What Is Telemedicine?

It sounds like a dream come true, doesn’t it?  You’re sick and you just pick up the phone and call your doctor.  Ten minutes and a secure video call later you’re on your way to the pharmacy to pick up a prescription for something to get you better.  No lost work time, no need to drive to the office and wait to be seen, and best of all, no long wait at the urgent care or emergency room.

This is the vision that telemedicine proponents would like you to believe.

What is telemedicine?  Telemedicine is defined as “the remote delivery of health care services using telecommunications technology: internet, wireless services, satellite and telephone media.”  It was initially developed in the VA system as a way to bring specialty services to underserved areas.

Veterans live everywhere in the USA and have a right to access the VA health system’s resources for their care.  However, if a veteran who lives in Copper Mountain, Colorado (population 385 and 2.5 hours from the VA medical center in Colorado Springs) needs care, the VA has developed technology to allow him to receive consultations with specialists via a secure video call using the health resources in his community.

This is very cool and an awesome use of technology to promote health in a very at-risk population of aging men and women who deserve the very best the US health care system can provide.  It is also starting to bleed over into other areas of medicine.  Super-sub-specialists with very targeted skills can be consulted from all over the world.  Dermatologists can be sent photos of rashes and skin spots and provide opinions without needing to see patients in-person (and can be paid by insurance companies for these consultations).  Pathologists and radiologists can do the same thing with images of tissue specimens and MRI scans.

I am very excited that this may soon be an option in my office.  I sometimes have to bring people in to the office to discuss complex test results and decide on a plan of care, not necessarily because I have to lay hands on and examine patients (most of the time I’ve seen the patient recently) but because it’s going to be a fairly complicated and time-consuming conversation.  Being able to have those discussions face-to-face via secure video conference would be a dream come true!

However, there times when a video “virtual” visit is NOT appropriate.  If physical examination (listening to heart, lungs and abdomen, looking in ears and throats, manipulating a painful joint or checking an in-office lab test) is required to diagnose a problem, then an in-person visit is most appropriate.

For instance, do I absolutely need to see someone in the office to tell if they have a cold or sinus infection?  No, not really.  I can tell a lot by the patient’s symptoms and how those symptoms have changed over time.  However, I can NOT diagnose bronchitis, pneumonia, ear infections or strep throat over the phone (or video call).  If someone thinks their respiratory symptoms are more than just a common cold, they need to be seen in the office because without examining them I am less likely to get the right diagnosis and prescribe the right treatment.

Before you call the Skype doctor to get an antibiotic for what feels like strep, consider whether you are doing yourself harm by not being properly evaluated for your illness.  Every treatment has benefits AND risks.  That antibiotic, if taken for what is actually a viral sore throat, can cause diarrhea or a vaginal yeast infection or even a life-threatening allergic reaction or C. diff infection WITHOUT doing a thing to help the sore throat.

Does the doctor you are calling know you well?  Does he or she know your history?  Do YOU know THEM and trust them to make the safest and best recommendation for you?  And if they tell you they can’t be sure what’s wrong without seeing you in the office, will you be OK with that?

If the answer to any of these questions is no, you probably would be safest calling your primary care doctor for a quick visit.  If you don’t have a primary care doctor, you should!  Ask friends and family for a referral, call your insurance company, or check ZocDoc.com.

There’s a reason why every doctor visit has 3 components: history (the story of your illness), physical examination, and medical decision making.  Don’t handicap your doctor!  Most of the time reaching the correct diagnosis and choosing the right treatment, especially for a new problem, requires all three.

QUESTION: What do you think of telemedicine?  Would you choose to see a doctor via Skype video call if you were sick or hurt?

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