How is Telehealth Changing the Doctor-Patient Relationship?

It’s clear that the virtual visit is changing medicine. Doctors must revamp workflows when implementing telemedicine applications. Patients must learn new ways of interacting with their physicians. From how we conduct the visit to how we bill it, telehealth forces us out of our comfort zone, creating new workflows in any practice setting.

But the benefits for doctors are have been well documented; telehealth visits cost less, requiring fewer resources. There can also be a corresponding increase in patient volumes, with a potentially positive impact on the bottom line of any physician practice.

But we all know healthcare is based on a trusted advisor relationship between the patient and their doctor. Could the virtual visit also change how doctors and patients relate and interact? What are the pros and cons of the patient perspective on how telehealth changes the traditional in-person visit?

“As a physician with over 20 years practicing medicine, I’ve always been an advocate of strong doctor-patient relationships. The strength of that relationship is the core of high-quality patient care. Contrary to what some physicians think, I believe telemedicine actually has the power to enhance and harness that relationship — if we use it in the right way.”
Glen McCracken, MD
The University of Arizona Telemedicine Program

For rural patients, telehealth may become their only access to care without undergoing extensive traveling. That’s because more than 70 community hospitals have closed since 2010 and another 280 or more are now in danger of closing, according to a report from Becker’s.

With telehealth, these patients won’t have to wait weeks for a physician or specialist to visit a clinic, or undergo the time and expense it takes to travel to an urban area to receive care. This is especially satisfying for the patient with orthopedic or other mobility issues; telehealth allows the doctor to come to the patient, alleviating the physical discomforts of travel.

Speaking of travel, the doctor-patient relationship can also be enhanced when the patient doesn’t have the frustrating experience of traveling to an office and waiting for care. Patients are able to enjoy a telehealth visit from wherever they have a Wi-Fi connection without being stuck in traffic or having to find parking. It is for this very reason that patient satisfaction scores remain high for telehealth visits.

The days of the $500 deductible are over. From a patient perspective, the birth of the high-deductible insurance premium means debt – and lots of it. There is still about 13% of the American adult population that doesn’t have insurance at all, and for the rest, there are high co-pays and deductibles.

High deductible plans are defined as requiring a minimum of $1,300 per person out-of-pocket annually. HealthDay cites a Center for Disease Control study that says the percentage of adults in high-deductible health plans rose in 2017 to 43.2% from 39.4% in 2016. A Bloomberg report this year says half of all workers have a deductible of $1,000 or higher per individual. The news from Forbes this year is worse; they reported on a Kaiser Family Foundation study showing the average deductible under Obamacare is almost $4,000. That number is only expected to increase.

We’ve all read the studies that show patients often skip needed treatment and are more likely to stop preventative care when they cannot afford the out-of-pocket costs.

Not only does the telehealth visit result in reduced clinical overhead for doctors, it’s a more cost-effective treatment method for patients. Studies have shown that telehealth visits keep patients out of the emergency room and reduces inpatient volumes. Certainly, that’s good news for our hospitals but it also means the potential for less out-of-pocket for our patients.

The bottom line is that the evidence shows telehealth actually builds the doctor-patient relationship at the same time that high-deductible insurance policies threaten to tear these relationships apart.

CNN Money published an excellent chart showing the average wait times to see physicians for cardiology, dermatology, ob/gyn, orthopedics, and family practice, by city. They found:

• For non-urgent care, it takes 32-days to get in to see a cardiologist in Washington D.C.
• In L.A. it takes an average of 14-days to get in to see a dermatologist.
• In Detroit, it takes 18-days for an orthopedic surgical appointment.

CNBC reports the average wait time to see a doctor today is around 24-days. As physician shortages increase, telehealth offers an alternative way to seek medical help without extensive wait times and delayed treatment.

“Listen to your patient; he is telling you the diagnosis.”
William Osler

Less Personal Contact for Patients

The chief drawback to telehealth has always been the impersonal nature of our digital communications. While texting and video conferencing have allowed more immediate access to our friends, family, and personal physician, in the case of healthcare, a telehealth visit will always lack the physical touch tied to the traditional office visit.

It’s been argued that a full and complete diagnosis cannot be made with a telehealth application. However, there are plenty of research outcomes that show diagnosis as not only possible but also that the end result of telehealth visits included lowered hospital inpatient admissions and better care.

In fact, smartphone applications like OrthoLive account for the off-site diagnosis with screen flipping, which is like a screen share in video conferencing. This allows doctors to view and diagnose parts of the patient’s body while asking the same clinical questions used in a physical exam room.

We all know that diagnosis relies heavily on this back and forth with patients – the importance of the history dates back to William Osler.

Screen sharing allows you to gauge breathing, skin tone, overall physicality and mobility, cognition, and speech clarity. These are standard visuals that we assess in the first minute or so of every exam. However, these are just some of the exam findings possible with telehealth.

With that said, some doctors may feel establishing a patient relationship is easier in a face-to-face interaction. That’s why they may choose to only use telehealth with established patients. But if a consumer isn’t seeking medical care because of the hassle, the best way to reach the patient is through telehealth.

Telemedicine is actually a way to improve the continuity of care. It helps us eliminate the silos of our fragmented care system, offering a low-cost way to consult with specialists or provide care to patients when they need it most, saving patients time and money while improving access to care.

Contact OrthoLive for a no-obligation demo of telehealth and see the benefits in real-time.