Since last March, telemedicine use rose dramatically, and practitioners performed at least half of their patient visits by computer and phone. However, researchers are concerned that overuse, waste, possible fraud and inadequate computer access and skill may jeopardize care and cause doctor errors.
According to limited research published in JAMA, patients receive the same or better clinical results as traditional care and virtual care does not harm patients through misdiagnosis and other errors.
But doctors should be mindful of missing diagnosis of conditions such as hypertension. It is much harder to check blood pressure or cholesterol or to see other problems when the entire body is not visible.
Ordering additional tests might reduce misdiagnosis concerns. However, tests may be overused if they were ordered to reduce the risks of liability or if a physician is overcompensating for the absence of a physical examination
Some insurers are offering virtual only plans with lower premiums and costs this year. Patients covered by these plans could receive inadequate care, however, because there may be times when an in-person appointment is needed.
One study, funded by the California Health Care Foundation, uncovered another issue. Payment policies may return to reimbursement only for video visits and terminate payment for audio-only consultations. This may disqualify senior and low-income patients whose telehealth access was restricted to audio visits.
Research also showed that many patients do not have the computer skills for video telehealth. Limiting coverage to video visits may deny care to these patients.
There is little information, so far, about the absence of physical contact. But virtual encounters lack the human interaction that is essential to effective care and important to the practitioners and patients emotional and mental needs.
Doctors should engage in non-verbal communication such as sitting up straight and leaning forward, heightened facial expressions, more head gestures and increasing eye contact by looking directly into the web camera.
In video consultations, practitioners must pay attention to patients’ closed body posture, nervous toe-tapping, hand wringing and other emotional signs. They should note the patient’s tone and volume and respond with empathy through their gestures.
Telemedicine may benefit patients in rural or underserved areas by lowering no-show rates, travel time or the need to take time from work. Because of financial incentives, however, practitioners may schedule more frequent but shorter telephone sessions that may not improve outcomes.
One recommendation is to limited telehealth coverage to specific populations and certain conditions and telehealth modalities. But practitioners may choose an in-person visit only because telemedicine is reimbursed at lower rates in some plans.
Malpractice victims may be entitled to compensation. An attorney can help them pursue this legal right.