By Wayne Leibhard, M.D.
Consumers desire health care like everything else in America, fast and easy, and they want it delivered by competent and empathetic professionals and telehealth seems to be the answer.
But timely, assessable, and affordable is useless—and potentially dangerous, if the diagnosis or the treatment is incorrect. “Fast and easy” is never supposed to imply “risky and unpredictable.” We trust that hamburger from McDonald’s because there is always someone in America looking out for the welfare of the consumer of everything commercially branded.
This, of course, begs the obvious question. How do you know the diagnosis is correct and/or the treatment is correct when you engage the medical system? Answer: you don’t know—at least not until you get better, or until the medicine you are taking makes your eyelashes fall out.
Why, then, would you engage the medical system at all, given the lack of certainty? There are two reasons and they both relate to a risk/benefit ratio.
First, you wouldn’t engage the medical system at all if you felt that there was more risk than potential benefit in doing so. Second, you’ve developed enough trust in Western medicine or in your “provider” of choice. In any case, your level of trust allows you to engage a system where potential risks are always present in its use.
With that in mind, who wouldn’t trust their care to a large medical conglomerate that owns hospitals—and all sorts of shiny new multiple-story buildings—when they advertise their telehealth services with the following: “get the same great care as an office visit?”
Certainly, in a rush to capitalize on the “new age” of telemedicine, a large medical conglomerate would never attempt to direct as many patients as possible, regardless of their presenting complaint, to a video visit. Right?
What about a slick online medical “provider,” with an attractive clinician pictured front and center in an ad? The clinician will note how easy it is to book an online appointment and how almost any health concern can be handled through a phone visit, “prescriptions, antibiotics, diabetes, refills, birth control, gout, hypertension, PrEP, pneumonia, hypothyroidism, lipid regulators, IBS, asthma, depression, ear infection, acne, anxiety, STDs, sinus infection, erectile dysfunction, cough, flu, UTI… and almost anything else!” Why stop there? Surely, the home appendix removal kit is right around the corner.
Or perhaps, an ad might entice a consumer this way, “The last thing you want to do is trek across town to see a doctor.” This sounds like: “The last thing you want to do is drive another two miles up the road to where the bungee jumping is safety monitored.”
By now it should be obvious to patients that Western medicine has, in fact, been lying to everyone for decades—for centuries. No one ever really needed to be examined in person by a doctor. It just took until now, when technology would allow, for us to admit that interaction on a screen is, in fact, superior to an interaction in person.
Undeniably, telehealth has an important place in the current delivery of medical care.
In fact, in some instances, and some circumstances, virtual health care is the best available modality through which to access certain kinds of care.
There is no doubt that, in remote areas, or in small hospitals without immediate access to specialty care, telemedicine can be a godsend as a conduit to that specialty care. There are also certain services (such as diabetic consults or mental health visits) that can be reasonably achieved through telemedicine consults when circumstances demand.
Trusted Virtual Clinicians?
In early 2020, as we all know, circumstances regarding medical care changed drastically, and the Centers for Medicare and Medicaid Services decided the rules previously governing the delivery of and remuneration for telemedicine services would also be changed drastically, to provide medical care during the COVID-19 pandemic.
Large health care systems took notice—immediately. Certainly, their doctors bought into the provision of urgent care by telemedicine for just about any condition imaginable, right?
Certainly, their doctors were consulted about how the telemedicine process would be set up, how it would work, and what conditions, as presented by patients, would be routed through for a telemedicine visit, right?
Certainly, their doctors were trained in the intricacies of providing care by telemedicine, more so than just the nuts and bolts of getting connected and instructing patients on how to stick their iPhones down their throats to get a peek at their tonsils, right?
Certainly, the control of the narrative, and therefore the control of the delivery of medical care in the United States, is in the hands of your trusted clinician, right?
Don’t bet on it.
Wayne Liebhard, M.D. (wdliebhard @yahoo.com) is an emergency and family medicine doctor in Minneapolis/St. Paul, Minnesota. His newest book is Walking the Tightrope—Trusting Your Life to Telemedicine, (Alethos Press: 2022).
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