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CVS, the largest drugstore chain in the USA, has announced that it is expanding its telemedicine program by working with three of the largest telehealth companies, American Well, Doctor On Demand, and Teladoc.
A more serious concern is that the doctor doesn't get the same kind of information from an on-line interview as from seeing the patient in person. It's nice that doctor doesn't have someone knocking on the door and saying, "Doctor, we need you in another room," but there's something impersonal about a doctor diagnosing a patient from a computer screen.
Many doctors, especially older doctors, will tell you that diagnosis begins before the doctor and patient begin to talk. The doctor may notice how the patients conduct themselves in the waiting room, how they walk into the examination room, whether their clothes are clean or dirty or their shoes are untied.
There is value to feeling a pulse or a rash or a bump or a pulled muscle. Just being a trustworthy face on a screen, a large number of physicians insist, isn't enough to establish a relationship of trust.
Legal Limitations On Telemedicine In Some States
Many healthcare providers are a little slow to stick their toe into the waters of telemedicine. The Mt Sinai Healthcare system in New York City is offering televisits only to established patients. The Jefferson Hospital system in Philadelphia restricts telemedicine exams to follow-up care after in-office visits to internists, urologists for urinary tract infections, and ear, nose, and throat specialists. The Mercy Healthcare system in St Louis recently completed a $54 million system to provide primary care to highest-risk patients.
Some state boards of medical examiners (who regulate what doctors can and can't do) have fought telemedicine in the courts.
The Texas State Board of Medical Examiners, for example, voted in June of 2015 to require doctors to have an a visit with the patient in person before offering diagnosis and treatment online. The State of Texas maintained that they did not want doctors to be able to prescribe dangerous drugs without physically examining a patient, but the fact that the major provider of telemedicine services in Texas, Teledoc, was competing with Texas doctors and offering medical care at substantially lower prices.
In its suit, the telemedicine company asserted that restrictions imposed by the Texas Board of Medical Examiners would lead to "higher prices, reduced choice, reduced access, reduced innovation and reduced overall supply of physician services." The courts agreed, and allowed Teledoc to continue providing services, even to first-time patients, in the state.
Rapid Expansion Expected
The 7800 telemedicine terminals at CVS, largely for people who aren't comfortable using Skype on their own, are just part of a huge expansion of virtual medicine in the USA. Already there are 75 million online visits with doctors every year in the USA. By 2018, there are expected to be 300 million. Moreover, if you get your health insurance through your employer, you will more than likely be seeing your doctor over a computer screen at least some of the time. The National Business Group on Health predicts that 74 percent of large employers in the USA will "offer" telemedicine to their insured employees.
Still, it is a good thing to establish an in-person relationship with a primary care provider you trust. When you do, telemedicine can save time and money and help you get better faster.
- Mark Crane. CVS to Expand Telemedicine Services at In-Store Clinics. Medscape Medical News. 28 August 2015.
- Photo courtesy of Tokuriki via Flickr: www.flickr.com/photos/tokuriki/52860993
- Photo courtesy of Tokuriki via Flickr: www.flickr.com/photos/tokuriki/52860993
- Photo courtesy of Consumerist Dot Com via Flickr: www.flickr.com/photos/consumerist/1893141861
- www.medscape.com/viewarticle/850250
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