Is the quality better than an in-person visit?
There has been much debate on whether a telemedicine visit is better than an in-person visit. I went into these interviews hoping to gain a definite answer, but unfortunately, the interviewees had split opinions. Interestingly, the opinions were split by the type of individuals: for example, parents and caregivers felt the physician did not have the ability to perform vitals such as blood pressure, oxygen level, weight, etc. which is a disadvantage for all patients. One patient stated, “the telemedicine visit was not helpful because the physician could not assess my pain level remotely and I was unable to get an EKG performed.” Additionally, one mother advised that the physician was unable to perform a thorough assessment of her son, because the visit was not in-person, especially with an autistic child.
One component that all the patients did agree on is that there were less to no interruptions competing for the physician’s attention. For example, one patient stated: “What I find to be better about a telemedicine visit regarding quality, is that my visits are less disrupted compared to the office. In the office, staff knock on doors during exams.” Ultimately, the jury is still out on whether telemedicine visits are as effective as an in-person visit.
Challenges connecting to the physician for a telemedicine visit
Adaptability and ease of technology is the most crucial component of whether or not a patient will use the technology. Interestingly, almost everyone I interviewed had issues with the technology with the exception of two patients who work in the Information Technology field. Here are some of the technology issues these patients faced:
- Using telemedicine was easy, but during the visit the physician lost connectivity, which ended the virtual visit prematurely. Thankfully, the physician contacted the patient via telephone to conclude the visit.
- The appointment had to be cancelled and rescheduled due to connection issues.
- The quality of the image was horrible, so the physician could not see the patient clearly and vice versa.
When asked how physicians handled the issues,. the patients commented that the physician had to become the “IT support resource” for the patient, resolving connectivity, video, and voice challenges.
Would you use telemedicine to see your physician again?
Even with all the technological challenges, the majority of the patients would use telemedicine to see their physician again, but only for simple medical issues such as cough, headache, medication refill, etc. Intriguingly, one caregiver advised that her mother was unable to connect on the cellphone, so the telemedicine visit was performed on the family’s desktop, but due to Covid-19 all family members were home. The mother did not feel comfortable talking about personal medical information to the physician, with other family members around. After talking to the caregiver, it made me realize that in extended families telemedicine visits may be challenging especially when they do not occur privately behind a closed door. Another patient, who would not use telemedicine again, stated, “the visit was very impersonal, I would rather go into the office and see my physician where he can show me my test results and discuss my health in more detail.” But on the other hand, one patient who would use telemedicine again felt, “I am not waiting in the office waiting room or the examination room to see my physician.” A telemedicine visit is more convenient for patients.
In this day and age, being “tech savvy” is not something we think of anymore, because we are all connected by smart devices such as Alexa, Siri, Nest, Google Home, and smartphones, but the reality is that for the older generation you must be “tech savvy” to use telemedicine. “My niece had to come over, to set up my phone, and download the application for the telemedicine visit” said one patient. “I was prompted to do an update, which I did not know how to do on my phone, so my son came over to set it up.” “I had to create another username and password for the telemedicine visit, and I thought it was tied to my patient portal, but it was not, so I got locked out.” Telemedicine technology must continue to evolve based on patient feedback and become simpler and easier to use.
Telemedicine is here to stay. It has tremendous benefits for patients of acute care and inpatient care. It has “pushed” patients who are not “tech savvy” into an arena where they are learning on the fly and depending on family members (mostly younger ones) to help them navigate this technological water. What I have learned from these interviews is that physicians must choose a telemedicine application that is easy to use for all patients.