Telemedicine: The Doctor Is Online, but at What Cost?

Andrew N. Wilner, MD


January 12, 2015

In This Article

Limits of E-visits: Wrong Question, Wrong Answer

According to the Deloitte report, many, if not most, telemedicine visits will lack the video component and be simply a matter of patients filling in questionnaires in order to receive written responses or prescriptions. For years, doctors have tried this approach in their own offices by asking patients to complete questionnaires in preparation for the visit or while in the waiting room.

It's been my experience that the answers rarely merit more than a 2-second glance. Even a seemingly straightforward question, such as "Do you have headaches?" may be answered incorrectly. Some patients may respond "no," meaning that they don't have a headache now, but actually have had them occasionally in the past. Other patients may answer "no," meaning that they often have headaches, but haven't had one recently. Still others may answer "no," meaning that they never get headaches, but actually have one right now. All of these answers confound the history rather than illuminate it.

Clinicians must ask the right questions in the right way for the right patient. Asking the key questions is a skill taught in medical school, but rarely honed until after many years of clinical practice. A questionnaire is a poor substitute for an in-person interview by an experienced clinician.

The success of an e-visit also depends upon patients making the right complaint. How many times has your doctor said, "I understand that you have pain in your (fill in the blank), but what's really bothering you?" In all likelihood, this type of nuance goes out the window in most telemedicine consults.

Lack of Continuity

Telemedicine may provide an option for data storage and continuity with the same doctor. But most services now available are more likely to offer a new provider who happens to be available in a catch-as-catch-can 24/7 service.

Laying On of Hands

In a recent Medscape interview with Eric Topol, MD, Abraham Verghese, MD, author of Cutting for Stone, emphasizes the importance of a doctor's touch in patient care. What happens to that in a virtual medical world? Until the advent of modern medicine, medical care lacked anesthesia, antibiotics, or any curative therapies. In fact, treatment often caused more harm than good (eg, leeches). One can only conclude that it was the physician's physical presence that provided comfort and facilitated patient improvement. Even with televisits, a critical human component is lost. There can be no more laying on of hands with telemedicine.


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