For years, doctors have been told to look at the patient — not the computer — when providing medical care. What we haven't been told is what to do when there's only a computer.
Telemedicine is perhaps the most rapidly evolving area in health care. About 15 million Americans receive some form of remote medical care every year. Investment in on-demand health-care services is estimated at $1 billion annually, according to Accenture Consulting. Kaiser Permanente, the nation's largest integrated delivery system, provides more visits virtually than it does in person.
All of which raises an important but overlooked question: Do doctors know how to use telemedicine?
As is often the case with technological change, our capacity to generate innovation has exceeded our capacity to understand its implications. With telemedicine, we've done what we generally do: Introduce a new treatment, technology or care model, and assume doctors will figure out how to use it.
But as telemedicine moves from a technology used to manage minor ailments — coughs, rashes, sore throats — to one that affects nearly every field of medicine, it's important to consider whether its increasingly complex application is being matched with increasingly sophisticated training.
Misdiagnosis, for example, remains a fundamental problem in medicine, and it's not clear whether telemedicine will ameliorate or exacerbate it. Much of medical diagnosis remains clinical gestalt: an integrated assessment based on labs, history and exam. But how should this evaluation vary by the medium in which a patient is cared for? Should doctors feel comfortable making some diagnoses remotely, but not others? Should they adjust their threshold for ordering more tests, or dismissing minor complaints, when caring for patients on a screen instead of in an office?
Building rapport with patients remotely is also more difficult than in person. The subtle cues that bond doctor and patient are largely absent during a virtual visit, and some argue we should teach not just bedside manner but also "webside manner."
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https://www.washingtonpost.com/national/health-science/telemedicine-is-getting-trendy-but-doctors-may-not-be-keeping-up/2018/04/20/681e1644-2178-11e8-badd-7c9f29a55815_story.html?
