In the future, we’re going to make fewer visits to the doctor’s office, and it will have little to do with scales that show more pounds than the ones at home or the interminable waits on cold exam tables.
It has to do with our phones.
After a tentative start, a form of telemedicine where doctors consult with patients through mobile video conversations is beginning to pick up steam. According to the research firm Park Associates, the number of these type of consultations will nearly triple over the next year, from 5.7 million in 2014 to more than 16 million next year. By 2018, it estimates that volume will jump to 130 million calls. A recent survey by the consulting firm Towers Watson found that almost 40 percent of the large employers (more than 1,000 employees) queried said that by 2015, they expect to offer their employees coverage for telemedicine consultations as a low-cost alternative to ER visits or face-to-face doctor appointments. Another 34 percent said they expect to do so by 2016 or 2017.
The doctor will phone you now
The strongest argument for telemedicine is that it’s a much more efficient and considerably less expensive way to deal with relatively minor ailments—sinus problems, urinary tract infections, a kid’s fever. Based on what they see and hear from the other side of the phone, doctors recommend treatments and can write short-term prescriptions, albeit not for narcotics, antidepressants or certain other mental health meds and non-therapeutic drugs, such as Viagra and Cialis.
Some have raised questions about the potential for teledoctors to overprescribe antibiotics, particularly for conditions that generally require a lab test to confirm, such as strep throat. As Lauri Hicks, an epidemiologist for the Centers for Disease Control (CDC) told a telehealth research group, "There is a lot of concern about making a diagnosis without examining a patient—not only for overprescribing, but also for underprescribing or misdiagnosing cases where there might be a more serious infection."
One thing that makes medical organizations uneasy about this type of medicine is that consults would rarely be with the patient’s own doctor, but rather with a physician they’ve never met, one who’s part of a large telemedicine network. Take the case of Doctor on Demand, a company that’s less than a year old, but has already gained a lot of attention, at least in part due to the involvement of Dr. Phil McGraw, the TV celebrity psychologist—he’s an investor and spokesperson and his son Jay is one of its founders.
Once a person downloads the free Doctor on Demand app, they can log in, enter their symptoms, provide a relevant medical history—medications they take, allergies and other information—and request a consult. Then a randomly selected physician—the company has a total of 1,400 board-certified doctors in its network—gets in touch with the patient, usually within 15 minutes, and starts asking questions. A typical virtual “visit” lasts less than 15 minutes and costs $40. The physician gets $30, and Doctor on Demand gets $10.
It seems a sensible way to deal with the afflictions that may not merit the aggravation and time involved in getting an appointment and going to the doctor’s office. But while acknowledging that telemedicine can be a good thing, the medical establishment so far has been wary of giving the technology a full embrace. In June, the American Medical Association (AMA) issued guidelines recommending that doctors giving advice over the phone should be licensed in the state where the patient lives. The AMA also agreed with the Federation of State Medical Boards that doctor consults through voice-only calls, emails or text messages don’t qualify as telemedicine. A video connection is needed, it said.
The AMA did bend a bit. Previously, it had taken the position that a valid doctor-patient relationship required at least one in-person meeting. Now, it’s willing to concede that a video meeting may be sufficient. The AMA guidelines aren’t binding, but they can affect how states regulate telemedicine and how insurance companies cover it.
Phoning it in
The AMA’s skittishness aside, there’s a sense of inevitability about using smartphones to connect with doctors, especially when you consider how much it can save in health care costs simply by reducing visits to doctor’s offices and emergency rooms. Take your kid to an ER for a bad cough and it can cost $750; spend a half hour on a video call with a doctor and it’s about $60.
Another thing boosting telemedicine’s appeal is the Affordable Care Act, aka Obamacare. With its incentives to doctors to focus on keeping people out of hospitals through preventive care and interacting more with patients, the law has been a boon to smartphone health care.
Like Doctor on Demand, other telemedicine companies such as Teladoc, MDLIVE and American Well make it very clear on their websites that first, they are not in the business of dealing with serious medical issues—don’t call about chest pains or breathing problems—and second, they are not meant to be a replacement for your regular doctor. They are not about building relationships; they’re about helping you through a sinus infection.
But it may just be a matter of time before doctors on the phone start addressing more chronic conditions, such as providing prescriptions to treat diabetes or hypertension, or dealing with more specialized medicine. Earlier this year, for instance, a tele-network called DermatologistOnCall opened for business.
That said, the real growth in this kind of telemedicine, at least in the near term, is likely to come from people who don’t have a regular doctor. A recent study by the RAND Corporation, in fact, found that patients who contacted doctors on the Teladoc network tended to be young and more likely to have never seen a doctor. It also determined that of the people who used Teladoc only 6 percent required a follow-up consult compared to 13 percent who visited a doctor and 20 percent who made a trip to an ER—although that could have as much to do with the relatively minor nature of ailments generally handled on telemedicine calls.
So, at least for now, this approach to health care seems to be less about changing people’s behavior than it is about attracting people who haven’t yet established a behavior, those who view calling a doctor like they would getting a ride on Uber—a service in a time of need.
If you need more evidence that video-chatting with doctors is something to be taken seriously, consider this. In August, Doctor on Demand raised $21 million from investors. Last month, Teladoc said it had raised $50 million.