The problem with telemedicine

July 12, 2018

If telemedicine is supposed to provide convenient and accessible care, why are so few using these services?

A recent study sponsored by Avizia, a telehealth provider based in Reston, Va., shows that after all of the hype about telemedicine being the future of medicine, the vast majority of patients still don’t take advantage of the technology.  In fact, 82 percent of patients surveyed said they don’t use a telemedicine service.

If telemedicine supposedly provides convenient and accessible care, especially to millennials and people in rural communities, why are so few using these services?

Some investors see the utilization problem as simply a lack of awareness. Others believe it is a financial issue, with confusion surrounding who pays for the service, out-of-pocket costs, and insurance.

But the problem with telemedicine is actually much bigger and more personal than marketing or money. With almost 15 years working closely with physicians and their patients, we have learned the most important thing when it comes to medicine and healing: trust. Patients want a doctor who knows them and can be counted on. When patients are sick and at their most vulnerable, they want someone who has been there for them and who understands their health history and lifestyle.

Would you trust an anonymous doctor who is seeing you and listening to you via a bad Skype connection to determine whether you should seek urgent care right away or if it’s just a cold? What is this doctor’s level of experience and what are his credentials?  Is this doctor even licensed to prescribe medicine in your state or will you be paying nearly $100 out-of-pocket to be told to follow up with a physician in person anyway? 

Telemedicine sounds like a dream come true, but its effectiveness is suspect. You may get treated without having to leave your bed, but what kind of care are you getting? Telemedicine in this form is just the further depersonalization of medicine.  

Besides, healthcare delivered quickly and face-to-face is widely available these days. There are minute clinics staffed with doctors, NPs, and PAs waiting for walk ins, and now even drug stores offer clinics where you get screened and tested quickly and then can purchase your medications all in one stop. Who needs an app?

Telemedicine can work effectively in a practice where the physician and the patient have a strong and trusting relationship – the physician knows the patient and their health history so well that both the physician and patient can be confident of a video-based diagnosis.  

Obviously, this kind of relationship is hard to come by these days. Practices are stretched, and the pressures of volume care makes connecting on the phone with a doctor difficult. Payers aren’t on board yet either. Insurance plans are resistant to adding another level of triage care that hasn’t proven to be cost-effective or valuable to the patient.  

In concierge medicine, however, one of the major benefits for patients is greater connectivity with their doctor.  Typically, patients have the ability to easily reach their personal doctor, even after hours or on weekends. Initially, this kind of availability can make a new concierge physician nervous-they may worry their phone will ring off the hook with patients who want to be treated at their convenience without being seen. However, they are usually surprised at how rarely that ever happens. Concierge patients are like any other patient-they want to be seen in person by their physician. They tend to call only when they are traveling and have a medical concern or when an urgent need strikes.

When offered by a trusted physician, telemedicine can be a good way to triage care and can provide a great service addition to an existing practice with strong patient relationships. But no matter how fancy the app or how slick the marketing, an anonymous doctor on the other side of a screen is not the same. There is still no substitute for a personal relationship with a trusted physician.

Wayne Lipton is managing partner for Concierge Choice Physicians, LLC, and one of the most experienced and successful executives in concierge medicine. Lipton graduated from Harvard College in 1973 with a degree in Biochemistry. He attended the University of Chicago Business School and the Boston Architectural Center. He was formerly a chief operating officer for PhyMatrix, a public healthcare company; chief operating officer for Physicians Choice, a Connecticut IPA and practice management company; and president and principal of Richmond Way Stores, a local chain of drug stores that he operated for 20 years.