AcuteCare Telemedicine Blog


DR. MATTHEWS GWYNN RESPONDS TO WALL STREET JOURNAL ARTICLE

As telemedicine becomes a model for the delivery of healthcare, The Wall Street Journal recently published an article questioning if telemedicine could replace an ER visit. Read the full article included below as published in the Wall Street Journal on August 2, 2015 followed by Dr. Gwynn’s comments.

When a Doctor Is Always a Phone Call Away Many of the 136 million ER visits in 2011 could have been replaced with a $50 telemedicine consultation.

By

Richard Boxer

Aug. 2, 2015 5:30 p.m. ET 

A 39-year-old truck driver was hauling through the Midwest in the middle of the night in 2011 when he began to feel a bit of indigestion. Then a lot of indigestion. He pulled over, recalling that his company had recently signed on with Teladoc, for which I was then the chief medical officer. The service allowed him to get a doctor on the phone within 15 minutes. He called and described his symptoms: nausea, chest pain, a little numbness in his left arm. He was having a heart attack, and his GPS guided him to the nearest emergency room.

Getting that doctor on the phone saved his life, and potentially the lives of whoever his 10-ton rig might have plowed into had he keeled over behind the wheel. If efficient and affordable quality treatment is the goal, telemedicine should be the future of health care.

When it comes to health care, “efficient” is a word that frightens people, calling to mind a soulless bureaucracy with an eye on the company’s bottom line. But it is inefficiency that is overburdening the medical system. Consider a woman with a urinary-tract infection who has to leave work to obtain a prescription from a doctor for a drug she already knows she needs. Or a man with a fever and hacking cough who has good health insurance, but who goes to the emergency room because his doctor’s office is closed.

Americans are struggling to obtain affordable, convenient care, and 103 million people in the U.S. live in areas with a shortage of primary health-care providers, according to the Health Resources and Services Administration. Yet the country is dependent on expensive, brick-and-mortar facilities that require time-consuming travel. 

Primary-care doctors tend to cluster in urban areas. If you get sick in rural Wyoming, even during the workweek, your only choice might be the emergency room. In 2011, the Centers for Disease Control and Prevention reports, 136 million people were seen in an ER; many of those visits could have been replaced with a $50 telemedicine consultation. Researchers at the University of Rochester found that 28% of the visits at one pediatric emergency room involved ailments such as ear infections or sore throats that could be diagnosed over the phone.

These problems are exacerbated by the increase in the elderly population, coupled with tens of millions of patients newly insured by the Affordable Care Act. A study in the Annals of Family Medicine projects that the U.S. will need 52,000 more primary-care doctors by 2025. Those positions aren’t filled easily. It takes 12 years and hundreds of thousands of public dollars to educate one primary-care doctor.

But there is an untapped resource: the many doctors leaving their practices, fed up with the regulations and other hassles, but who love their patients, and the older physicians eyeing retirement because they no longer want to maintain an office. Why not let these doctors offer their expertise to patients by smartphone?

Doctors who contract with a telemedicine company can opt for a specific block of time when they are “on call” to patients, picking up the phone and answering questions in 10- to 15-minute intervals. The doctor is paid and the patient gets a prompt and inexpensive answer to a concern.

Home care of individuals with major chronic conditions would also substantially benefit from telemedicine. Millions of houses have cable and satellite connections that can be used to monitor patients wearing wireless devices, allowing health professionals to intercede at the first sign of trouble. This can reduce rates of hospitalization by half or more, some studies suggest.

While there is worry about the quality of these interactions, telemedicine companies assess their doctors routinely and maintain strong quality-assurance programs. Every doctor is taught in medical school that 80% of diagnoses are obtained through a medical history and symptoms, and not by what a doctor sees, touches or tests.

Telemedicine will never completely supplant face-to-face visits, and most doctors naturally would prefer to treat a patient in person. The American Medical Association, for instance, has encouraged restriction of telemedicine to patients who have an established relationship with a doctor, and some state medical boards try to enforce that view.

But the perfect cannot be the enemy of the good—and by continuing to practice medicine as usual, we are making it so. Millions of Americans live in areas that are short of primary-care doctors, and millions more go to the emergency room when they have a sore throat. Entrepreneurs have responded by creating methods of connecting patients to doctors remotely, which reduces costs and satisfies patients.

There is no scenario for sustaining or improving health care in America without telemedicine. State and federal governments, as well as the medical establishment, should embrace the technology. For one thing, they should change Medicare and Medicaid to allow reimbursement for telemedicine consultations, most of which are currently not covered. Ask that truck driver if he thinks talking to a doctor over the phone has value: He is still alive and trucking.

Dr. Boxer is the chief telehealth officer of Pager and chief medical officer of Well Via. 

Corrections & Amplifications

An earlier version of this article misstated the name of the journal that published a study of the need for 52,000 more primary-care doctors by 2025. It is the Annals of Family Medicine.

Dr. Matthews Gwynn, Partner, ACT, responds to the article saying, “One may argue plausibly whether a phone call, such as in Dr. Boxer’s example of the trucker, is adequate or not for general medical care, but there is no reasonable argument against audiovisual encounters combating emergency medical conditions such as stroke, provided remotely by experienced physicians to underserved urban, suburban and rural hospitals.”

Gwynn also comments, “In-person visits will likely remain the mainstay for local care for those fortunate enough to be around many physicians, but when minutes count in emergencies experts can step in and make the decisions that will determine a lifetime of health instead of a lifetime of disability. Telemedicine isn’t a fad but rather a disruptive innovation that flows naturally out of technological advances and has already contributed immensely to our society’s health. It’s a perfect fit for our shrinking resources.”

Telemedicine is a critical part of the new healthcare delivery model. As healthcare organizations begin adopting new practices, the conversation around proper use, application, and the effect on patient outcomes will continue.


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