Telemedicine can fill many gaps in American health care. However, some doctors and others are trepidatious about delivering care by audio, video or remote telemetry through a smartphone, tablet or laptop, rather than a traditional face-to-face visit.
That’s fine. There are public policy questions to resolve — many related to jurisdiction. If a Massachusetts doctor treats a Virginia patient, should the doctor be licensed in Massachusetts, Virginia or both? If that patient is harmed by the encounter, in which state should legal action occur? What if the Massachusetts doctor is vacationing in Hawaii and the Virginia patient is traveling in Maryland when their encounter occurs?
These and others questions are worth exploring, provided they don’t paralyze lawmakers. As they explore these questions, it’s important to remember the many advantages telemedicine offers:
FLEXIBILITY: Telemedicine can deliver quick, convenient and sometimes lifesaving care. Telemedicine’s great virtue is flexibility. Patients can obtain care anywhere, anytime. For single parents, hourly wage-earners, and those with mobility problems, getting to a doctor’s office during routine 9-to-5 hours can be challenging and sometimes impossible.
RURAL CARE: Telemedicine can bring constant, reliable care to rural areas facing chronic shortages of primary care physicians and specialists. Teledoctors can deliver care to a rural community without relocating there or even visiting with any frequency.
URBAN CARE: Like rural regions, some urban areas — especially lower-income, inner-city neighborhoods — are short on physicians, particularly at hours convenient to residents. Telemedicine can reach these areas as it can rural areas.
LINGUISTIC MINORITY CARE: For those who don’t speak English, the health care system can be a disquieting labyrinth. Many, though not all, providers can link Spanish-speaking patients up with Spanish-speaking doctors. But speakers of other languages can have a much more difficult time. Telemedicine can bring doctors who speak Greek or Urdu or American Sign Language to any community on short notice.
EARLY INTERVENTION: Telemedicine is an excellent tool for early detection and treatment. One of the authors of this article (Graboyes) has a personal story: “When my late mother was 92, she was chatting one evening via FaceTime with her grandson, an emergency doctor. She mentioned feeling rather well, other than having a sore that didn’t seem to be healing. She added that she would try to see a doctor in a few days. With the help of my mother’s iPad, my nephew was able to listen to my mother’s breathing, observe her movements, and view the wound itself. He quickly determined that she might be in the early stages of septic shock. She was rushed to the hospital where she was diagnosed with a life-threatening infection. This quick action likely saved her life. But such care shouldn’t be limited to those whose grandchildren are physicians.”
ADVANTAGES OVER FACE-TO-FACE: Without overstating the case, telemedicine can sometimes deliver care that is superior to face-to-face encounters. A blood pressure reading at home may be more representative than one taken after a patient has slogged through traffic, struggled to find a parking spot, dashed into the office, and faced a battery of white coats. Some psychological or psychiatric patients are more regular with visits and responsive when they can communicate from home, on a flexible schedule, rather than visiting an office on a rigid schedule. For instance, veterans who suffer from PTSD may be reluctant to visit psychiatrists’ offices, but more willing to chat from home via video link.
DEMAND-SMOOTHING: Conceivably, telemedicine can smooth health care demand across regions. If a particular region is dealing with a flu epidemic, local doctors’ offices may be jammed, with long waits. In such cases, remote teledoctors can relieve some of the demand. This, in turn, reduces the excess capacity — extra doctors, nurses, buildings, etc. — required for peak-demand periods. This also reduces the quantity of brick-and-mortar facilities required in individual communities.
VARIETY: Telemedicine already delivers care for various segments of health care, including primary care, cardiology, psychiatry, ophthalmology, psychological counseling, pharmacy and even dentistry.
Telemedicine can complement traditional health care, providing patients with the flexible, high-quality care they want or need. Like any pathbreaking innovation, the specifics of telemedicine policy have yet to be fully worked out. It is hoped lawmakers won’t let uncertainty steer them away from the many advantages of telemedicine.
