Photo Credit: Jacob Wackerhausen
Telehealth, although a convenient service for patients, provides physicians with new diagnosis challenges.
Unforeseen challenges for patients and providers burdened healthcare during the COVID-19 pandemic. Many physicians offered telehealth services to maintain care when face-to-face interactions were potentially dangerous. Kristen Fuller, MD, determined that telehealth was necessary but a poor substitute for in-person visits, in which she could perform a physical exam and optimally determine the appropriate course of care for her patients. Providing a diagnosis and prescribing treatment can be nerve-wracking without a face-to-face meeting. For example, Dr. Fuller reluctantly prescribed antibiotics to a boy aged 2 years after his mom described his symptoms in a telehealth visit, which appeared to be due to an ear infection. While Dr. Fuller urged the child’s mom to take him to urgent care for an in-person diagnosis, the mother was concerned about exposing her child and herself to COVID-19. Dr. Fuller wrote the prescription and emphasized that the mother should take her child to urgent care if the antibiotics did not appear to work within 48 hours.
Beyond the inferiority of virtual exams to physical exams, telehealth visits make it challenging for physicians to read a patient’s body language. Dr. Fuller notes that it is difficult to determine the severity of a sickness when that patient is virtually present than when they are physically present. It is unrealistic for doctors to obtain vital signs in a telehealth session. Adding to the issues, patients are generally distracted in virtual meetings, which makes appointments less effective and interferes with a solid physician-to-patient connection.
According to Dr. Fuller, telehealth enabled patient laziness and complacency, likening patients’ desire to attend a doctor’s appointment to their willingness to wait in line at the DMV. Dr. Fuller stressed concern that patients would often choose the convenient and less time-consuming route of telehealth instead of in-person visits. A Cosmos Study posted on Epic Research’s website found that patients are less inclined to schedule follow-up appointments after a telehealth visit. This choice can potentially compromise the patient’s well-being, both presently and in the future. Despite the downsides to telehealth, Dr. Fuller notes that insurance companies are huge proponents of telehealth sessions, as they are less expensive than in-person visits. For example, the insurance payout for an emergency room visit is significantly less than for a virtual visit. This risks patient well-being as insurance companies incentivize telehealth.
A study published in JAMA Dermatology tested the accuracy of virtual diagnoses by having physicians identify skin diseases based on uploaded photos. Researchers concluded that physicians misdiagnosed everything from skin cancers to herpes to syphilis. Dr. Fuller noted that many doctors overlooked asking basic questions, and some prescribed medications without acquiring substantial information on the patient’s history. Almost no telehealth services require copies of a patient’s primary care physician records. The study authors found that two telehealth sites featured non-US-based physicians not licensed to practice in the applicable state.
According to a study in the Journal of the American Geriatric Society, older adult populations benefit from telehealth, as it spares them from securing transportation and being exposed to infectious diseases. However, older adult patients noted that virtual visits are not a comparable substitute to in-person care. 22% of respondents felt less confident that telehealth physicians would view patients in totality, primarily focusing on the reason for the appointment rather than taking the time to assess patients holistically. The authors found that patients were less inclined to confide in their physician during telehealth visits.
In Dr. Fuller’s opinion, the best role for telehealth is as a supplement rather than a frontline form of healthcare. Dr. Fuller notes that many ailments, like acute illnesses that require a physical exam and laboratory test for diagnosis, are best evaluated in person. There are certain instances in which a telehealth visit may suffice, such as for follow-ups. Telehealth visits can be valuable for rurally located physicians who might require further diagnostic help from a specialist. Nonetheless, assessing anything from vital signs to a body rash and determining the severity of illness is almost impossible to accurately accomplish when a visit is virtual.
