Virtual Doctor Visits: Cutting Edge or Cutting Corners?

I am so old that I can remember when our family physician, Doc Hicks, made house calls in his old jalopy. His black bag was filled with all sorts of equipment, from tongue depressors and a stethoscope to a rectal thermometer and an otoscope to look in ears. The most worrisome was the syringe, which almost inevitably led to a painful shot in the butt. But Dr Hicks was also kind and supportive and his healing touch was reassuring. These days, house calls have virtually disappeared. Instead, we are moving to a world of virtual doctor visits. Some people love the convenience. Others hate the lack of physical touch and connection. What about you?

The Internet Is Taking Over Our Lives:

A lot of people love working from home instead of commuting to work. Avoiding traffic jams or public transportation can be a blessing. Zoom business meetings allow people to connect with others from a home office.

Many people bank online or file their taxes electronically. Instead of going to a movie theatre, lots of folks stream movies directly to their “entertainment center.” And shopping online has become big business! Just ask Jeff Bezos, one of the richest men in the world thanks to Amazon.

One of the consequences of the pandemic was the adoption of virtual visits for primary health care. The rationale was to avoid transmission of the SARS-CoV-2 virus to otherwise healthy people. Like the rest of the world, many healthcare providers worked remotely when that was feasible.

What’s an E-Visit?

Even after the pandemic had mostly disappeared, the healthcare industry continued to embrace telemedicine. Many patient “portals” to healthcare systems have links to an “E-visit.”

Here is how one “MyChart” system describes this procedure:

“An E-Visit is a way to get care for certain conditions without needing to schedule an appointment or come in to the clinic. We’ll ask you some questions about yourself and your symptoms, and a member of our E-Visit team will respond with a care plan or recommendations for what to do next. An E-Visit can take 10-20 minutes to complete.”

This is not a phone or video virtual doctor visit, though. It is for “non-urgent” conditions such as pink eye, shingles, poison ivy, a gout attack or a bladder infection. I am not totally convinced that such health problems are always non-urgent, though.

What Is the Impact of Virtual Doctor Visits?

People have differing reactions to seeing their doctors in a Zoom-like setting. Some people love it and some people hate it.

One reader described her positive experience with an online physician.

“I developed a urinary tract infection last year while I was out of town and not near an emergency center where I could see a doctor. I pulled up Doctor On Demand on my phone, explained my symptoms (which were the usual urgency and burning pain when urinating) and was put onto a FaceTime with a board-certified gynecologist.

“After a 30-minute conversation discussing everything from my age to medication allergies, she prescribed an antibiotic. She even told me to start taking a probiotic along with the Keflex. Within one day I was better and able to enjoy the rest of our trip.

“Fast forward to last week, one year from that first UTI. I had the same symptoms, so I went to my gynecologist who took a specimen. That turned out to be negative. They said they would not prescribe anything for my symptoms because the test was negative. My urine specimen showed no infection.

“Four days later, I had blood in my urine. The doctor didn’t believe it could be an infection because the urine was clear four days ago. However, I insisted on a quick in/out catheterization, and sure enough, the urine showed blood due to infection.

“I was put on an antibiotic. My urine has cleared up and I have no more symptoms. But I practically had to fight my doctor to convince him I needed more attention! I have learned so much from The People’s Pharmacy about advocating for myself.”

We are delighted this patient advocated for herself! Whether they are in-office visits or virtual doctor visits, it is essential that patients tell their story and ask tough questions.

Telemedicine or Virtual Doctor Visits?

Another reader offered this perspective.

“My doctor and I have been doing this for several years: when I have an issue I can’t adequately describe, I take a picture with my iPhone and email it to him with accompanying narrative. A while back when I was in the office, he said, ‘you know, we are practicing telemedicine.’”

Another person likes the idea of home visits via computer. Part of that is due to dissatisfaction with in-person office visits.

“Most doctors spend your visit looking at a computer screen anyway. I don’t need to be in front of them for that.

“I can answer questions and they can input data with me sitting in my comfortable chair at home. I can take my temperature and heart rate and even check my blood pressure at home with minimal monetary investment.”

Thumbs Down on Virtual Doctor Visits:

Not everyone is enthusiastic about tele-medicine, though.

Here is a different viewpoint.

“THUMBS DOWN! In my opinion, so-called ‘tele-medicine’ is a horrible scam on the public! You get no personal face-to-face interaction with the caregiver, who may not even be an actual MD. They can’t take vital signs or blood pressure, and you have no opportunity to discuss other ailments.

“Instead, I see big benefits for corporate medicine and big pharma. They have less real estate and office space to be maintained and paid for. Plus they can ‘see’ more patients in a shorter time.”

Many patients like the convenience of at-home visits using a computer. But there are situations when a hands-on physical examination is essential. Finding the right balance between historical healing traditions and instantaneous computerized connections is the challenge.

Does Science Support Virtual Doctor Visits?

How do virtual visits stack up against in-person care? A recent study shows that telemedicine visits are just as good as in-person office visits for most primary care problems (Annals of Internal Medicine, Oct. 2023).

The study, published in the Annals of Internal Medicine, was based on analysis of records from more than 1.5 million patients of Kaiser Permanente in 2021. Roughly half of the interactions between patients and providers were in person. The others were split between video and telephone visits.

Most Visits Went Well:

The investigators found that rates of follow-up emergency department visits and hospitalization was low for all visits. There were a few more follow-up office visits within a week of telephone (7.6%) or video visits (6.2%). Such follow-up visits were most likely if the initial visit was for a condition that caused pain. The investigators could not evaluate symptom severity from the records.

In addition, video and telephone visits resulted in slightly fewer prescriptions of medication. According to the records, 47% of patients received prescriptions during in-person visits. That compares to 35% of telephone visits and 38% of video visits resulting in prescriptions. Overall, however, the differences between these types of patient-provider interactions were minimal.

The Pandemic Accelerated Telemedicine:

The trend toward electronic connections between patients and their healthcare providers was already underway. Back in 2019, a study published in JAMA explored the pros and cons of direct-to-consumer telemedicine for prescriptions. The prescriptions included drugs for erectile dysfunction or genital herpes. The 2023 study stands in contrast to that, as the providers patients saw (virtually or in-person) were part of their usual care team.

An internist at Baylor University Medical Center writes this about “Trends in Telemedicine (Baylor University Medical Center Proceedings, Dec. 20, 2023):

“Telemedicine offers patients the ability to obtain medical advice and counseling from a telephone or computer while at home, work, or anywhere in the world, and at any given time or day. This form of communication has great potential to enhance contact between patients and providers.

“The first recorded application of telehealth occurred in 1876 after Alexander Graham Bell made his historic demonstration of conversation on a telephone and asked for advice about treatment to burned skin from a sulfuric acid spillage. Interestingly, as use of the telephone later became more common among physicians, there became concern that the phone itself might be a source of infection.

“More recent studies have extolled the use of telemedicine, supporting the idea that it is capable of addressing most patient concerns, especially for patients with barriers to in-person visits.”

How Should You Decide About Virtual Doctor Visits?

Some people embrace technology. They have blood pressure monitors and home electrocardiogram devices that are barely bigger than a credit card. Such people may also track their steps, weight and other health metrics on a smart phone. I admit it, I do love health technology.

Some may wear CGMs (continuous glucose monitors) even if they don’t have diabetes. That’s because they carefully monitor their blood glucose levels to see how food affects their minute-to-minute blood sugar readings. You can read more about this and other devices at this link:

” How Are Home Tests and Devices Revolutionizing Healthcare?”

As much as some people love technology and virtual doctor visits, others want to have direct eye contact with a healthcare provider. They want the doctor, physician associate or nurse practitioner to put hands on and verify that everything is OK. And if it’s not, they want to look in the provider’s eye and be told face-to-face what is worrisome.

Getting bad news electronically is doubly challenging. I was pushing for patients to have access to their health records two decades ago. But I also worried that lab results could be devastating if a doctor is not there to interpret the nuances of the data. Getting a cancer diagnosis via computer can be shattering.

What has been your experience? Do you like virtual doctor visits or do you prefer person-to-person interactions? How important is a hands-on approach? Please share your thoughts in the comment section below.