Clinical News

Virtual Doctor Visits Have Their Limitations, Too

Virtual Doctor Visits Have Their Limitations, Too

Throughout the years, we have seen the world of medicine constantly change thanks to advancements in technology. Today, telemedicine jobs are on the rise and telehealth is living up to its potential. Telemedicine involves the distribution of health-related information from one site to another via electronic communications. Although it has been around for more than 40 years, telemedicine is overturning healthcare delivery nowadays because in-office visits with doctors and specialists have become much more difficult to come by. The waiting list can be quite long and a referral does not promise a quick appointment. The main objective of telemedicine is to bring you and patients closer together in a more efficient manner.

A lot of doctors want to hop on the telemedicine bandwagon, and for good reason too. They can consult with other doctors and specialists via electronic communication and connect with patients via telephone, email, and web-camera. Patients can even use new devices to measure heart rate, blood pressure, and other vital signs so that they can share this information with their doctors and learn how to manage and cope with medical conditions at home.

Like any technology, telemedicine has its benefits and limitations. Its benefits include more convenient patient care in areas where medical expertise is scarce, extended doctor access, extended patient base, cost-efficiency, increased patient engagement, and better-quality care. However, some doctors are skeptic of its delivery, claiming that a virtual doctor visit cannot compare to that of an in-person visit. So, what are some limitations of virtual doctor visits?

  • Physical exams are limited

While telemedicine allows for easy access to virtual appointments to diagnose or treat a patient, it is not enough for thorough medical care. Physical exams are limited because doctors are not always comfortable conducting examinations via video-chat. For this reason, most patients choose an in-person visit as opposed to a virtual doctor visit.

  • Regulations differ among states

Telemedicine regulations differ among states, making it more difficult to determine what is needed in order to meet the proper guidelines in your particular state. Moreover, some doctors are concerned that a few telemedicine tools may not fall under the category of security, meaning that patient privacy may not be sufficiently protected.

  • Technical hitches may come up

Telemedicine includes remote healthcare services, which run on software and hardware. As with most technology, technical hitches tend to come up. If a problem occurs during a virtual visit, then communication between you and the patient stops. The risk may be great enough for some doctors to to steer clear of telehealth.

  • Technical training and equipment can be costly

Telemedicine can be costly in that it may require hiring extra IT staff members and purchasing servers and other types of equipment. Moreover, training IT staff members and setting up/maintaining the equipment takes time and costs money as well. Typically, doctors invest in telemedicine if they feel the financial risk is low, the cost of entry is low, and the security features offered are top of the line. For smaller healthcare facilities, telemedicine may prove too costly.

  • In-person consultations are reduced

In cases where patients cannot come in for in-person consultations, telemedicine is a good alternative. However, a majority of doctors worry that certain medical conditions and health problems require face-to-face examination and reduced in-person consultations may lead to possible misdiagnosis and patient mismanagement.

  • Doctor-patient bonds are reduced

Telemedicine can offer several advantages to those in remote areas; however, it cannot replace the personal, face-to-face relationship between you and a patient. Health is a very sensitive subject and reduced doctor-patient bonds replace the personal touch of medicine.

  • Care continuity is reduced

Telemedicine services tend to reduce care continuity because patients are connected to a random doctor. You may not have access to a patient’s records from other visits and therefore, their incomplete medical history may increase the risk of misdiagnosis. In turn, reduced care continuity can diminish quality of care.

A recent study conducted in the United States examined 67 participants in order to test whether virtual visits could be a match for in-person visits. In the study, the participants acted as if they had experienced common health-related problems and they were sent to virtual doctors from organizations such as NowClinic, Doctor on Demand, and more. The results from the study revealed that 1 in 4 patients received a misdiagnosis or no diagnosis at all from their virtual visits (a total of 599 visits from 2013-2014). Additionally, virtual doctors only followed standard care protocols 30-60% of the time. “One of the more surprising findings of the study was the universally low rate of testing when it was needed. We don’t know why, but it may reflect the challenges of ordering or following up on tests performed near where the patient lives but far from where the doctor is, or concern about the costs to the patient of additional testing,” said Dr. Adam Schoenfeld, lead researcher.

The study did prove to have one particular limitation. The results gathered were simply from virtual visits and did not include a comparison with the results that would have derived from in-person visits. “There is a built-in barrier to getting testing, which led to worse care for ankle pain and recurrent urinary tract infections, for which the doctors should have ordered a test, and better care for low back pain, for which doctors should not have ordered a test,” said Dr. Jeffrey Linder, researcher at Brigham and Women’s Hospital. “Although virtual urgent care and in-person urgent care have not been compared head-to-head, virtual urgent care has its downsides – indirect physical exams, difficult access to testing, and unclear follow-ups. While quality of care is not perfect anywhere, a patient’s primary care doctor should be a person’s first point of contact,” said Dr. David Levine, also a researcher at Brigham and Women’s Hospital.

Telemedicine is an $18 billion-dollar industry that is expected to grow over 18% on an annual basis, from the years 2015 to 2020. Although its biggest limitation will always be a virtual doctor visit vs. an in-person visit, a large percentage of healthcare professionals are working on improving patients’ access to quality care. Moreover, patients should be properly educated on the rise of the virtual healthcare system and what to do in cases regarding additional diagnostic services.

New tools and technologies are continuously being introduced and applied on a broad level. By now, smart watches and smart glasses can monitor patients’ health and send the results in real time to healthcare professionals. Even programs such as clmtrackr can examine an individual’s emotional well-being based on their facial expressions. What’s more, advancements in surgical procedures, such as robotic surgeries, are allowing surgeons to operate on patients from remote locations. As technology continues to advance, so will telemedicine. If you think about it, we have grown accustomed to email, instant messaging and voice calls, so it is only a matter of time before virtual visits become a habit in the clinical environment. Within time, better tools will be introduced and better understanding and awareness will be seen among both doctors and their patients. While telemedicine needs to overcome several barriers, including regulatory and administrative requirements, it has come a long way and shows great promise for the years to come. “Of course, there will come a time when that strep test can be done in-home, at the time of the virtual visit or even before. We’ll have better tools for determining which cases of bronchitis should be treated with antibiotics. Who knows, we might even be able to do some sort of portable imaging for your low back pain. Until then, we’ll be well served to educate both providers and consumers regarding both the excitement and the limitations of virtual visits," said Joseph Kvedar, founder and director of the Center for Connected Health.

Key Takeaways

  • Virtual meetings reduce the intimacy and personal touch of medicine. 
  • Virtual doctors only follow standard care protocols about half the time, according to a study.
  • New technology is being developed to better the future of virtual visits.