How I wish I could simply call a doctor to find out if this sickness is something I can just “wait-out.”
It is 11:30 PM and my nagging cold symptoms are keeping me from falling asleep. I think: “Is it a sinus infection? Strep? Am I going to have to take off work to go to the doctor? Will there be an appointment available? This is annoying and frustrating!”
Since you have likely been in a similar position at some point, it is no surprise that telemedicine companies are growing rapidly. In our fast-paced lives, such an “on demand” service is incredibly convenient.
Sure, it is convenient. But, to employers hoping to reduce healthcare costs, simply adding telemedicine on top of our broken healthcare system is not the answer.
What Is Telemedicine?
When I use the term “telemedicine”, I am referring to services that provide patients first-contact with a physician via phone or video regarding a new or ongoing ailment (such as the example above). Specifically, I am referring to services that focus on primary care (e.g. Teledoc and Doctor On Demand). I am not referring to remote vital-sign monitoring or telemedicine occurring inside or between hospitals during a patient admission.
Why Won’t Telemedicine Save Money?
First, as Dr. Ashish Jha, practicing physician and prominent healthcare policy researcher at Harvard, says: when you add the total cost up in the end, telemedicine does not save money. Why?
“It tends to be an addition,” he explains. “You do the telemedicine; it leads to more tests. It leads to more follow-up visits. And, over time, when you look at the data, it turns out that telemedicine overall is not necessarily a big cost saver.”
Second, according to a 2014 study supported by the 4 largest telemedicine vendors, the most common calls on their systems are for sinusitis and colds (32%): two ailments that require nothing more than “watchful waiting” to cure. Therefore, how many telemedicine calls and unnecessary antibiotics are prescribed for conditions that likely would have gone away on their own without the need for medical intervention?
In fact, a peer-reviewed study of primary care telemedicine demonstrated that physicians were much more likely to prescribe antibiotics for sinusitis and urinary tract infections (UTIs) during telemedicine visits than in-person visits.
If telemedicine leads to increased use of unnecessary antibiotics, what other increased utilization is telemedicine producing?
Lastly, and this is the most important takeaway, while the convenience of telemedicine is great, this convenience is most beneficial to those that are largely healthy and simply have a one-off, minor ailment. The data shows, 94% of telemedicine patients use the service only once or twice a year. The fact is, those of us who are healthy are not the reason for our high healthcare costs. We are not going to cut US healthcare costs by treating all inexpensive sinusitis and UTIs over the phone!
Instead, 86% of healthcare cost is due to chronic conditions. In order to reduce US healthcare costs, we must recognize the need to properly manage chronic conditions so that they do not result in high-cost episodes such as heart attacks and strokes.
The key to properly managing chronic conditions lies in the relationship between a patient and primary care physician. Positive health outcomes result from easy access to continual, comprehensive and coordinated care, along with coaching and empathy – a real, in-person relationship with a primary care physician. And, since we are social beings desiring of human connection, simply calling a different, random doctor every time an issue arises is not going to help a patient manage his diabetes any better. Strong, ongoing human relationships cannot be achieved if we view our interactions with a primary care doctor as simply a one-time, transactional episode. One cannot cure chronic conditions “on-demand” (not yet, anyway).
Why Not Try It?
The absurdity is not lost on me: here I am arguing over a technology (the phone) that has existed for over 100 years!
Upon reading this, one might think: “Is this guy arguing that we shouldn’t be using technology to access healthcare?”
No, that is not my belief at all.
My overall argument is that we are thinking about telemedicine in healthcare all the wrong way – by thinking that simply providing an add-on or substitute transactional convenience will fix our fundamental healthcare problems.
Enhance Relationships, Not Replace Them
There is no doubt that technology has opened up incredible ways to enhance relationships in our everyday lives. However, most relationships have the freedom to be formed over time through interpersonal communication whenever individuals feel like interacting. For instance, I can visit, call, text, email or video chat a friend at any time, and he can chose to respond if and when he wants.
Unfortunately, that freedom does not exist in our healthcare system. Instead, our payment system dictates when, where and how interaction between patients and physicians will occur. Our insurance-based payment system views our patient-physician interactions as transactions instead of a relationship – physicians do not get paid to develop strong patient-physician relationships, nor are they compensated for phone calls, texts, emails, etc. That is why when you call up your doctor with an issue, you usually end up on hold for 20 minutes or you leave a message without ever receiving a response.
A one-way, take-it-or-leave-it approach is certainly not something a rational person would call a relationship.
Telemedicine will truly have a legitimate impact and save money only when we give patients and physicians the freedom to form strong individual relationships with each other in whatever manner is best to achieve positive health outcomes – whether through face-to-face interaction, phone, email, text, video, or whatever new technology is dreamed up.
Therefore, telemedicine and other communication technology can work brilliantly as an enhancement to the patient-physician relationship. Telemedicine cannot replace that critical relationship.
Yes, telemedicine might conveniently help me with my cold or my colleague’s urinary tract infection. But, with nearly 50% of us having at least one chronic condition and the near-guarantee that all of us will eventually have at least one if we live long enough, in order to reduce healthcare costs, it will require strong patient-physician relationships rather than a quick phone call to a random and unfamiliar doctor.