Telecommunicating with patients

New programs allow patients to use computers to have face-to-face interaction with a physician.
New programs allow patients to use computers to have face-to-face interaction with a physician.

Recently, I received a pamphlet in the mail from my insurance company advertising a new program they've launched that allows their customers to use computers to have face-to-face interaction with a physician at any time during the day. The selling point of the program is that you don't have to leave your home and you can contact them at any time, even in the middle of the night. In turn, the physician can evaluate a patient and determine if he or she has a viral illness, which is best treated symptomatically. The physician could also determine whether a patient has an illness such as strep throat that can be treated by calling in a prescription to the local pharmacy,  or determine whether a patient should go to the emergency department to seek medical treatment. In addition, the co-pay is less than an actual office visit.

I have mixed thoughts about this idea.

When I first heard about the idea of teleconferencing with a patient, I was horrified. Teleconferencing with someone simply does not replace a traditional interaction with a physician or advanced practice professional (APP). By teleconferencing with a patient, you can obtain a medical history, but you are not able to perform an accurate physical exam. You cannot listen to their lungs to determine if rales are present. You can't feel their lymph nodes to note the degree of swelling. You can't lay a hand on them to determine if one extremity is warmer than the other.  I feel like this creates a dangerous situation, because the physician performing this type of evaluation may be missing a crucial factor of the patient's illness that would only be picked up on physical exam.  For instance, a patient who has flu-like symptoms may be diagnosed with a viral illness, when the cause of the patient's symptoms are actually related to a large diabetic ulcer on the bottom of their foot that the physician would be unaware of and would only find  when performing a physical exam.  

 

In addition, teleconference companies often meet patients for the first time online and do not have any prior information. They are unable to determine how reliable a patient is to follow up with their primary care doctor, or how compliant they are about taking their medications.

While my initial response to telecommunication was to completely reject the idea, the more I thought about this concept, the more I realized that there are actually some benefits. After all, this is a concept doctors and APPs have been using for years.  When patients call their primary care office, doctors and APPs on call are tasked with making a diagnosis based off of what the patient is telling them. Often times, they are prescribing medications for them in the middle of the night with the promise that the patient will come in within the next several days. Teleconferencing offers the ability to at least look at the person and evaluate their general appearance. In addition, this is beneficial for patients who may not have transportation to their physician's office, or for people who live in rural areas where going to their physician's office may mean a long or treacherous trip.

In conclusion, I think there are pros and cons to the idea of teleconferencing. Providers are able to interview patients and make decisions based off of medical history and general appearance, which can be sufficient for problems such as viral illnesses and rashes.  When in doubt, physicians can refer patients to the emergency department or primary care provider for better evaluation and testing. However, teleconferencing is often performed by companies who are unfamiliar with patients and this can create issues because they do not have a complete sense of the patient's past medical history. At this point, I think that teleconferencing does not replace a traditional office visit, but I'm interested to see how it evolves in the future.

Jillian Knowles, MMS, PA-C is an emergency medicine physician assistant in the Philadelphia area. 

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