Telemedicine is growing at a rapid pace. Consider these stats: almost 15 million Americans receive some kind of remote care every year. And an estimated $1 billion annually is being invested in “on-demand health services.” The question is: has our ability to generate technological innovation getting ahead of our capability of making the best use of these developments.
According to Dr. Dhruv Khullar, “as telemedicine moves from a technology used to manage minor ailments — coughs, rashes, sore throats — to one that affects nearly every field of medicine, it’s important to consider whether its increasingly complex application is being matched with increasingly sophisticated training.
Khullar, a physician and researcher at Weill Cornell Medicine and director of policy dissemination at the Physicians Foundation Center for Physician Practice and Leadership, points out that misdiagnosis remains a major problem. And, it is not certain as yet whether telemedicine minimizes the problem or makes it worse.
Patient rapport could suffer as telemedicine expands. He comments. “Building rapport with patients remotely is also more difficult than in person. The subtle cues that bond doctor and patient are largely absent during a virtual visit, and some argue we should teach not just bedside manner but also webside manner.”
In a Washington Post article, Eric Topol, digital health expert and executive vice president of the Scripps Research Institute in La Jolla, Calif. refers to telemedicine as a video chat. But soon, telemedicine will be a data-exchange platform, in which patients are generating and transmitting data — vital signs, genetic scores, microbiome information — in real time to doctors.
Most experts believe more physician training is imperative. In fact, Rahul Sharma, emergency physician in chief at New York Presbyterian-Weill Cornell Medical Center, thinks we need a new medical specialty entirely: the “medical virtualist.”
Medical virtualists would be doctors who spend most or all of their time caring for patients remotely and who receive dedicated training and certification. He argues that specialties such as intensive care, interventional radiology and surgical subspecialties were derived from advances in medical knowledge and technology, and the same should now hold true for telemedicine.
There is a program that trains doctors to provide virtual care. It utilizes consultants who specialize in presentation and public speaking. It also trains them on how to examine patients remotely. “Physicians can, for example, ask patients with sore throats to take a photo with their smartphone, or ask family members to help with basic physical exam maneuvers,” notes Khullar.
There are now emerging all forms of physician education. For example, medical students at Weill Cornell can take a two-week telemedicine and digital health elective in which they learn to interview patients virtually, participate in telestroke and telepsychiatry visits, and understand the legal and regulatory issues around telemedicine.
Dr. Khullar concludes:” Going forward, more-effective telemedicine may require more-effective telemedicine training.”