Telemedicine offers great advances in care delivery, but providers need to be savvy to the pitfalls, such as non evidence-based apps and patients misrepresenting themselves online. A little “buyer beware” will go a long way.
Written by Jodi Lyons
As the telemedicine market opens up, patients will be exposed to even more unverified, unhelpful information than they already are. Many of you have had patients show up to your offices with “evidence” printed off of some random website and demanding a particular “medical” treatment. “Dr. Internet” is a popular physician who never went to medical school and doesn’t know the patient, yet dispenses “not- quite-but-awfully-close-to-medical” advice. Whether it’s coconut oil for Alzheimer’s Disease or krill oil for cancer, patients are sure to get upset when you tell them that their requested treatment is quackery.
Patients therefore are forced into an odd dichotomy – a balance between buyer beware and buyer have faith. “Buyer have faith” – credat emptor – is a term that describes the scenario in which the buyer should ethically be able to trust the advice and expertise of the “seller” – in this case, the person providing medical information or care. To quote an old commercial, “an educated consumer is our best customer.”
This challenge is only going to get worse as the telemedicine market opens up and web-based applications “replace” human-to-human interaction between medical professionals and patients. The art and science of medicine can be supported by, but not replaced by, an algorithm. It is important to preserve the instinct, training, education, experience, and compassion that medical professionals bring to the table so that the diagnosis and treatment plan don’t take place in a vacuum. The analysis of data is only one part of the equation.
Products based on symptom checkers and the like present a particular challenge. Think of how many diseases or adverse reactions to medications manifest themselves in “flu-like symptoms.” Another challenge is mimicking symptoms: is it a GI bleed or a side effect of bismuth sulfide? How are patients to know if they have a serious problem or not? How do they know who or what to trust? Consumer education is vital as is a clear means of differentiating between reliable sources and quacks. Most professionals understand the difference between scientifically validated information with peer review and the information found in a chat room where no one has any medical expertise. Many consumers don’t know the difference.
It also is important to differentiate between “real” telemedicine and “there’s an app for that” faux telemedicine. The telemedicine industry needs to thoroughly educate the consumer base so that the distinction between legitimate telemedicine practices and quacks are more easily identifiable. This is vital for patient protection– buyer beware.
The second side of the equation is “seller beware.” Medical professionals face a particular challenge if they don’t have a preexisting, face-to-face relationship with the patients before embarking on a telemedicine relationship. That is the “danger” of relying on patient self-reported symptoms and allergies. While similar challenges exist when enrolling a new patient even in a traditional office visit, the online-only world raises the stakes. There is limited data on the patient, and that data often is patient self-reported. How is the practitioner supposed to know if or how much the patient is cognitively impaired? A drug user/abuser? Confused? Misunderstanding the questions or situation? Doctor-shopping? Lonely and just needing someone to talk to? A hypochondriac? It is often easier to “see” these challenges face-to-face.
Particularly in the world of geriatrics, it is important in both face to face and telemedicine interactions to perform some sort of cognitive and mood screening that identifies executive functioning and decisional capacity, not just a test of short-term memory. This allows the medical professionals a chance to decide whether or not to trust the patient’s self-reporting, to know if the patient truly is able to understand the medical recommendations, to identify whether or not the patient is capable of adhering to the recommendations, and to decide whether or not to treat the patient. There are evidence-based, scientifically validated cognitive assessment and mood screening tools that can be administered in 15 minutes or less in-person, online, or over the phone even over asynchronous care. Using them protects both the patient and the medical professional. Short-term memory retention only tells a small part of the story and tests like the MMSE don’t give enough guidance to the practitioner.
Additionally, as the population ages, it becomes even more important to understand the psychosocial and practical implications of the medical interaction. If the medical practitioner calls in a prescription, does s/he know if the patient is able to get the medication and take it properly? Does the practitioner need to know or have they done their job just by calling in the prescription? Is there a need for follow up? Who arranges the follow up?
The expanding world of telemedicine and web-based medical advice creates many opportunities to expand access to medical care, especially to those who are not well- served by “traditional” means. Yet, just as patients need to beware of bad information on the Internet, medical professionals need to beware of bad information from the patients. Buyer and seller, beware!