As a physician with over 20 years practicing medicine, I've always been an advocate of strong doctor-patient relationships. The strength of that relationship is the core of high-quality patient care.
Contrary to what some physicians think, I believe telemedicine actually has the power to enhance and harness that relationship — if we use it in the right way. Some physicians argue that virtual care can't equate to an in-office visit. But anyone in the know about telemedicine understands why that argument just doesn't hold up. In fact, virtual visits can be a great way to build trust with patients and maintain continuity of care (by keeping patients in your practice and competing with retail health, for instance).
The typical consumer-directed telemedicine model pairs patients with whichever doctor is available. While this may be a "quick fix" for our current care shortage, it simply isn't as effective in the long run. The doctor-patient relationship is a key ingredient to successful telemedicine. Here's why.
1: A prescription is more than a medication
For patients, one of the biggest benefits of having a primary care provider is having a doctor who is familiar with your medical history and lifestyle. When physicians write prescriptions, they don't just consider what combination of medications will help treat the patient, they consider the patient’s history, what’s worked for them in the past, what other medications they’re taking, and what medications they will actually take. So many factors go into selecting the best treatment option for a patient, and much of that hinges on knowing the patient’s full history.
A great example of this is in pediatrics. Any physician who's worked with children — or anyone who has children of their own — knows how picky kids can be. A pediatrician who has a relationship with the child will know their preferences and what works best for them. They’re also more likely to understand that child’s family situation — and provide special instructions accordingly.
Adults, too, benefit from working directly with their primary care provider, especially if they've had unpleasant reactions to medications in the past or if they’re on a long, complicated list of prescriptions. Many times when medical errors and unnecessary hospital admissions happen, it’s because the patient was treated by a physician who didn’t have the whole picture.
2: Patients may be wary of telemedicine
Physicians and patients face the same challenges that come with medical technology's quick development. The mHealth field is growing rapidly, and while that's good news in the long run, it can be overwhelming. What health tools are safe to use, and which need to be researched further? How can patients and physicians keep protected health information safe? Who's to say the next big thing in mobile health won't be obsolete next week? Patients ask these questions, too, and when they want answers, they'll turn to their nearest health expert. And who better to answer their questions than their trusted physician?
It's unfair to ask patients to experiment with new treatment technology and an unfamiliar physician. While patients want more convenient care, they really want more convenient access to that familiar face – that doctor they’ve built a relationship with. That familiarity will make patients more open and comfortable sharing their very personal medical details – something they might avoid sharing with a virtual doctor they haven’t met.
3: It maintains continuity of care
Our health system in general is trending towards more fragmented care – patients looking for quick care end up at retail clinics, urgent care centers, or online telemedicine visits with an unfamiliar doctor. This not only often leads to unnecessary ER visits (I see this all the time in the ER), it makes it harder to provide high-quality care to these patients. Often, the notes from all these different visits aren’t accessible and you’re probably relying on the patient to remember past treatments.
While consumer-directed telemedicine models provide a great service for quick care, they’re breaking down that relationship between patients and their primary care provider. Without the primary care provider, patients lose their advocate – that physician who knows them in and out and can provide that invaluable information to consulting doctors.
Telemedicine is a rapidly changing field and one that still needs guidelines set. If we really want to make telemedicine the best possible clinical tool, we have to use it in combination with the doctor-patient relationship. And chances are, that greater accessibility will get your patients more engaged in their care, and more likely to stay with the provider they trust.
