Telemedicine, also known as virtual health care, seems destined to grow robustly in the years ahead as patient demand for convenient access to health care expands. Also fueling the growth of telemedicine is the public’s increasing dependence on the sophisticated mobile devices that facilitate telemedicine encounters.
This increasingly popular alternative — or perhaps more precisely an adjunct — to person-to-person consultations between doctor and patient puts pressure on physicians to tailor their bedside manner to fit the small screen. In other words, what works in an encounter with a patient in the doctor’s office might not translate seamlessly to a telemedicine consultation.
In a recent article posted at Wired.com, senior writer Robbie Gonzalez looks at the challenges that medical professionals face in adjusting to this new form of health care delivery and in developing a “webside” manner. Among those interviewed by Gonzalez was pediatrician David M. Steinhorn, M.D., director of palliative care at Children’s National Medical System and the head of a telemedicine pilot program conducted by the system.
Telemedicine Demands a Different Approach
A strong believer in the power of telemedicine’s digital tools to connect clinicians with their patients, Steinhorn acknowledges that health care providers need to develop a slightly different way of relating to their patients in a telemedicine setting. However, he believes that once clinicians successfully clear some initial hurdles they can “maintain an intimate, immediate connection with patients that in some cases may be more therapeutically useful than even in-person interactions.”
Those initial hurdles can pose a more daunting challenge than Steinhorn suggests, however. While medical professionals must take into consideration such technical factors as lighting, backdrop, webcam resolution, and internet connection, perhaps the most important concern is the health care provider’s on-screen behavior.
Every Move Is Magnified
Elizabeth Krupinski, associate director of evaluation for the telemedicine program at the University of Arizona, points out to Gonzalez that every action a provider takes is magnified in the telemedicine setting. While a patient might think nothing of a doctor’s fidgeting, slouching, or gesticulating in an office setting, such movements could be distracting in a telemedicine encounter.
Krupinski offers these examples of provider behavior that could be somewhat off-putting in a telemedicine consultation. “You take a sip of coffee and your mug takes up the whole screen, and all they hear is the sound of you slurping. Or you turn away to make a note, and now all your patient sees is your shoulder. Maybe you disappear from the frame entirely.”
May Not Fit All Doctors
For some doctors, the telemedicine model of health care delivery may prove to be an inappropriate medium to reach their patients. Krupinski notes that some doctors may come across as caring and empathetic in a person-to-person setting but find themselves unable to convey these important emotions during a telemedicine encounter.
Jim Marcin, director of the pediatric telemedicine program at the University of California, Davis, told Gonzalez that his program has designed telemedicine clinics customized to address the unique demands of virtual health care. “We try our best to control as much of the environment as we can, so the doctors can be doctors.”
UC Davis Sets Up Ideal Clinic
To that end, the UC Davis telemedicine clinic is set up like an office but with better lighting. The clinic features a desk for the care provider with a wall of books as a backdrop. The entire room is wired for sound so that everything the doctor says can be heard clearly by the patient.
A growing number of doctors are finding that they can supplement their income by adding virtual consultations to the range of services they offer. In an article posted at the website of Medical Economics, part of the Modern Medicine online network, writer Ken Terry recounts the experiences of Brian Miller, M.D., an emergency department doctor at Cone Health in North Carolina.
In his spare time, Miller does virtual visits for MDLive, a Florida-based telemedicine provider that offers virtual health care services nationwide. Miller takes calls from patients in both North Carolina and Texas, where he is also licensed. The calls take an average of 7 to 10 minutes each. He told Terry that roughly 5 to 10 percent of the calls he takes are for medical matters more serious than those he can deal with in a virtual visit. Miller says he tells such patients to visit the closest emergency room or urgent care center in person.
Provides Additional Income
Miller says the virtual visits he does for MDLive generate a significant amount of additional income for him and can be fit into his spare time with relative ease. “I can take consults while driving in the car with my wife; I can take them while sitting home watching a football game,” he said. “It’s very convenient for the provider.”
A study published in the February 2017 issue of the “Journal of Medical Internet Research” evaluated the outlook for telemedicine as a method of delivery for nonurgent care. Researchers compared the quality of virtual care and its cost with that offered by in-person visits to retail health clinics, urgent care centers, hospital emergency departments, and primary care physicians.
Data from 60,000 Visits Analyzed
Researchers analyzed relevant data from nearly 60,000 visits — 4,635 virtual visits and 55,310 nonvirtual visits — for nonurgent care. They found that patients involved in virtual visits had comparable rates of follow-up outpatient visits to those who visited primary care physicians and retail health clinics. The follow-up visit rate for virtual visits was 28.09 percent, compared with 28.1 percent for visits to primary care physicians and 28.59 percent for visits to retail health clinics.
The percentage of referrals for lab testing was lower for patients who had virtual visits than for those who received traditional in-office care. Lab rates for virtual visits were 12.56 percent, compared with 36.79 percent for retail health clinics, 39.01 percent for urgent care centers, 53.15 percent for hospital emergency departments, and 37.4 percent for primary care physicians. Imaging rates for virtual visits were 6.62 percent, compared with 8.77 percent for urgent care centers, 43.06 percent for emergency departments, 11.26 percent for primary care physicians, and 5.97 percent for retail health clinics.
Cost Savings Significant
Comparisons of the the total costs (including both medical and pharmacy costs) of visits showed that virtual visits were considerably less expensive than all forms of in-person visits. Specifically, researchers found that visits to retail health clinics typically cost $36 more, while visits to urgent care centers cost $153 more, and visits to primary care physicians cost $162 more. A typical visit to a hospital emergency room ran up a whopping tab of $1,735.
In the conclusion to their study, researchers observed that “virtual care appears to be a low-cost alternative to care administered in other settings with lower testing rates. The similar follow-up rate suggests adequate clinical resolution and that patients are not using virtual visits as a first step before seeking in-person care.”
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