The Doctor Will ‘See’ You Now?>
Be Well

The Doctor Will ‘See’ You Now

by John Swartzberg, M.D.  

Telehealth, also called telemedicine, has been available for some years now—I prac­ticed it myself about 15 years ago with a patient who lived 300 miles away in a rural part of California, but only by phone back then. Today, telehealth allows doctors to evaluate medical condi­tions and direct the course of treatment not only through low-tech phone calls but also via video or other computer-based technolo­gies—all without the patient’s physical presence in their office.

For instance, patients can send blood sugar and blood pressure read­ings, send or show (in real time) images of suspicious skin lesions, see X-ray results on-screen, and check in after surgery. They can even conduct a modified electrocardiogram of their heart rhythm with a device that attaches to their chest at home and then upload the results into a patient portal so the doctor can see what’s going on.

But the Covid-19 pandemic has necessitated telehealth on a grand scale, accelerating its use to new levels. According to a study in the Journal of the American Medical Informatics Association, from the beginning of March this year, when physical distancing guide­lines were implemented in the U.S., until the middle of April, one large health care service (with providers in four hospitals and more than 500 doctors’ offices) went from seeing just a few hundred non-urgent care patients via video a day to more than 8,000 a day. It’s possible or even likely that you’ve had a telehealth visit yourself over the last few months.

No doubt, telehealth offers convenience and the potential for increased access to health care professionals, especially for people in underserved communities. During the pandemic, it has been a true lifesaver, since most routine in-office medical care was at least ini­tially halted. As just a small example, reported in Diabetes Technology & Therapeutics in May, two people with diabetes, who otherwise might not have made it to their doctor appointments, were able to manage their disease and avoid serious complications by doing vir­tual visits through a public hospital.

It makes sense: In this case, the patients were from one of the poorer parts of Los Angeles, and, as the study’s authors pointed out, if people can see their doctor from home, “no longer do they need to take three buses to come into clinic or take a morning off from work.” And since the pandemic, the no-show rate in this particular medical center dropped to “an unheard of 9% low,” thanks to remote care being part of the mix. Telehealth increases opportunity for medical care everywhere, really, even in affluent areas, where medical resources are more abundant.

But is something lost by “seeing” patients two-dimensionally? Absolutely. The laying on of hands in medicine—palpating a lump to know if it’s soft, hard, or rubbery, for instance—can’t be completely replaced with watching patients on a computer screen do it them­selves. Tapping a patient’s back with a finger to hear if it sounds like the lungs are clear or filling with fluid also isn’t doable across the ether. Tactile information is critical in medicine, as are nonverbal cues, which are easier to pick up in person when you can see a patient’s entire body and observe body language. There’s something extremely therapeutic that comes from the intimacy of the doctor-patient rela­tionship, and that, too, can be compromised in the virtual world.

Bottom line: I’m on board with virtual medicine. It can’t fully replace seeing a doctor in person, but it can fill in gaps in care. One worry is that health care systems will push doctors to devote more time to telehealth, resulting in fewer in-office services. And then there are the technology glitches that are still all too common and can make for a bumpy visit. But a judicious mix and match of in-office and virtual visits may be the best way to deliver health care that’s responsive to patients’ current circumstances and needs. If you are interested in telehealth, ask your doctor if he or she is set up to do it and how the process works, including how payment is made.

This article first appeared in the UC Berkeley Wellness Letter.