Industry Voices—Bridging the gap between virtual care and the ICU starts with clinicians

It takes a certain type of doctor to be drawn toward critical care. Shifts in the ICU are grueling and exhausting, both physically and mentally.

It also takes a certain type of doctor to be drawn toward telemedicine. Motivation and drive often come from reaching a wider range of patients, including those who often struggle to access in-person care. 

Looking at the Venn diagram of the medical community, the two worlds between the ICU and virtual care rarely overlap. Yet for us, as two critical care doctors and early telemedicine adopters, we’ve spent the last several years of our career advocating for how these two worlds should be integrated—especially as virtual care innovation has picked up steam. 

We first met as pulmonary critical care fellows at Cleveland Clinic, working 18-hour shifts and earning less than $40,000 per year. We were exhausted, overwhelmed, and couldn’t shake the constant stress of our looming medical school debt. We initially saw telemedicine as an easy opportunity to spend a few hours a week augmenting our paltry paycheck. 

Instead, we were met with the invaluable gratification of reaching patients who were facing significant access issues. We both have clear recollections of patients that would have ended up in the hospital if it weren’t for telemedicine. Over time, we began to recognize the potential of reaching these patients before it was too late—addressing preventive care “upstream” via telemedicine to help prevent negative outcomes “downstream” in the ICU.  

This experience eventually led us to split our time between seeing patients in the ICU and leading clinical teams at virtual care companies. While our colleagues initially questioned our decision to take a left turn off the predetermined paths, we felt our decision was an obvious choice and worth dealing with a healthy amount of skepticism and cynicism from peers.

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Over the last several months, we’ve been disappointed to find that the brief détente between telemedicine skeptics and advocates was quickly replaced with the latest heated debate around the status of virtual care in a post-COVID world. Once again, we’ve distracted ourselves with our knee-jerk reaction toward academic debates and our delay in action is simply pouring gasoline on the fire. 

While our textbooks and training didn’t cover telemedicine or virtual care, they also didn’t prepare us for a global pandemic that would stretch on for more than a year. Now is the time to brush aside our conventional thinking, get creative and, most importantly, find common ground.

Here’s what we believe we can agree on: 

1) The pandemic has tragically created the “perfect storm” for the 60% of Americans living with a chronic disease. 1 in 5 adults recently reported someone in their household was unable to get medical care for a serious health problem, and more than half said they experienced negative health consequences as a result. The medical community has been ringing the alarm bells over the last year, and we’re already starting to see the impact in the ICU over delayed and disrupted treatment. 

 2) Even the loudest and fiercest telehealth advocates will argue that virtual care is a complement rather than a replacement. While virtual care presents the opportunity to deliver quality care at scale, treating patients behind a screen can only be applied when safe and appropriate. Whether the care delivery model is virtual-first or virtual-integrated, there will always be the need to balance between in-person care and remote care.

 3) The apprehension in the medical community toward virtual care is understandable. The biggest tech endeavor in the healthcare system—the electronic medical record—has also become the biggest failure and thorn in our side. When the end user is left out of the development process, technology will only fail to meet its promise.

RELATED: In rush to embrace telehealth, many physicians still have concerns about quality of care, survey finds

 4) To date, the digital health industry has largely found traction with episodic care. While this can help relieve some of the pressure on our healthcare system, transactional care will only lead to a marginal impact. At the same time, we’ve kept the two care streams between telemedicine and in-person care far too siloed, despite the fact that as clinicians we’re inherently trained to collaborate. 

If we’ve learned anything from politicians over the last year, divisiveness is a poison to the medical community. We have the great honor and responsibility of keeping our patients safe and healthy as clinicians. We’ll only have a fighting chance at responding to the next stress on the healthcare system by finding common ground and moving forward together. 

Virtual care isn’t a specialization of medicine, it’s a tool and channel for care. Integrating our approaches provides us with a clear path forward that can balance clinical heavy loads with earlier intervention. By taking the next step in reimagining the patient journey—with collective physician insight at the center of development—we’ll be able to determine a care delivery model that has the best interest of the patient and the clinician.

Rafid Fadul, M.D., is Wheel’s executive medical director and Jonathan Wiesen, M.D., is the founder and chief medical officer at MediOrbis.