Telemedicine use has rapidly increased due to the COVID-19 pandemic which has kept patients away from doctors’ offices. 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 phone or video (e.g., Skype or FaceTime) or telephone. Additionally, some systems allow patients to send photos to their doctors using integrated software, allowing doctors to see areas of concern more clearly, such as moles, burns or bruises.
Telehealth 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. And some telemedicine tools include the use of chatbots and automated algorithms.
To clarify, there are two main avenues for telemedicine services. Large companies, like Teladoc and Amwell (aka American Well), 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.
On the other hand, doctors and even urgent care centers increasingly offer virtual appointments with their own patients.
The use of telemedicine is rapidly growing as more doctors and patients participate, especially with the COVID-19 pandemic. However, there are pros and cons of telemedicine – read on to learn more.
The pros and cons of telemedicine.
When weighing the pros and cons of telemedicine, realize that no doctor, or service is perfect. Errors are possible in all methods of healthcare delivery.
Telemedicine has many benefits.
Telemedicine limits exposure to dangerous germs.
Clearly, 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 care for infected patients. Conversely, patients without COVID-19 could pick up the infection from someone they encounter at a medical appointment.
Clearly, 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. For instance, many patients don’t have access to a geneticist to diagnose rare genetic disorders, and telemedicine can bridge that gap.
For more information, read my blog post Can Telemedicine Help You Get a Proper Diagnosis for a Rare Disease?
It’s so convenient!
Why 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.
And of course, telemedicine is a great tool if you cannot get to the doctor due to illness, transportation issues or other impediments.
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 to the doctor or go to the 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…telemedicine delivers a superior product, with greater outcomes and patient satisfaction.”
However, on a personal note, I know of a patient whose potentially fatal condition “slipped through the cracks” due to telemedicine. This patient had several telemedicine appointments, but the lack of in-person care made it hard for the doctor to realize just how sick she was.
The cons of telemedicine.
You can’t get physical!
Firstly, 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 feel for swollen glands or look at throats or noses to test for COVID-19, strep throat or other infections.
Additionally, doctors can’t screen for blood pressure or cholesterol levels over the phone. In fact, the decrease in the number of in-person doctor visits due to COVID-19 led to a significant decrease in cardiovascular screenings, both important for the prevention of heart attacks and strokes.
Researchers compared primary care visits in the 2nd quarter of 2020 with the 2nd quarters of 2018 and 2019. They found:
- Blood pressure checks dropped by 50.1%
- Cholesterol tests fell by 36.9%
- New medication visits decreased by 26.0%
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.
Technical glitches and obstacles.
Certainly, it’s frustrating when the image of friends or family freeze on the screen, or when audio cuts out, when chatting on video calls. But it’s more than annoying when glitches occur during a telemedicine appointment. A really bad connection can force you to cut the appointment short or reschedule altogether.
Additionally, connecting to a telemedicine appointment can be frustrating and time consuming. Sometimes you can simply click on a link you receive via email or text, but other times you have to download a computer application and then click through multiple steps to log in.
Not everyone can use video for appointments.
Unfortunately, it can be difficult, if not impossible, for lower income people to take advantage of video calling for telemedicine appointments. In fact, a 2020 study of telemedicine appointments among lower income patients found that most of the telemedicine appointments were conducted over the phone.
Could this impact the quality of care? Probably. Experts express concerns about the quality of audio-only appointments, as compared to video appointments.
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 the care you receive. Additionally, a new doctor will not have had any chance to earn your trust, yet trusting the opinion of your doctors is an important part of healthcare. Simply put, will you fully trust the advice of a doctor you never met?
Distractions can lower the quality of the appointment.
When patients meet with doctors in person, it’s easy to stay focused on the conversation. However, when patients have telehealth appointments, the opportunities for distraction are endless. And these distractions can lead to less engagement, which can negatively impact your health and care.
How distracted are we? According to a 2020 survey conducted by DrFirst, many patients are distracted during telemedicine appointments. Interestingly, 73% of male respondents and 39% of female respondents reported multitasking during telehealth visits. Distractions include:
- Surfing web, checking email, texting – 24.5%
- Watching the news, TV, or movie – 24%
- Scrolling through social media – 21%
- Playing a video game – 19%
- Exercising – 18%
- Driving a car – 10%
- Having an alcoholic beverage – 9.4%
Telehealth appointments might not be effective after emergency department visits.
For patients discharged from the emergency department (ED), seeing a doctor for a follow-up visit is often an important next step. In fact, experts state that timely in-person appointments after an ED visit is associated with a decreased risk of death.
But what about follow-up visits via telehealth? One study evaluated 17,000 ED visits and found that ED patients who had follow-up appointments via telehealth were more likely to return to the ED or be hospitalized than patients who followed up with doctors in person. What does this mean for effectiveness of telehealth appointments in general? Certainly more research is needed.
State laws can narrow access to out-of-state doctors.
Each state makes their own laws regarding telemedicine appointments with doctors licensed in other states. When COVID-19 made in-person visits dangerous for patients and doctors, many states relaxed their rules, allowing broad patient access to out-of-state doctors.
However, some states are reverting back to their old rules and not allowing their residents to have telemedicine appointments with doctors licensed in other states. Importantly, if an out-of-state doctor is also licensed in your state, a telemedicine appointment should not be a problem.
Pediatric patients might get unneeded antibiotics.
Interestingly, researchers examined treatment recommendations 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.
Clearly, this may be one place where the cons of telemedicine outweigh the pros. 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 notable concern in telemedicine. Unfortunately, cybercriminals can hack into telemedicine systems to steal personal and private healthcare information. Not only is this worrisome, but it’s also 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.
The financial pros and cons of telemedicine.
Just 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 these visits are covered – and don’t assume your co-pay will be the same as for in-person visits.
Additionally, 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!
Most states have telemedicine 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.
Medicare and telemedicine.
In 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 are the pros and cons of telemedicine?
Certainly, patients realize there are pros and cons of telemedicine. But, 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.
How can you decide if you should see a doctor in person?
Firstly, in most cases, this decision is up to you. Even if your doctor or the person who schedules appointments recommends a telemedicine appointment, you can ask for an in-person appointment.
But when are in-person appointments a good idea?
Generally speaking, you should try to see a doctor in person if:
- It’s your first visit.
- You think you need a physical exam.
- If you develop new symptoms.
Get the most of every virtual appointment.
Even though your appointment is via the phone or computer, 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. For instance, write down your questions prior to your appointment. And have a list of medications taken, along with a record of your symptoms and side effects.
Additionally, as with any appointment, make sure your doctor understands your concerns, listens to your story, and answers your questions. Finally, make sure you understand next steps.
For more information on getting the most out of every appointment, read these blog posts:
- 10 Tips to Communicate Better with Doctors
- 10 Tips for a Better Medical Appointment
- Why Take Detailed Notes at Doctor Appointments?
- 10 Steps to Reduce Your Risk of Diagnostic Error
- Should you Speak Up if You Think Your Doctor is Wrong? YES!
- Personal Stories of Diagnostic Errors.
My final thoughts…
There are many pros and cons related to telemedicine, so consider your needs before scheduling a telemedicine appointment. My recent telemedicine appointments were successful, and I hope to continue with telemedicine appointments even after COVID-19 is no longer a threat. But I know there will also be times I want to see my doctors in-person.
NOTE: I updated this post on 11-1-21.