Telemedicine's Quality of Care

May 15, 2014

As the use of "telemedicine" spreads across the U.S., medical regulators are asking whether a phone call can actually take the place of an office visit, reports the Wall Street Journal.

The number of web-based health care companies is rising, as doctors evaluate patients over the phone or online, even sending prescriptions. Evaluations typically cost $40 to $50. Just last year, Teladoc, MDLIVE, and American Well -- three telemedicine companies -- processed between 400,000 and 500,000 doctor-patient interactions, twice the amount that took place in 2011.

But some doctors and medical boards are concerned about the online doctor visits, insisting that doctors should not diagnose and prescribe medicine for patients that they have never met.

  • Critics also note that these services often prescribe antibiotics for conditions such as strep throat or unitary tract infections, even though both conditions require lab tests for a definitive diagnosis.
  • Companies' methods of diagnosing illnesses have also been criticized by medical experts. Some telemedicine companies, for example, ask patients to examine their own lymph nodes, not a reliable way to predict strep throat.

States are considering updating their medical practice regulations as a result. Recently, the Federation of State Medical Boards approved a set of model guidelines. The guidelines ask that virtual doctor visits meet the same standards of care as traditional visits, establish doctor-patient relationships and allow patients to confer with their physicians over video, not just the telephone. The guidelines also require doctors to be licensed to practice in the same state as the patient and require that a plan be in place for emergency care. According to the federation, treatment based on an online questionnaire would generally not meet the appropriate standard of care.

Telemedicine company American Well comes closest to meeting the federation's proposed guidelines. Patients download an app, choose a doctor in their state, and consult with that doctor over a video feed.

Telemedicine could increase access to doctors, especially for patients in rural areas, but telemedicine supporters are concerned that new regulations -- including requiring doctors to be licensed in the state where the patient is located -- could halt expansion of the model. 

Source: Melinda Beck, "Where Does It Hurt? Log On. The Doctor Is In," Wall Street Journal, May 8, 2014. 

 

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