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How the Typical Telemedicine Model Gets it Wrong

Posted by Dr. Glen McCracken, Feb 10, 2015

Most telemedicine companies connect patients with doctors they've never met before.  While this is one way to provide more accessible healthcare, it's not the best path to sustainable, high-quality care.

What's wrong with this model? The care isn't being provided by the patient's own physician. Why is this important? It’s simple. Telemedicine isn't as effective without a foundation of trust.

Imagine this scenario: A young woman thinks she may have an ear infection, coupled with a nasty cough and a very sore throat. After two weeks, she finally makes an appointment to see a doctor in the city she’s recently moved to. She hates going to see a doctor unnecessarily, but she hasn’t been able to beat this illness and she’s starting to miss work.

She walks into the new clinic feeling achy and miserable, and the office staff hands her a clipboard of papers. She fills out the intake forms and follows a nurse to the exam room where she waits to see her new primary care provider. She closes her eyes, exhausted, hoping the Yelp reviews she read about this new doctor are accurate. And then the doctor walks in—she’s warm, engaging, smart, and asks the patient what brought her in today.

Not wanting to appear too needy, our sick patient understates her problems: “I don’t feel well and I’m not sure what’s wrong." The doctor looks straight at her, “You seem like you don’t come to the doctor for just anything. What’s really going on, and how can I help?” Finally, the real symptoms are discussed.

It is this type of trust and intuition that makes a good physician: a doctor who can read the non-verbal cues of a patient and know when there’s more to the story. This type of engaged care leads to patient loyalty and trust.

While much of medicine is science-based and about accurate research and cold hard facts, a large component is also about people, trust, and relationships. It's the constant dance of any healthcare provider: bringing both the head and the heart to the treatment room.

For this reason, I believe telemedicine is only truly effective for physicians who already have relationships with their patients. Context is everything. When your patient already trusts you, telemedicine is convenient, efficient, and an excellent resource. However, when you’ve never established rapport with a patient, telemedicine can be frustrating; it can be a hurdle to the relationship, rather than an asset.

With your current patients, you already know how they respond to information and whether they tend to be nervous, excited, or reserved. You can better understand their description of their symptoms in emails because you know their personalities.

It is hard to trust a doctor—let alone any person—who is a complete stranger, especially when you're talking through a computer screen. Thus, telemedicine programs that are simply connecting providers with patients without an opportunity for in-person interaction are at a severe disadvantage. I would even argue that they will not be sustainable long-term.

This is why our team at eVisit is working with healthcare providers to create a telemedicine software for their current patient base, rather than building another app that mimics an impersonal medical chat room. It’s simply not as effective. Digital healthcare works best when the patient and physician already have an established relationship.

[Tweet "#Digitalhealth works best when the #patient and #physician already have an established relationship."]

The Counter Argument

Proponents of the traditional telemedicine model, where patients are connected with any doctor who's available, argue that their model will make healthcare more accessible for everyone, including those who don't have a PCP.

So, are there ways to make telemedicine more effective even in situations where there isn't an established relationship?

While I think the provider-patient relationship is the most crucial element to telemedicine's success, there are three other key factors that determine how effective telemedicine can be:

  • Trust: Patients need to trust the advice they're receiving from their healthcare provider. Relaying a physician’s credentials, and having a conversation about the physician’s experience and treatment philosophy can help establish rapport.
  • Honesty: Patients need to be honest about their symptoms. This may actually be easier via telemedicine because a patient is slightly removed from the pressure of an exam room and may not feel the shame associated with some medical disclosures (e.g. STDs).
  • Technology: Video calls make telemedicine feasible and allow for physicians to pick up on those non-verbal cues. They also help provide a better context for both the physician and patient. With the growing popularity of smartphones and HIPPA compliant apps, we are well on our way to solving many of the original concerns around telemedicine.

What factors do you think most impact the effectiveness of telemedicine? Leave a comment and let us know where you stand.

Topics: eVisit Blog Posts, patient-doctor relationship, physician empathy, Telemedicine

Dr. Glen McCracken

About Dr. Glen McCracken

Dr. Glen McCracken is President of eVisit and a practicing ER physician with over 20 years of experience. You can connect with Glen on Linkedin.

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