Where Teledoctors Go Wrong

In another study, researchers with the RAND Corporation, the California Public Employees' Retirement System, and Harvard University took a retrospective look at 4,647 Teladoc visits by State of California employees as part of their health insurance coverage. They looked at the same ailments covered in the other study, and noted whether virtual doctors were any better or worse at following guidelines for good practice than office doctors.

In this study:

• All of the doctors given a strep throat patient were expected to order a strep test. Just 50 percent of the brick-and-mortar office doctors ordered the test. Only 3 percent of the virtual doctors did.
• All of the doctors given a lower back pain patient were expected to order x-rays or other forms of imaging. Only 21 percent of the office doctors ordered these tests. Only 12 percent of virtual doctors did.
• All of the doctors were expected not to order antibiotics for bronchitis patients, based on the information they were given by the actor. However, 72 percent of office doctors and 83 percent of online doctors ordered the unnecessary drugs.

There may be a simple explanation of why online doctors did not order throat cultures to test for strep throat. It is extra work for the doctor to order and then review the test for step bacteria. Patients may be left wondering "If I have to come in to the office anyway, why did I bother to do this online?" Similarly, the doctor may want to cover all bases and order antibiotics just in case the bronchitis actually was caused by bacteria despite the information the actor-patient gave.

The general impression from these studies, however, is that doctors don't do quite as good a job when they are seeing patients online, through videoconferencing or Skype, or speaking with them over the phone. How can you tell which kind of doctor visit will work best for you?

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• Recognize that many health conditions can't be diagnosed or treated without an in-person visit to the doctor's office. It may be necessary to go into the office for blood draws, X-rays, or an in-person medical exam allowing the doctor to feel and listen as well as see you.
• Recognize that if you live in a remote or rural area, your doctor may alter your treatment to save you travel if you don't make it clear that you are willing to come in as necessary. If you live considerable distance away from the doctor, then you are more likely to get prescriptions you don't need (in case they could keep you from having to travel to the doctor's office) but also less likely to get testing that you do need.
• Don't be hesitant to use emails, text messaging, video, or chat in dealing with your doctor, assuming your doctor is comfortable with the technology, but don't forget you need to come in to the office occasionally, too. Nearly everyone needs to see a primary care provider in person once or twice a year, to provide the baseline from which the doctor can make better decisions even if future exams are conducted online or over the phone.