Big Red-Flag Study on Telemedicine

Should we be worried?

https://www.medpagetoday.com/resource-centers/ms-resource-centertime-start-treating-ms-earlier/1652

Can telemedicine replace a traditional visit to the doctor? Dr. Mike doesn’t think so. He’s worried that the drive for profits will take center stage, shoving proper healthcare to the rear.

Following is a transcript of his remarks in the video:

To summarize, a study was published in the Journal of Pediatrics that showed children who had a consultation with a telemedicine doctor had a much higher rate for a prescription of antibiotics than if they were to be seen at a primary care office like my own. Now why is this problematic? Well, I’ll tell you. The huge majority of respiratory tract infections, basically colds, don’t require antibiotics. This is because antibiotics don’t work on viruses. You’ve heard me say this literally a million times.

Why is that such a big deal? They got more antibiotics. Doesn’t that mean they got better care? No, not necessarily. In fact, definitely not. Respiratory tract infections by the huge majority are caused by a virus, meaning that they don’t require an antibiotic. Antibiotics only work on bacteria, and I’ll briefly run through the list of why over-prescribing antibiotics is bad.

One, cost. You shouldn’t be paying for a medicine you don’t need. Two, antibiotics are not benign medications. They have true adverse events: diarrhea — like we talked about at the opening — rashes, allergic reactions, your throat closing up, and finally resistance. That superbug I’m always talking about, about that bacteria that can get into your system where antibiotics can’t even fix it, that’s scary stuff.

I understand why telemedicine is so popular. I mean us, millennials, we treasure convenience almost above all else. We want to save time. We may be traveling. We don’t have access to a doctor. The cost is less when we use a telemedicine consultation, as opposed to going to a doctor’s office.

But it truly is alarming to hear that telemedicine may be hurting the outcomes for these people who want better convenience, who want more access for lower costs. I think the reason why telemedicine doctors are over-prescribing antibiotics are as follows. First and foremost, there is usually no relationship with the doctor and the patient.

Now, if one of my patients comes to see me, I know what they’re like. I know if they’re really sensitive, that if they have a stuffy nose they can act very dramatic. Or, I have some patients that if I see they have some pain, they have such a high pain tolerance that I really do worry and get an X-ray early on. But if you don’t have that sort of doctor-patient relationship, you may come to an incorrect conclusion.

Second, if you’re doing a telephone consultation, there is no physical exam. Think about that for a baby. If a mother calls and says her child is fussy and has a fever, it’s hard to decide whether it’s viral or bacterial without a proper physical exam. I mean, you need to look in that baby’s ear. But without that physical exam, you may be practicing what’s known as C.Y.A. Medicine, cover-your-butt medicine. That’s when you’re so worried about being sued by a patient, by them becoming worse and you not treating them with antibiotics, that you just over-prescribe antibiotics in the hopes of covering your butt.

Now I’ve seen this happen one too many times, even in primary care offices, so I can only imagine how much more often it’s happening in a telemedicine consultation where there’s no existing relationship and no proper physical exam done. It’s obvious that you’re not going to have great outcomes in this case.

One of the more concerning things that I’ve actually read in a study that was done in late 2018 was that doctors who practice telemedicine, who are generally just scattered throughout the country, those doctors had higher satisfaction rates and shorter visit times. And guess what doctors get compensated on? Shorter visit times and higher patient satisfaction scores. That’s the problem right there.

If doctors are more motivated to get you out the door and just keep you happy, they’re going to give you whatever it is that you want. Just because you want an antibiotic, it doesn’t mean that it’s the right treatment plan. Sometimes, the visit may need to take longer because the doctor should be educating you on why you don’t need an antibiotic, on what lifestyle things you can do to maybe speed up your recovery, and maybe to prevent you from having the same symptoms next time.

It’s kind of crazy to me as a doctor that by doing the wrong thing, over-prescribing antibiotics, you can have higher patient satisfaction and shorter visit times. That’s wild. As a young doctor, it really gets me excited when technology and healthcare combine. So when I hear the story about telemedicine not giving quality care to patients, it truly upsets me because I see how advantageous telemedicine can be. You can have lower costs and better access to care. You can have consultations with specialists who may be in a totally different city than you, but who can give you really great advice. It’s just in this case the standards of care are not being maintained. We need to hold telemedicine docs accountable for over-prescription of medications, change the incentive system so that we don’t just focus on patient satisfaction and shorter visit times, but instead focus on quality medicine, in addition to those factors.

I’m excited for the future of telemedicine and frankly, you should be too. Telemedicine antibiotics seem to be struggling. But here’s another instance where telemedicine fell short. Check out my video here. Click it.

Mikhail Varshavski, DO, (better known on social media as “Doctor Mike”) is a board-certified family medicine physician at the Atlantic Health System’s Overlook Medical Center in Summit, New Jersey. His YouTube channel educates over 3 million subscribers with two weekly shows covering everything from trending medical stories, to health myths, to reaction videos critiquing popular medical TV dramas. His goal is to expose medical misinformation and increase the health literacy of young adults.