Technology is moving on but don’t assume the Doctors using it are…

This USA Today video interview with Dr Ankush Bansal highlights for me many of the common challenges Doctors face with the concept of remote video consulting:

Here’s a few of the issues I felt were highlighted by the video:

“Virtual” Consulting

It’s unsurprising that people who have never done a remote video consultation with a Doctor refer to it as a “virtual” experience. But there is NOTHING virtual about a registered Doctor consulting with you about your health over video especially if they have your full history.

Arguing it is ‘virtual’ is to my mind like claiming I virtually flew to the Middle East last last week because I arranged it all online.

“Morning! morning Doctor how are you today? Good, can you tell me your name please?”

These opening lines of the video suggest to me this Doctor has very little experience of effective remote consulting.

I’m quite confident of this as in 6 years of offering 3G Doctor we’ve never had to ask a patient to tell us their name. Why? Because it’s not an effective way to ensure the identity of your patient (you should at least be referring to a stored facial image in their EMR), there are better ways (like discussing the details in the history they’ve shared before the consultation), it’s a waste of time that’s akin to the lack of purpose and pointlessness you pick up from video call demos in which participants wave to one another due to their discomfort and lack of focus.

“Telemedicine is a fairly new medium”

Really? Ever consider the work of the Royal Flying Doctors? Ever wonder how the Navy, oil rig workers or Astronauts access care?

“I don’t think it will replace traditional medicine. It will just be an adjunct for patients who have simple issues or who are between Doctors or need a refill”

This is really typical of the pessimism surrounding mHealth that still exists amongst some Doctors. It’s a big challenge getting guys like this to appreciate:

> Rather than supplementary an instant connection with a remote Doctor with specialist skills can be life saving eg. check out Rafael Grossmann Zamora, a Trauma Surgeon, who is using an $229 iPod to improve the quality of care and save lives across Maine.

> Rather than patients who have simple issues informed remote care (eg. where the patient has shared their medical history with the Doctor and she has reviewed it and done neccessary research before the consultation begins) will be the only way to provide value for patients with complex medical conditions and treatment histories. The days when there were revolving clinic doors through which Doctors took a history, made a diagnosis and treated the patient in a rushed 5 minute consultation are coming to an end and this is a good thing as except for the simple things these don’t offer patients value and are dangerous.

> Instead of thinking it’s all about patients with a need for a medication refill think about the value that can be offered to a patient who wants to discuss an issue within the 40 minute video that has been given to them by the oncologist who will be operating on them next week. Or perhaps this is a patient that has done their own research and wants to (hold onto your seat!) discuss a video they themselves have found.

Think about how we add value and work with patients who are already wanting to participate in their own care. Then try and have empathy for a patient that has their own unique informational needs eg. they want an opinion on something they’ve read on a online patient community.

“I think when I can do more of a physical exam of the patient”

I’ve heard this over and over (here’s an interesting post on the subject) but whilst I wouldn’t say physical exams are over rated I think it’s fair to say that there are many areas where we’re failing as a society and proactive efforts are needed as reactionary sick care approaches are failing eg. the obesity epidemic or the Veteran Suicide Explosion.

How will we know the corner is being turned by these Doctors?

First of all I think we’ll stop talking about how “Virtual doctors visits catch on with insurers, employers” and start talking about how flexible home working opportunities are helping some of the best Doctors be more productive and provide more value to patients at a time and place that suits them.

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