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August 16, 2022

Why a longtime telemedicine skeptic changed her mind

Daily Briefing

    Writing for The Atlantic, primary care physician Danielle Ofri explains how she became a supporter of telemedicine after being a long-time "staunch defender of old-fashioned, one-on-one, direct medical care." 

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    Dismissing telemedicine as a 'second rate' option

    In her career as a primary care physician, Ofri has always "stressed the irreplaceable value of the connection between patient and clinician not just for the human element, but for the documented medical benefits."

    "To put my biases on the table, I've always been a staunch defender of old-fashioned, one-on-one, direct medical care," Ofri writes.

    When Ofri first heard about telemedicine, she dismissed it as a "second-rate" option that was only valuable to rural communities with limited access to care. Even when the Covid-19 pandemic halted in-person visits, Ofri thought telemedicine should just be a temporary measure.

    "But two years of video and telephone visits have convinced me that these are valid clinical options," Ofri writes. "At times, they're even more helpful than in-person visits. My pre-pandemic self would blanch at these statements, but I've come to recognize that connection comes in many forms."

    Becoming a supporter of telemedicine

    During the pandemic, Ofri's opinion on telemedicine started to shift as she discovered the benefits of connecting with patients virtually.

    Most patients have complicated lives—they may be balancing child care, demanding careers, and overwhelming transportation logistics. According to Ofri, this "competing carousel of daily exigencies" often leads to cancelled appointments. However, most people can make time to speak with their doctor over phone or video. "I can more easily rejigger my schedule to accommodate their hectic realities when a packed waiting room isn't bearing down on me," Ofri writes. "The no-show rate on days when I do telemedicine is nearly zero."

    Even patients who don't face these types of logistical challenges have told Ofri that they prefer meeting with her in "the privacy and comfort of their own home."

    According to Ofri, another "unexpected—and, frankly, counterintuitive—benefit" of telemedicine is increased eye contact. "During in-person visits, I'm forced to yank my gaze back and forth between the patient and the computer," Ofri writes. "In video visits, however, the patient and the computer are aligned in the same direction. We can look at each other even as we flip through lab results and imaging studies."

    While some may regard telemedicine as "a cold electronic colossus," Ofri notes that virtual visits mirror the intimacy of a house call. "I can view the practical challenges of adherence to medical treatment," she notes. "But most important, I can provide medical care that might have been lost completely had in-person visits been the only option."

    Notably, patient surveys suggest that most have a positive view of telemedicine, citing convenience as a top factor—with realistic views of telemedicine's limitations.

    Research suggests that patient outcomes are similar among patients who attend in-person visits and those who meet virtually. In one study that compared two clinics—one with telemedicine and one with only in-person visits—patients had comparable outcomes for diabetes, hypertension, and kidney disease, and telemedicine patients said they were very satisfied with the care they received.

    To compare care outcomes, "[w]e don't have randomized controlled trials during the pandemic," said Ateev Mehrotra, a professor of healthcare policy and medicine at Harvard Medical School. However, when comparing health settings that use telemedicine extensively with those that use it less "[w]e don't see much difference" in general outcomes, including medication compliance, diabetes control, and ED admissions, he added.

    While Ofri maintains that in-person medicine "remains the bedrock of medical care," she believes that telemedicine has become "a robust component of the modern clinical palette."

    Still, telemedicine cannot replace in-person visits that require physical exams or testing, and it can be less appropriate for certain conversations.

    "Technical hurdles are ever present," Ofri writes. "Even so, the general sense is that although patients still want in-person visits, they consider telemedicine a great option for some part of their medical care." (Ofri, The Atlantic, 8/15)

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