Where Telemedicine Falls Short
by David Blumenthal
June 30, 2020
[Excerpts] Telehealth use has surged during the coronavirus pandemic, with the technology spreading far and fast. Doctors and patients alike must be wondering if this is the beginning of a whole new kind of doctor–patient relationship, one that might totally transform our health care system.
I am not skeptical because of the technology: I am a strong supporter of health information technology and believe new IT holds huge benefits for patients and their caregivers.
But I am also a primary care physician. I know that trusting relationships between patients and clinicians can be a boon to giving and receiving care.
I also know that well-trained clinicians use all their senses — not just hearing and vision. They appraise the whole patient: Is there a new limp, a shift in posture, a new pallor?
And there is no diagnostic test more cost-effective than the laying on of hands. I have found treatable cancers multiple times in routine exams that would be impossible to replicate in the virtual world.
There are times and places where virtual care makes perfect sense. During the pandemic, when in-person exposure has to be limited, it has been crucial for keeping doctors and patients And in parts of America where no alternatives exist, telehealth has been a lifesaver — especially in enabling the delivery of scarce specialty services to support family physicians in remote areas.
There are also situations where virtual connections deliver excellent care with greater convenience and lower cost than in-person visits. Examples include routine and repetitive issues like monitoring blood pressure or mild respiratory symptoms (Covid-19 notwithstanding).
There is growing evidence that virtual care for some mental health conditions works well, too. And virtual care likely works better for the young and healthy than the elderly and sick.
The past few months represent a crash course in telehealth for doctors and their patients, and this exposure will undoubtedly leave us better positioned to use the technology moving forward.
But telecare will work best when it is adapted to humans and their needs rather than the reverse. It should be one more tool that builds upon, and promotes, the human relationships and caring clinical eyes, ears, and hands that have always sustained us when we are sick.
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