I understand the draw to telemedicine.
It’s easy to access anytime without having to wait in a provider’s office.
No dressing up, no tiresome travel.
Telemedicine definitely has a place in those whose medical care, labs, and annual studies are up to date and stable. Telemedicine evaluations are a great way to touch base, reassess any issues with medications, discuss home blood pressure checks, refill prescriptions, and more.
But it should never be used as an alternative to actual hands-on face-to-face medical care. Something we all deserve and should demand. Talking on a computer only goes so far. It doesn’t allow for the most pivotal part of our diagnostic skills- the physical exam.
It is estimated that half of Americans will be obese by 2030. But it’s not just the BMI that’s important, where the fat is located has an impact. Abdominal girth is a critical part of diagnosing metabolic syndrome. More than 35 inches for women or greater than 40 for men. Something that cannot be defined over on a digital screen.
Other important vitals are missing as well. Studies estimate over 50% of Americans have cardiovascular disease, including high blood pressure. Before committing to a diagnosis that requires long term medication, it’s important to have a skilled provider check it and teach patients how to take their pressures properly to ensure accuracy. Comparing the home cuff numbers with in-office readings and seeing how it is taken can significantly impact the decision process.
Too often, telemedicine relies on a patient relating their symptoms or even stating a diagnosis in order to get a desired treatment. A famous telemedicine company does this with erectile dysfunction and birth control. But both have dangerous consequences if underlying issues aren’t assessed before prescribing. Cardiovascular disease, especially hypertension, can cause erectile dysfunction, but it can’t be discerned in a seemingly healthy male over the internet. Abnormal paps, especially HPV, pelvic issues such as ovarian cysts, genital warts, elevated blood pressures, and heart murmurs will never be checked because an in-person exam isn’t possible.
Occasional telemedicine visits with an established provider who knows your medical history, what medications you take, and has a long list of vital signs and exam data to correlate with that day’s concerns makes sense. But talking to someone you’ve never seen, has no records, can’t examine you in person and relies only on information you provide is like me deciding to sell my house or go to court against a certified and knowledgeable real estate broker or lawyer and expecting good results.
Most of us, especially when we are sick or scared, can’t remember everything we take, our medical history or all-encompassing symptoms. Having a provider prescribe based on those presentations can lead to devastating consequences.
The pandemic created a terrifying situation. For years, people put off seeing their providers, scared of the exposure. But that’s all changed with vaccines and treatments. Sadly, I am seeing vast numbers of individuals in crisis. Even those seemingly controlled just a year ago. One man in his forties had been on a diabetic medicine with perfect lab values nine months ago to now have it so out of control he requires insulin. Another’s blood pressure was perfect just six months ago but now needs a second medication. A common complaint of “pink eye” that is caused by a bacterial infection is often actually allergies. And allergy complaints in this day and age could be COVID. Urinary complaints may not be from the urinary system but a yeast infection. Back pain may not be from a pulled muscle but instead a kidney stone or prostate infection. “Heartburn” may actually be a cardiac event. Shortness of breath may not be “just my asthma acting up” but a sign of heart failure or pneumonia.
I can’t see how you sit, stand, or walk. If your legs are swollen. I can’t listen to your lungs. Check your eyes, ears, throat and define if it’s simple allergies versus a sinus infection. Check your oxygenation level or see if you become short of breath walking a few feet. Pick up heart irregularities such as a murmur or abnormal heart beats. Push on your abdomen/ back to decide if the pain is concerning enough to warrant further tests or an emergency room evaluation. Define if the swelling in your legs is benign water retention from being on your feet all day long or from heart failure, or worse, a deep venous clot. Decide if your chest complaints are cardiac, pulmonary, indigestion, or muscular.
With telemedicine I can sit around in my pajamas, I don’t have to go anywhere when I’m feeling sick or lose work, money and time getting in a car driving somewhere. I can just turn on my computer, tell someone what I’m sure is the problem and get what I believe I need.
But that may not be the answer.
Tying our hands, limiting our gaze, and forcing providers to diagnose one dimensionally is a recipe for disaster. I’m seeing those results every day.
Telemedicine has a place.
But it doesn’t, shouldn’t and can’t replace the in-person care we all deserve.