January 17, 2019
Visit doctor

Are Online Doctors Any Good?

by Nancy Metcalf  

If you’re sick but getting to the doctor is too inconvenient, you might be tempted to use one of the websites that offer “virtual” doctor visits. You enter some information into the site and are then connected via videoconference, phone, or webchat to a live doctor. But is the care any good? A study published in JAMA Internal Medicine suggests it varies widely, depending on which company you use and the nature of your ailment.

The researchers, from the University of California, San Francisco, and Harvard, trained 67 actors and medical students to pose as patients on the eight largest virtual visit websites. (The companies were Ameridoc, Amwell, Consult a Doctor, Doctor on Demand, MDAligne, MDLIVE, MeMD, and NowClinic.)

The “patients” presented with symptoms of six common, minor acute conditions: a twisted ankle, a viral sore throat, strep throat, sinusitis, low back pain, and a recurrent female urinary tract infection. The researchers then compared the care the patients received to professional treatment guidelines for each condition.

On average, the virtual doctors did a reasonably good job at diagnosis. Accuracy ranged from 91 percent for the recurrent UTI to 71 percent for sinusitis. But there was wide variation among companies, with the best company’s doctors getting the right diagnosis more than 90 percent of the time, and the worst only about two-thirds of the time.

The news was less rosy when it came to testing and treatment recommendations. The virtual docs didn’t send enough patients for urine cultures for suspected UTIs, for example, and many didn’t refer patients with ankle pain for X-rays even when such imaging was warranted—shortcomings the study’s authors attributed to the “logistical challenges” of ordering tests from afar.

The virtual doctors also prescribed antibiotics for the viral sore throat and sinusitis about 45 percent of the time, which goes against treatment guidelines. (Sore throats are most often caused by viruses and won’t benefit from antibiotics, which only treat bacterial infections; the vast majority of sinusitis cases are viral or allergy-related.) But that also frequently happens at in-person doctors’ offices and emergency rooms, as the authors pointed out (and as we’ve reported previously).

Overall, adherence to guidelines was highest for low back pain and strep throat, and lowest for ankle pain and UTI, the study found. While quality varied significantly by condition and company, the authors found no variation by mode of communication (phone, videoconference, or webchat).

Bottom line: Consulting a virtual doctor may be a reasonable option if you have a common, minor complaint and are in a pinch—you are on vacation and can’t access an in-person doctor, for example. Some insurers now cover virtual visits, according to the study; check with your plan. Make sure you get a record of the visit and follow up with any recommended testing. And always go to a brick-and-mortar medical office or emergency room for a real emergency.