The Teledoctor Will See You Now
Wendy Kagan | July 2, 2017For a busy working mom like Kieran Geffert, the thought of having access to a doctor 24/7 via Facetime video on her phone was very intriguing. “I had read about how telemedicine was revolutionizing healthcare and people’s access to it,” she says. So when she got an email about a year ago from her HR office at work saying that her company, CBS Corporation in San Francisco, was offering the telemedicine service Doctor on Demand, she downloaded the app right away and linked it to her insurance. “Even though I was a little skeptical about how it would work, I thought, ‘I’ll have it all ready to go, should I need it.’ I’m all about preventive medicine and being on top of things.” A couple of months later, her teenage son developed a suspicious blister inside his lip. “It was bothering him and it just kind of looked funny. I thought, ‘Well, let’s try Doctor on Demand.'”
Geffert had no idea what to expect when she used the app to request an MD. “It was the weekend, and I thought it would be a long wait—maybe the doctor was biking up Mount Tam?” But within less than a minute she and her son were Facetiming with a physician in a white coat. She was able to use the camera on her phone to show him the blister on her son’s mouth. Suspecting a virus, the doctor delivered a prescription electronically to her local pharmacy, which she picked up about 15 minutes later. “My son started on the medicine, and in two days the blister was gone.” Impressed by the ease and speed of the experience—and the handy avoidance of scheduling an appointment, driving to a doctor’s office, and sitting in a crowded, potentially germ-filled waiting room—Geffert used Doctor on Demand three more times over the next year, including once to get steroids for a case of poison oak that had gone systemic. She Facetimed with a doctor as she was getting ready for work and was able to pick up the prescription when the pharmacy opened. “I was able to do it all by multitasking, and it didn’t take any time out of my day. It was great.”
Telemedicine, or telehealth—in which care is transmitted from providers to patients via telecommunications technology—is beginning to take off. One of the most game-changing trends in healthcare today, telemedicine is expected to reach seven million patient users by 2018, up from 350,000 users in 2013, according to a report by IHS Technology. “There are multiple signs that telemedicine’s time is coming, if not here,” says Ian Tong, MD, chief medical officer for Doctor on Demand. “One is that we’re seeing an evolution of patient behavior: Patients are coming to us and asking us to be able to take care of more complex problems. So there’s an appetite for more.” Tong adds that the adoption of telemedicine regulations and guidelines have increased nationwide. “More states have established more sophisticated guidelines around what they want to see a telemedicine program or provider be able to achieve in their platform and in their offering to patients.”
All told, this mode of care is still in its infancy; many industry analysts believe that its most significant growth will happen in the next five to ten years. “It’s new, and so there’s some hesitation as to what is achievable over telemedicine,” says Ross Friedberg, general counsel for Doctor on Demand. “People wonder, can a physician provide me with good care this way? We’re so used to going to a doctor’s office and getting a physical exam. It takes a while for people’s attitudes to change as they get used to something new, especially when it comes to something as intimate as the doctor-patient relationship. But once people experience telemedicine, they discover its value and what can be achieved.”
Patients and caregivers stand to gain from the virtual experience. “Telemedicine is a more affordable healthcare option, and a lot more accessible,” says Friedberg. Not just for the privileged, telemedicine visits are often more affordable than urgent care, ranging from $0 when covered by insurance to $75 out of pocket, with most Doctor on Demand visits averaging about $49 (or more for mental-health counseling). For medical providers, it can lower overhead and offer more flexibility than an office or hospital-based practice. It can also help address much of what is wrong with our medical system today. “Part of the reason we exist is because our healthcare system is not working,” says Friedberg. “It’s become too expensive and disconnected from the needs of patients. When people start using telemedicine, if it’s a good program, they keep using it.”
A Return of the (Virtual) House Call
Even if it can’t meet every healthcare need (you can’t get stitches over Facetime, or have your teleprovider pop a dislocated shoulder back into place), telemedicine offers healthcare consumers more choice—and many patients find that empowering. While they’re all a little bit different, telemedicine services like Doctor on Demand, American Well, and MD Live are helping to bring back the 1950s house call, translated into modern mobile device culture. Doctors can “visit” you at home, even in the wee hours of the night. While something is lost in the virtual experience—physical presence and touch, for example—a lot is gained, too. “When I go to the pediatrician or my physician, there’s a lot going on,” says Geffert. “There’s something about the video visit that gives you a doctor’s undivided attention. It’s one to one. There’s no nurse knocking on the door and interrupting. They’re not typing everything you say into their laptop. They’re really present. You have their time, which I think is a valuable differentiator.”
Patients who worry about the limitations of virtual care are often surprised by what can be accomplished over their smartphone. “We can actually do a physical exam. We do it by walking the patient through one and showing them what to do,” says Tong. For example, if sinuses are the problem, an in-person doctor might press on them in various places and ask, ‘Does it hurt here? Or here?’ A teleprovider will walk the patient through the same process, showing them how and where to press on their own sinuses and asking them if it hurts. In some cases, depending on the service and its platform, patients can form relationships with their teledoctors, requesting them for appointments just like they can at brick-and-mortar practices.
As an alternative to urgent care or primary care, telemedicine can be a place to “go” on your phone if you suspect that you have the flu or a urinary tract infection. In some cases, when a teledoctor can assess the situation and assure the patient that it’s not necessary, telemedicine can help people avoid an emergency room visit. Especially when telemedicine is combined with health-tracking apps that monitor heart rate and other vital signs, it also has the potential to help manage chronic illnesses like diabetes or hypertension. “We’re reducing the burden of disease and providing more touch points for the patient,” says Tong. “People coming to multiple doctor appointments might have to deal with traffic and waiting rooms full of sick people. If we can cut those visits in half, for a diabetic, that’s a big reduction. This is the future of where we can go with telemedicine. That’s what makes me so passionate about it.”
The Rise of Holistic Tele-Care
While many doctors work for a telemedicine service like Doctor on Demand or American Well, a few doctors are branching out into telemedicine on their own. That is the case for Drs. Eugene Perlov and Lauren Shaiova, married MDs who practice in New York and offer telemedicine in addition to their in-person practices. They are also certified medical marijuana providers, which has thrown a lot of patients their way since New York legalized medical marijuana in 2014. “Once the dispensaries opened, it just blew up,” says Shaiova. “People from Brooklyn to Albany call us. They might have cancer or chronic pain, and they want an alternative to opioids. We’ll do a video encounter before we certify them. They transmit their medical records first so that we know they have a bona fide disease process commensurate with medical marijuana treatment.”
As primary care physicians with a sub-specialty in palliative care, Perlov and Shaiova see telemedicine as a way to combine a holistic, integrative approach with modern video technology. “We offer very thorough encounters,” says Perlov. “We don’t just give people a certificate for medical marijuana and send them on their way.” The couple may spend an hour or more with a patient who pays out of pocket, as opposed to a 10-minute Facetime call through a service that may be covered by insurance. In one recent case, Perlov and Shaiova consulted with a Belgian couple from Manhattan. “She was a 75-year-old Holocaust survivor who was going for spinal-stenosis surgery and wanted medical marijuana to help with the post-op pain,” says Shaiova. “We did telemedicine from their living room to our living room, and we certified her for medical marijuana the night before her surgery. You can have one proxy designated to pick up the marijuana from a dispensary, and that was her husband. He called me a few times after the procedure and said she was doing great. The medical marijuana helped her manage the pain and nausea. She was good to go.”
With today’s e-scribing technology, doctors can do almost everything electronically. “You can write a note in a patient’s electronic medical record, send a prescription to their pharmacy, order labs, do medical marijuana certification or primary care,” says Perlov. “Everything from counseling to lifestyle changes to nutrition and medications can go through this e-scribing portal.” For people in remote areas, or housebound patients, telemedicine can be transformative. “An isolated mom who is depressed or anxious, and who doesn’t have time to see a doctor, can get telemedicine therapy or find groups online and get tremendous support,” adds Perlov.
Geffert, too, sees countless possibilities for everyday use with her family. “My daughter is going to college next year and will be 3,000 miles away. I like knowing that she’ll be able to take care of some things with just a quick video visit through Doctor on Demand. When we’re traveling I can also see it being very handy, because if something goes wrong we’re just a video conference away from a doctor.” Her only gripe is that she didn’t have the technology earlier, when her children were small. “All those trips to the pediatrician for pink eye could have been avoided.”
Telemedicine offers more choice and convenience in a field that, until now, was never known for handing out consumer-friendly alternatives. But it is only one piece of the puzzle of how to fix modern healthcare and keep people healthy. “I don’t think telemedicine should completely replace traditional medicine,” says Perlov. “But it can certainly augment it and make it better.”
