehealth, is the use of telecommunications to provide clinical services to patients. (Although it’s worth noting that these terms are often used interchangeably.)

For telemedicine appointments, doctors and other healthcare professionals conduct virtual appointments with patients via video (e.g. Skype or FaceTime). Additionally, patients can send photos to their doctors using integrated software, allowing doctors to more clearly see areas of concern, such as moles, burns or bruises. Additionally, telemedicine may include the use of at home monitoring systems that make it easy for doctors to track a patient’s important health parameters, such as heart rate and blood pressure. Finally, some telemedicine tools include the use of chatbots and automated algorithms.

The use of telemedicine is rapidly growing as more doctors and patients participate, especially with the COVID-19 pandemic.

To clarify, there are two main avenues for telemedicine services. There are large companies, like Teladoc and Amwell (aka American Well), that are primarily telemedicine companies. Their doctors never see patients in person. When patients “visit” a doctor from a telemedicine company, they are speaking with doctors they do not know. Conversely, some primary care doctors and specialists are turning to phone and video appointments with their patients. In response to COVID-19, many doctors’ offices and urgent care centers are increasing their telemedicine capabilities in order to reach as many patients as possible while reducing the spread of germs.

Telehealth may be coming to a pharmacy near you!

NewYork-Presbyterian Hospital has partnered with Walgreens to provide telehealth services at self-serve kiosks in Manhattan Walgreens stores.  The kiosks, which are located in private rooms, connect patients with a clinician from Weill Cornell Medicine emergency department. Through this program, doctors can treat non-life-threatening illnesses and prescribe treatments for patients. I expect these types of programs will expand in the future.

Six benefits of telemedicine.

Telemedicine limits exposure to dangerous germs.

doctor putting on gloves - pros and cons of telemedicineClearly, telemedicine protects both patients and doctors from dangerous germs. As the world fights COVID-19, healthcare workers are at great risk of contracting the potentially deadly virus as they tend to infected patients. And, it’s best for everyone, including the greater community, if patients who suspect they might be infected stay home. But this isn’t only true for COVID-19. Keeping sick patients at home, when their conditions allow, helps reduce the spread of any type of germ. Certainly, a benefit of telemedicine is that it can help patients get medical care without leaving their homes.

Improved access to doctors, including specialists.

Plain and simple – telemedicine improves access to doctors. Since there are widespread shortages of doctors and other healthcare providers, in both rural and urban areas, telemedicine provides access to services and doctors that would otherwise be nearly impossible. Similarly, patients with rare diseases can connect with hard-to-find specialists who are too far to see in person. Furthermore, telemedicine is a great tool if you cannot get to the doctor due to illness, transportation issues or other impediments.

It’s so convenient!

photo of cars on a highway - pros and cons of telemedicineWhy would you want to travel to your doctor’s office and wait in the waiting room for 20-30 minutes when you could wait for your telemedicine appointment while at home or at work? Interestingly, one study found the average in-office medical visit takes 121 minutes – 20 minutes seeing the doctor and 101 minutes traveling to/from the doctor and sitting in the waiting room. Clearly, virtual visits save you time and eliminate travel-related stresses and expenses. And all that driving and waiting usually means more time away from work, family and other obligations.

It can minimize unneeded visits to the doctor or ER.

It can be a waste of time and money to go to a doctor or the ER if your health doesn’t require an in-person visit. With telemedicine, you can speak with a doctor from the comfort of your home or job. Together you can decide if you should follow up with a visit the doctor or ER.

Reduced healthcare costs.

Telemedicine can reduce or contain healthcare spending by increasing efficiency via better management of chronic diseases, reduced travel times, and fewer or shorter hospital stays. Since so many of us have high deductible insurance plans, as well as responsibility for a portion of each bill, lowering healthcare costs helps us all.

There is a potential of improved quality of healthcare.

Telemedicine has the potential to improve the quality of care by making it easier to for providers to stay engaged with patients. Additionally, when doctors remotely track a patient’s health via monitoring systems, they can identify problems as soon as they develop.

Studies show that the quality of telemedicine services delivered are as good those provided through in-person appointments. Interestingly, according to the American Telemedicine Association, “in some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction.”

But, keep in mind that no doctor, or service is perfect. Errors are possible in all methods of healthcare delivery.

But there are cons to telemedicine as well.

You can’t get physical!

photo of smiling doctor examines patientFirstly, it goes without saying that physical exams are impossible via phone of computer. And of course, there are circumstances when an in-person visit is essential for diagnosis and treatment. For instance, doctors on the phone or computer can’t swab noses and throats to test for COVID-19, strep throat or for signs of other infections.

However, for patient follow-ups and minor conditions, a virtual visit may be enough. And if the patient is too ill to leave their house or can’t leave due to the risk of exposing others to a potentially dangerous germ, a virtual appointment can be a good starting point. And if a patient cannot travel far distances for an in-person appointment, a virtual appointment is far better than no appointment at all.

You might not know the doctor on the other side of the phone. 

As mentioned, the doctor you speak with during a virtual appointment may be a stranger to you since some doctors use outside telemedicine companies to provide virtual care for their patients. Additionally, many employers now provide telemedicine services from 3rd party vendors as part of their benefit offerings. In these circumstances, you’ll connect with doctors who are unfamiliar with you and your medical history, which can impact care.

Pediatric patients might get unneeded antibiotics.

Researchers examined treatment recommendationsphoto muslim grandmother playing with grandchild - pros and cons of telemedicine from over 500,000 cases of children with acute respiratory infections (ARI). Their analysis found that children with ARI who were treated through telemedicine were significantly more likely to receive antibiotics. The percent of children with ARI who received antibiotics was as follows:

  • 52% of those who used telemedicine services
  • 42% of patients who went to urgent care
  • 31% of those who saw their primary care providers

Additionally, a higher proportion of the antibiotics prescriptions written through telemedicine appointments disregarded medical guidelines regarding when to prescribe antibiotics. This was primarily due to doctors prescribing bacteria-fighting antibiotics to treat viral illnesses (e.g. colds and flus) which cannot be cured with antibiotics. Why is this important? Prescribing unneeded antibiotics increases the chances of side effects and contributes to the increase of antibiotic-resistant germs. And that is nothing to sneeze at! Experts speculate that antibiotic-resistant germs may kill more people than cancer in the coming decades. (For more information, read this blog post on the dangers of too many antibiotics.)

Interestingly, there is no evidence that adult patients receive a higher number of unneeded antibiotics from telemedicine appointments, as compared to urgent care or primary care doctor visits.

Does this mean that all patients who use telemedicine might get unneeded medications? I don’t know, but it’s worth keeping this study in mind if/when you use telemedicine services.

Chatbots and automated algorithms are far from perfect.

Some telemedicine tools include chatbots and automated algorithms. Importantly, there’s no way for patients to know about the accuracy of these chatbots.

Since many people have turned to chatbots to see if their symptoms could be from COVID-19, STAT reporters put several chatbot symptom checkers to the test. They entered the same symptoms into more than 6 symptom checkers, with the goal of assessing the consistency and clarity of their advice. Unfortunately, information they received related to their level of COVID-19 risk varied widely. For instance, the chatbot on the Centers for Disease Control and Prevention (CDC) website determined he had “one or more symptom(s) that may be related to COVID-19” and suggested he contact a healthcare provider within 24 hours “and start home isolation immediately.” Conversely, another symptom checker chatbot reported his risk of COVID-19 infection was currently low. Others reported he was at “medium risk” or “might have the infection.”

Until the accuracy of these chatbots is proven, I suggest you don’t rely on them for medical information. Of course, this concern doesn’t apply to the accuracy of advice you receive when speaking with doctors.

Data security concerns.

Cybersecurity is a huge concern in medicine these days, and telemedicine is no exception. Unfortunately, cybercriminals can hack into telemedicine systems to steal personal and private healthcare information. Not only is this worrisome, it’s a violation of HIPAA laws. Sadly, there are currently no existing solutions to stop these criminals, but many experts across the world are hard at work trying to thwart these attacks.

Money matters.

piles of US 10 dollar bills - pros and cons of telemedicineJust like any other medical appointment, telemedicine visits come with a fee. If you use a telemedicine company provided through your employer, there may be little or no cost for you. Or, it might be billed like any other medical appointment, with the same copays and deductibles. To avoid unexpected bills, ask your employer about cost and possible copays before you make an appointment.

If you schedule a virtual appointment through your doctor, your insurance will likely cover it. But don’t assume theses visits are covered – and don’t assume your co-pay will be the same as for in-person visits. Most states have telehealth laws requiring coverage, but state policies change frequently. To learn about coverage in your state, visit the Center for Connected Health Policy website. It’s also a good idea to call your insurance company and ask them about coverage, including co-pays, for telemedicine services.

Additionally, it’s important to realize that some doctors charge a convenience fee, which can range from $35 – $125, on top of the normal visit fee. These fees are not covered by insurance, so ask about fees before your virtual appointment!

Medicare and telemedicine.  

photo US capitol buildingsIn 2018, the Centers for Medicare & Medicaid Services (CMS) updated their rules to cover some telehealth services for patients in rural areas. However, due to COVID-19, CMS is now covering telehealth services by doctors and other healthcare providers to treat patients with COVID-19 and for other “medically reasonable purposes”. The new rules, effective March 6, 2020, cover virtual visits from offices, hospitals and places of residence. Note that coinsurance and deductibles apply. It’s unclear if these updated rules will be permanent – time will tell.

What do patients think of telemedicine?

It seems like most patients are willing to give it a try. Over the past 15 years, many studies report patient satisfaction and support for telemedical services.

A 2015 patient survey by Software Advice found that:

  • Among patients who have not used a telemedicine service, 75% express interest in using one in place of an in-person medical visit.
  • Only 16% of patients would prefer care in an ER for a minor ailment, even if they also had access to telemedical services.
  • 2% of telemedicine users say security is their main concern with the telemedical system used.
  • 21% of patients who had virtual appointments say the quality of care was similar to or higher than an in-person visit.

And similar results were found in a 2017 survey by Amwell (a telemedicine company). Their survey showed that 2/3 of people expressed a willingness to see a doctor via video.

How many patients use telemedicine?

Telemedicine is gaining traction quickly, particularly with the COVID-19 pandemic.

But even before the COVID-19 outbreak, the number of patients using telehealth services in the US grew 53% between 2016 to 2017. To put this increase in perspective, by comparison, this increase was far greater than the increase in use of urgent care centers (+14%) and retail clinics (+7%). Interestingly, and likely related, the use of Emergency Rooms decreased 2% during that period.

Get the most of every virtual appointment.

Even though your appointment is via the phone, don’t just sit back in your favorite TV chair and relax. You need to prepare for these appointments the same way you would prepare for any in-person medical appointment. And, you need to make sure your doctor is listening to you, your questions are answered, and you understand next steps.

For more information on getting the most out of every appointment, read these blog posts:

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