Physician 'face time' is not optional, regardless of technology

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In a new Accenture consumer survey, 90 percent of respondents said they wanted to have online access to their medical information. The results also show that most consumers would like to be able to book appointments, request prescription refills and receive e-mail reminders when it's time for follow-up care.

None of that's surprising. What is surprising is that so many practices still don't provide these tools to patients, more than a decade after the technology became available.

Three-quarters of the respondents wanted to be able to have e-mail consultations with physicians. However, 85 percent said they still wanted to have face-to-face interactions with their doctors when needed. That makes sense, but it also makes me wonder what the other 15 percent were thinking. Did they suppose they could diagnose themselves--or be diagnosed--on their smartphones or on the Internet, no matter what they had?

Accenture apparently believes that's a real possibility. "Patients increasingly want access to their personal medical information, anytime, anywhere," Kaveh Safavi, M.D., who heads up Accenture's North America health industry group, said in an announcement. "But they're not willing to give up the option of face time with their physicians."

When did a physical examination by a doctor become an option? On one level, this statement just shows the cluelessness that general-purpose consulting firms often exhibit. But on another level, it represents the over-reliance on technology that typifies the current era.

Many routine healthcare issues can now be taken care of in e-mail or texting consultations. Telehealth services can help patients in rural and other underserved areas access specialized care, and some big insurers and employers are offering remote access to primary care through online services that reduce the cost and downtime from work. Telehealth is also being harnessed to help take care of patients at home and in assisted living facilities and retirement communities.

But as some physicians have pointed out, healthcare by remote control is no substitute for in-person doctor visits when a patient needs care for a serious problem. And if a patient is experiencing symptoms that require immediate attention, that person should go directly to the nearest emergency room.

Guidelines that once were taken for granted in e-mail consultations, however, have been quietly retired in recent years. Ordinary e-mail communication between doctors and patients, rather than secure messaging, is now considered acceptable.

And while no self-respecting doctor would have done an online consult with a patient he or she didn't know in earlier times, UnitedHealth Group's Now Clinic website advertises for patients to "Share your symptoms, receive a diagnosis, and even get a prescription, if clinically appropriate--24 hours a day, 365 days a year. No appointment necessary. Simply log-on ... and choose a doctor that's right for you."

While a disclaimer states that this service is not intended for patients with emergencies, customers are interacting with physicians who know nothing about them, must rely on the patients' reports of the medications they're taking, and cannot physically examine them. It's a bit frightening, when you think about it.

All of this is not to say that telehealth and other new technologies can't be helpful in increasing access to providers and consumers' engagement in their own healthcare. But when I see that companies such as American Well and TelaDoc are offering patients online access to physicians who have never treated them before--and may even replace the doctors who do know them--I worry about the outcomes of some of these consultations. 

Moreover, the business model of telehealth, if taken far enough, could drive still more small practices under by creating additional competition. Such competition might eventually come from brand-name organizations--a Mayo, a Geisinger, or a Partners--that offer remote consults to patients outside their service areas.

Above all, let's not forget that patients occasionally--or often--need in-person consultations with physicians. It's also important to recognize the crucial role that the physician-patient relationship plays in healthcare. If we neglect that in the mad rush to capitalize on new technology, there might be serious unintended consequences for both patients and providers. - Ken

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