Telemedicine used as a Clinical Tool
One aspect that most people overlook — clinicians and non-clinicians alike — is that telemedicine is simply a tool in the physicians’ tool chest. It’s one way to deliver care and it can be and should be consciously used. Over the years, clinicians have become excellent masters of “clinical tools”: deciding which exam, which bodily fluid test, which imaging modality will shine more information on the mysterious condition or help to confirm the suspicion, the intuitive assumption about how to best help the patient.
And therein lies the power of telemedicine as a clinical tool: That it is one way to provide healthcare. And the same applies to the telemedicine modality, whether this is via text, over the phone or via live audio/video: the right tool, the right modality must be selected deliberately to provide the best possible care.
What I’m seeing mostly these days is that it is the clinicians “uneasiness” with the video technology that has them justify using the phone only, oftentimes hiding behind excuses that the patients don’t want video, don’t have the technology, or don’t have the technology.
In my analysis of the root causes — as I indicated above — the solutions are simple, cheap, quick and very effective:
- Select a user-friendly, designed-for-healthcare telemedicine technology
- Create consciously designed clinical telemedicine workflows
- Provide clinicians with confidence building training, letting them in on the handful of tips and tricks that are intuitive to integrate
Is Audio-Only Telehealth Good Medicine?
To answer that question, let me get one thing out of the way very clearly: Telehealth, regardless of the modality, is always better than no care. And if telehealth cannot facilitate a diagnosis or care decision, the patient still has the option of being seen in person.
The comparison between in-person and virtual care is “nice”, but often not pragmatic when for example patients in their 80s with underlying health conditions understandably do not want to leave the house during a global pandemic that is highly deadly for people like them. Or when patients do not have the transportation or the time to make it to a doctor’s appointment. Did you know that for many well-executed telehealth services, no shows for telehealth visits oftentimes drop from the mid-20s to single-digit percentages. That’s a very big return on investment into telehealth right there.
So what about comparing telephonic care with video visits? Here, again telephonic care will beat “no care” anytime. But by not exploring and implementing video visits whenever possible, diagnostic accuracy and health outcomes can suffer.
As I said above, Telehealth must be seen and wielded as a clinical tool. It therefore should be a deliberate, conscious decision between telephonic, video and in-person care. There are numerous clinical consult scenarios where telephonic communication is absolutely adequate and even preferred.
Virtual visits over the phone work exceptionally well in established relationships, such as ongoing psychotherapy or chronic care management. Here, the nuances of the voice provide an interpretable picture of the patients’ emotional state, due to the long-standing relationship between clinician and patient.
It is therefore imperative, and we are working on this with multiple clients right now, to develop clinical guidelines as to when which mode of care delivery is appropriate and what the preferred “escalation path” is, i.e., when to switch to a different modality.