“In the future, we’re going to make fewer visits to the doctor’s office, and it will have little to do with scales that show more pounds than the ones at home or the interminable waits on cold exam tables. It has to do with our phones. After a tentative start, a form of telemedicine where doctors consult with patients through mobile video conversations is beginning to pick up steam. According to the research firm Park Associates, the number of these type of consultations will nearly triple over the next year, from 5.7 million in 2014 to more than 16 million next year. By 2018, it estimates that volume will jump to 130 million calls. A recent survey by the consulting firm Towers Watson found that almost 40 percent of the large employers (more than 1,000 employees) queried said that by 2015, they expect to offer their employees coverage for telemedicine consultations as a low-cost alternative to ER visits or face-to-face doctor appointments. Another 34 percent said they expect to do so by 2016 or 2017. The doctor will phone you now” Randy Rieland in the Smithsonian.
“Need a Quick Diagnosis? A Prescription for What Ails You?”
While I think documented video consultations are making the prospect of clinic visits seem increasingly like sending a letter instead of a SMS it surprises me that so many think video calls with a registered Doctor are all about just finding an easy quick fix. While it’s easy to see the appeal of a service providing ‘a quick diagnosis’ the reality is that the vast majority of healthcare spend and in-office consultations that are undertaken today are with Patients who already have a diagnosis.
Why do people want to talk up the importance of getting a prescription and ignore the importance of just sharing your concerns and getting some advice from a Doctor? Do journalists pretend they never get mental issues or have they picked up that silent undiagnosed epidemic from Doctors?
“The Doctor Will Video Chat With You Now”
It’s great to sense that the “The Doctor Can See You Now” slogan we’ve been using at 3G Doctor for 8 years resonates with US journalists commenting on mobile video consultations in 2014.
“The strongest argument for telemedicine is that it’s a much more efficient and considerably less expensive way to deal with relatively minor ailments—sinus problems, urinary tract infections, a kid’s fever”
It amazes me that so many think remote consulting is all about the ‘minor ailments’. I can only presume this is a US thing that might arise from the shortage of functioning Primary Care services eg. in the UK/Ireland it’s normal for Pharmacists and Practice Nurses to manage such minor ailments.
For some reason it reminds me of the people who used to think online payments were going to be all about paying for digital content – as though we’d never use such tech to for simple things like buying a coffee (within it’s first 12 months of offering mobile payments 10% of Starbucks customers migrated to using it).
“Based on what they see and hear from the other side of the phone, doctors recommend treatments and can write short-term prescriptions, albeit not for narcotics, antidepressants or certain other mental health meds and non-therapeutic drugs, such as Viagra and Cialis”
Once again the author suggests remote consultations are again going to be limited eg. this time to drug seeking behaviour. I wonder if Randy Rieland has ever wanted to just get an impartial independent second opinion from a Doctor before or if he has a family member who’s a Doctor?
“As Lauri Hicks, an epidemiologist for the Centers for Disease Control (CDC) told a tele health research group, “There is a lot of concern about making a diagnosis without examining a patient—not only for overprescribing, but also for under prescribing or misdiagnosing cases where there might be a more serious infection.””
It astounds me that so many people think this is the real issue. There have been plenty of registered Doctors that have been closed down before for thoughtlessly prescribing and/or misdiagnosing.
I think this is clearly one of those problems that self correct very quickly eg. American lawyers will close down any Doctor Video Consulting brands that are involved with such practices very quickly and any Doctors that are so clueless that they’d offer their video advice in a regulated market like America without effective documentation of their Patients symptoms and history will be struck off the register much quicker than they would if they provided the same low quality services within undocumented office consultations (because as with Google Glass video consults make it much easier for Patients to document their own consults).
“One thing that makes medical organisations uneasy about this type of medicine is that consults would rarely be with the patient’s own doctor, but rather with a physician they’ve never met, one who’s part of a large telemedicine network… …It seems a sensible way to deal with the afflictions that may not merit the aggravation and time involved in getting an appointment and going to the doctor’s office”
While not easy I think we need to move beyond thinking about the limits of video consults as otherwise we’re likely to completely miss the big opportunities. Reading this interesting piece by Brad Feld on Tech startup company Founder Suicides and it is striking to me that here’s a group of people who can manage their entire life without needing to even lift their smartphone to their ear (order/pay for a taxi, shopping, dinner, a gift, coffee, flight, AirBnB bed for the night, etc, etc) but as soon as it comes to their mental health they go right back to 1980 ringing a volunteer on the end of a telephone line at the National Suicide Prevention Lifeline because we have a healthcare provider system that still clings to the one size fits all mantra (Note: in the UK we’ve an even more outdated approach as the Samaritans use a premium rate number).
“The AMA’s skittishness aside, there’s a sense of inevitability about using smartphones to connect with doctors, especially when you consider how much it can save in health care costs simply by reducing visits to doctor’s offices and emergency rooms. Take your kid to an ER for a bad cough and it can cost $750; spend a half hour on a video call with a doctor and it’s about $60”
I think once this author experiences a documented Video Consultation with a Doctor his opinion will radically change as he’ll quickly pick up on the much more important possibilities eg. there’s an inevitability when you consider the shortage of Primary Care Doctors and how the demands on Doctor time in clinics with costly overheads and demanding managers have Patients struggling to avoid being interrupted, the rise in female Doctors and the opportunity for home working opportunities for Doctors, the need to take a different approach to infectious diseases (not just the obvious things like Ebola but also the seasonal Flu etc), etc, etc.
“Like Doctor on Demand, other telemedicine companies such as Teladoc, MDLIVE and American Well make it very clear on their websites that first, they are not in the business of dealing with serious medical issues—don’t call about chest pains or breathing problems—and second, they are not meant to be a replacement for your regular doctor. They are not about building relationships; they’re about helping you through a sinus infection”
It’s clear a lot of people need to spend some time thinking creatively about the product healthcare professionals provide beyond the office consult as there’s a lot more scope than merely helping Patients through a sinus infection for which my good friend Prof John Bachman MD at the Mayo Clinic published evidence in 2010 showing that through the use of Patient History Taking Software the vast majority of cases can be effectively managed without the need for the office visit or even the in-person video consultation:
“But it may just be a matter of time before doctors on the phone start addressing more chronic conditions, such as providing prescriptions to treat diabetes or hypertension, or dealing with more specialized medicine. Earlier this year, for instance, a tele-network called DermatologistOnCall opened for business”
This is already happening eg. see Endocrinologists who are prescribing their Patients mobile embedded glucometers from Telcare.com, or the Cardiologists who are providing their Patients with Alivecors to go home from the Hospital, etc.
“If you need more evidence that video-chatting with doctors is something to be taken seriously, consider this. In August, Doctor on Demand raised $21 million from investors. Last month, Teladoc said it had raised $50 million”
This is actually a low estimate of investor interest (eg. while TelaDoc did recently raise another $50M this was a follow on investment and to date they have taken onboard some $96M in venture funds) and it should be no surprise when you notice that many of the world’s wealthiest self made Billionaires are already made personal investments into mHealth startups.