Written by Guest Blogger Dr. G, a Board Certified Internal Medicine Physician trained at UConn Health Center
By now, the words “TeleHealth” or “TeleMedicine” ring in our ears. A service where you can call in and have your medical concern evaluated by a healthcare professional on the other line (usually a nurse), with advice and recommendations sounds great right? Do you know your local number? Well chances are you don’t. Like millions of Americans each year, you will likely head to your nearest ER instead of picking up the phone and calling a hotline for your medical problem. Wouldn’t it be much more convenient to use your cell phone and get an answer to your pressing problem? Well, if that’s the case, then why is Telehealth not nearly as commonly used as it could be? It can increase efficiency, healthcare savings, and reduce re-hospitalizations. Yet, there were less than 350,000 calls made last year in the USA. Although the use is increasing, especially in rural areas, there are several reasons why this service will likely never become as commonplace as a visit to your doctor or to the ER. Some of these reasons are obvious and won’t surprise you.
First and foremost is that most patients prefer to talk to someone who is right there in front of them and able to physically examine them. If you have a sore throat, wouldn’t you want someone to look into your throat with a light, or palpate your neck for lymph nodes? It may not add much to the end result of the doctor visit, but it is reassuring and comforting to know that a medical professional has actually physically examined you. A big part of why you see a doctor is so they can look, touch, feel, and see exactly what you are talking about. With Telehealth, they can only listen to your descriptions, and are lacking fundamental information from physically being present to examine you.
This leads us to the next point (which is no surprise in the United States) – liability and lawsuits. Very few professionals would want to give any medical advice without a full medical workup like a physical exam. And rightfully so – in the event of a big mistake leading to serious injury or death, what court would side with the healthcare professional who gave medical advice on the phone without performing a full work up with a physical exam, blood work, or imaging studies? The issue of liability is a large one and should not be taken lightly in a country where a medical mistake can cost the healthcare worker (or their insurance company) millions of dollars. In countries with largely socialized medicine, medical lawsuits are much fewer than in the USA. This is mainly because healthcare is government owned and operated. In essence, you would be suing the government indirectly. In these countries, Telehealth has actually increased significantly in the last few years. In Canada alone, there are over 5700 Telehealth systems in over 1175 communities nationwide. This helps accommodate for doctor shortages and provides a convenient way around the long ER wait times. But is it really quality medicine? Of course, each call usually ends with “please go to the ER, see your doctor, or call us again if symptoms worsen”, but this would never be an adequate way to cover yourself against lawsuits here in the USA.
There are other less obvious reasons of why Telehealth has failed to take off in this country. If one company makes a profit, it may be taking it away from someone else. The loser in this scheme would be hospitals nationwide. They depend on ER visits that can turn into hospital admissions. Of course, more admissions mean more money. Telehealth can provide reassurance, leading a patient to cancel an ER visit, or delay it for several days resulting in lost revenue for the hospital. Hospitals are large companies that are mainly for-profit and can employ up to several thousand people each. They depend on hospital admissions to keep their doors open. These entities have a hefty amount of money and power in the community, and I would not be surprised if they are, or have been involved in suppressing Telehealth from proliferating. They may even be involved in suppressing it at a political level, since they do have powerful lobbies at the Federal and State levels.
At the end of the day, there are many challenges facing healthcare in the United States. Telehealth is just a part of the ever-complex puzzle, and its place in healthcare has yet to be determined. Even if implemented fully, it would not be capable of solving the vast healthcare problems we face with regards to professional shortages, expenses, and the general health and overall well-being of Americans. Only time will tell where this service lands in the big scheme of things. I think it has its purposes, but certainly could never replace the service provided by a real flesh and blood health care professional. Regardless, it wouldn’t hurt looking up your local number and giving it a try. You may end up liking it, and it could save you a trip to the ER, putting money back in your pocket.