A virtual office visit for your cold is not a good idea

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A version of this column was published on January 13, 2013 in USA Today.

Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.

I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an antibiotic over the Internet?”

If health insurers had their way, more doctors would be seeing patients and possibly prescribing medications online. However, I would be wary of this scenario.

Despite video chats being commonplace, so-called virtual office visits have yet to be the standard in healthcare. It seems that companies and health insurers are currently driven by cutting costs and are open to changing the physician/patient interaction process. More are starting to offer services where patients can consult doctors through a webcam-enabled laptop, or through a smartphone or tablet. According to a survey by Mercer, a human resource consulting firm, 15% of very large employers use some form of telemedicine, and another 39% are considering it.

This type of process typically costs around $40, and patients with minor illnesses can instantly access a physician or nurse practitioner and be prescribed medication online. Patients rave about the convenience, while they sidestep the frustration of scheduling an appointment with a doctor, or worse, going to the emergency room, which can cost hundreds of dollars.

But something is lost through these virtual connections. There is value to face-to-face interaction, where a provider talks to and examines a patient in person. For example, I’ve seen a patient convinced that he had a sinus infection only to find that he had a tumor inside his nose. Another complained of minor ear pain, but after examining her, I saw that it had spread to the point where she needed to be hospitalized for intravenous antibiotics. Both of these diagnoses would have been missed had I only treated them over the Internet.

Without the ability to talk to and examine patients in the exam room, many doctors play it safe and reflexively prescribe drugs, whether patients need them or not. A recent study from the Journal of the American Medical Association found that patients who were treated through Internet-based virtual visits had higher antibiotic prescription rates for their sinus infections, compared to patients whom were seen in the office.

That’s a problem when you consider that most sinus infections clear up themselves, and don’t require antibiotics. A study last year found that patients who had sinus infections felt the same after a few days, whether they received antibiotics or not. Worse, unnecessary drugs contribute to the growing problem of antibiotics resistance. Guidelines from the Infectious Diseases Society of America and Choosing Wisely, a consortium of national medical societies that provide evidence-based guidelines, also recommend against knee-jerk antibiotic prescriptions for sinus infections.

It is important to consider what would happen if something went wrong after the online only consultation. For example, what if the patient had an allergic reaction to an antibiotic, or symptoms that got worse? Good luck getting a follow-up from that same online doctor.

I do believe that there is some room for virtual visits, with stricter conditions. For patients that I have already met and know well, managing their hypertension and diabetes through a video chat on my tablet is tremendously helpful. But I would not feel comfortable treating patients on the web that I’ve only met minutes earlier.

Currently, only 13 states allow doctors to prescribe drugs and treat patients online, without actually meeting the person in person first. With the zeal to cut costs and maximize convenience to patients, there will be tremendous pressure to expand that number. Please remember what is cheapest for insurers, and easiest for patients, isn’t necessarily what is best.

Kevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.