Beware the limits of telemedicine

I’d be willing to bet most of you have heard of, or previously used, telemedicine in some shape, form or fashion.  Stated simply, telemedicine is the process of seeking care from a medical provider using your phone or laptop.  This field is exploding, and I have no doubt popularity will continue to grow as large health systems and pharmacy giants dive in.

It’s easy to appreciate the convenience and efficiency of telemedicine services, but there are potential risks for patients that haven’t been commonly discussed. This post isn’t to deter you from using telemedicine, but instead to educate you on this new technology so you can make an informed decision. Let’s take a closer look.

Perhaps the most common form of telemedicine is when a large medical practice creates online “virtual” appointments. This involves using a webcam to remotely discuss a concern with a medical provider that is associated with the medical group where you’ve already established care. This is by far, in my opinion, the safest form of telemedicine. Why do I feel this way? The medical provider chatting with you will have access to your medical records and can recommend you come in for a real-life visit if your concerns are not easily evaluated in a virtual environment.

Remember, however, the virtual provider will be unable to conduct a physical exam, so this limits diagnostic capability for many medical complaints. Second, no matter how good the technology, online meetings always lose something in the way of nonverbal communication. It’s just not the same. Having said that, these visits can nonetheless be great for counseling and simple medication titration for pre-existing conditions (e.g., hypertension or diabetes).

A second type of telemedicine that is exploding in popularity involves remote medical visits offered by private telemedicine companies. There are many of them online that you can find. These companies are not associated with specific health systems and contract with their own medical providers to conduct the visits.

Now, before you use this form of telemedicine, it’s crucial to understand some limitations and potential risks of the technology. Let’s take a quick look at a few of them:

1. Geography. Let’s say you’re located in one state and the virtual provider you see is based in another. If you have a bad outcome and want to file a grievance (or even a malpractice claim), what happens? Well, you might be surprised to know standards haven’t been set yet for physicians giving medical advice virtually or across state lines. It hasn’t been established in the legal system yet. So now what? Things could get messy in a hurry.

2. Malpractice. This area of medicine is already complex, and grows even more complicated by adding the technological effects of telemedicine. For example, can a bad audio connection still make a doctor liable? What if the connection is slow?

3. Standard of care. There are clearly established standards of care for in-person visits in each state. Did you know only a few states have established a standard of care for telemedicine thus far? That’s concerning for both physician and patient.

4. Data breaches. There is risk of data breach with any internet-based service.

5. Fraud and abuse. Once again, clear guidelines are set for in-person evaluations, but not yet for telemedicine. For example, how can you ensure your virtual provider is credentialed as they claim to be? You often can’t, so you must take their word for it.

In summary, I feel it would be safest to avoid using most telemedicine services until many of these issues are sorted out. One exception, as stated above, would be a virtual visit with your established doctor or medical practice. Otherwise, you’re better off heading to your PCP’s office or an urgent care center to be evaluated by a living, breathing human. For now, your iPhone can’t safely duplicate it.

Kevin Tolliver is an internal medicine physician who blogs at My Medical Musings.

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