Patients like the convenience, and insurers save money. But diagnoses can go awry.
Like many primary-care doctors, I'm seeing many patients this winter who are suffering from colds and/or the flu. Some patients think such ailments are so commonplace that a doctor should be able to prescribe an antibiotic after a conversation with them over the phone or Internet.
If health insurers had their way, more doctors would be performing online video chats with patients. However, I would be wary of this growing trend.
Companies and insurers seem willing to change the physician/patient relationship to cut costs. More are offering services where patients can consult doctors through a webcam-enabled laptop, or smartphone or tablet. According to a survey by Mercer, a human resource consulting firm, 15% of very large employers use some form of telemedicine, and 39% are considering it.
These so-called virtual office visits cost about $40, and patients with minor illnesses can quickly access a physician or nurse practitioner and be prescribed medication online. Patients rave about the convenience, but something is lost through these virtual connections.
Dangers of errors
Accurate diagnoses can be missed without the face-to-face interaction. For example, I've seen a patient convinced he had a sinus infection only to find that he had a tumor inside his nose. Another complained of minor ear pain, but after examining her, I saw that an infection had spread to the point she needed to be hospitalized for intravenous antibiotics.
Without the ability to examine patients, many doctors play it safe and prescribe drugs. A recent study from the Journal of the American Medical Association found that patients who were treated through virtual visits had higher antibiotic prescription rates for their sinus infections than patients who were seen in the office.
Most sinus infections actually clear up themselves without antibiotics. A study published last year found that patients who had sinus infections felt the same after a few days, whether they received antibiotics or not. Worse, unnecessary drugs contribute to the growing problem of antibiotics resistance. Guidelines from the Infectious Diseases Society of America and Choosing Wisely, a consortium of medical societies that provide evidence-based guidelines, also recommend against knee-jerk antibiotic prescriptions for sinus infections.
More important, consider what would happen if something went wrong after the online-only consultation. For example, what if the patient had an allergic reaction to an antibiotic, or symptoms that got worse? And would a doctor face liability for missing something he or she could not see in a video visit?
There is some room for virtual visits, with stricter conditions. For longtime patients, managing their hypertension and diabetes through a video chat is helpful. But I would not feel comfortable treating new patients on the Web.
Currently, only 13 states allow doctors to prescribe drugs and treat patients online without actually meeting in person first. With the zeal to cut costs and maximize convenience to patients, there will be tremendous pressure to expand that number. Please remember, though, that what is cheapest for insurers, and easiest for patients, isn't necessarily what is best.