Telemedicine or telehealth is an exciting and seemingly overdue evolution in medical care. It enables the patient to obtain medical consultation and treatment from anywhere via computer or smartphone. Telemedicine services emerged in the early 2000s but were used rather sparingly until the onset of the pandemic in 2020. The U.S. Dept. of Health and Human Services recently reported that that the share of Medicare visits alone conducted through telehealth increased 63-fold since 2020, from approximately 840,000 in 2019 to 52.7 million. States with the highest use of telehealth in 2020 included Massachusetts, Vermont, Rhode Island, New Hampshire and Connecticut. Another report from McKinsey & Co. revealed that telehealth utilization overall has approached up to 17 percent of all outpatient/office visit.
It is now obvious that telehealth appears poised to increase as a robust option for medical care based on continued utilization, favorable consumer perception, the regulatory environment, and strong venture capital investment into this space.
Therefore, it is important to balance the benefits and risks to both providers and patients and to consider some measures both of them can to avoid the risk of future harm to patients via this method.
Benefits to Patients and Providers:
Undoubtedly, there are significant benefits associated with telemedicine. It allows for care to more patients more often, particularly those who live in remote and rural areas. It is also a major convenience for those many patients who are ill, disabled, elderly, or have childcare issues. It also avoids exposing patients to COVID and other illnesses found in hospitals and doctor’s offices. In addition, some patients have what is called “White Coat Syndrome,” a fear of hospitals and health care providers that is an obstacle to pursuing health care. Finally, it allows for family members who may live far away to participate (with permission) in the appointments, which is a substantial benefit when the patient is elderly or impaired.
Risks to Patients and Providers;
However, a full assessment of telemedicine needs to take into consideration the risks and detriments associated with it. Telemedicine can lead to less meaningful interactions between patient and provider and, accordingly, inadequate history taking. It may also make it more difficult to communicate empathy and compassion, which is an essential aspect of a trust-based provider-patient relationship. Obviously, there is no ability to do physical exam, such as palpating an area to reproduce pain, watching the patient walk, etc.). Then, there is the frequently occurring technological glitches, patient lack of comfort/familiarity with technology, and the temptation to multitask while on Zoom, all of which amplify the risks to the patient.
Consequently, there is the risk of increased misdiagnoses and treatments. CRICO Insurance Co, a major malpractice carrier in Massachusetts, reported that 66% of telehealth-related malpractice claims pre-pandemic between 2014-2018 pertained to missed diagnoses. According to another study by The Doctor’s Company, these missed diagnosis claims are often life-threatening including 25% cancer, 20% stroke, 20% infection. In addition, the ability to obtain the patient’s informed consent, which requires taking the time to explain the risks of pursuing or not pursuing a particular recommended course of treatment, may be impaired.
How to Prevent Harm;
Several factors can be employed to prevent or decrease the amount of malpractice associated with the expansion of telemedicine. Telemedicine is most amenable to care of conditions such as sinus problems, minor respiratory infections, and allergies, which are conditions unlikely to result in malpractice claims. Second, it should be used sparingly by specialists such as neurologists and neurosurgeons who treat patients with conditions that involve high risk of severe injury or death. Providers should also document why the visit was done remotely and why it was safe to do so. This will give the provider another opportunity to reconsider whether an in-person visit is safer. It would also be beneficial to implement policies and protocols to help guide practitioners on these issues.
For patients, it is prudent to supplement telemedicine visits with emails or portal messages to communicate symptoms to providers. Doctors are required to create notes of their telemedicine visits but, as with any visit, it is possible that information does not get relayed and/or documented in your medical record. This can lead to poor continuity of care and, more concerning, negligent diagnosis and treatment recommendations. Most importantly, the patient should not sacrifice safely for convenience. Just because telemedicine is easier does not mean it is appropriate for your particular health-related concerns. If you feel that an in-person visit is more appropriate, it is your right to insist on it. Your health, or your life, may depend on it.
