Tele-medicine is becoming a popular option among adults and families. However, this is not always the best option for your child. Below is from a handout a fellow pediatrician put together to better inform families about this growing trend.
Your child does not have a virtual illness, so why do you want a virtual doctor?
Insurers are promoting “telehealth” encounters in place of conventional visits with established clinicians
It has come to our attention that some insurers now promote third party telehealth visits for their subscribers. These are being offered by companies who have no affiliation with our medical group. Before considering this offer, we would like our families to consider whether such opportunity reflects an advance in the quality of clinical care for your child.
While technology continues to improve, we do not believe that telemedicine encounters equal the quality and comprehensiveness taken for granted at a conventional office visit. Enticements by some services promising that parents do not have to pay if a prescription is not provided, or that a prescription will be available in 20 minutes, appear premature, especially when they are made before any clinical information has been obtained.
Quality of the history
The person at the other end of your smartphone does not know either your child or your child’s past history, nor do they know if there are other elements that may alter medical decision making. Because we follow our own patients and know their histories, usually from birth. we do not have to overcome the disadvantages inherent in being unaware of this important information.
Quality of the examination
This type of telemedicine encounter utilizes a webcam or the camera on a smart phone. The visual information is equivalent to observing a patient across the room.This is not an examination. There is no capacity to listen to the lungs, look in the back of the throat, feel for glands in the neck or determine the texture of a rash, or look in the ears. The notion that the current level of smartphone technology matches the accuracy of a physical examination is bizarre.. The concept that the physical examination is not necessary to make a diagnosis is very strange.
In fact, in California, failure to provide a prior “good faith” physical examination is grounds for the medical board to find a clinician has committed non-professional conduct (1) possibly exposing the clinician to sanctions or loss of their license to practice. We believe it is unclear that telemedicine encounters of the nature being promoted by insurers meet the medical board’s standard. They do not meet ours. .
Laboratory studies
Many clinical impressions require laboratory studies to confirm impressions from the history and physical. Third party telemedicine providers rarely have the opportunity to order, collect, interpret, and follow up on such tests that may be required to meet best practices or community standard for evaluation and management of a given condition. We do not know who many of these contracted entities are, and we have no way to contact them. None has ever tried to contact us.
Quality of the diagnosis
If the above elements are compromised or suboptimal, it does not stand to reason that the diagnosis has the best likelihood of being correct or complete. It is axiomatic in medicine that many things do not turn out to be what they initially appear. Delays in accurate diagnoses rarely diminish pain, discomfort, duration of illness, or potential for complications.
Follow up
It can be difficult either to know the educational background of the telemedicine provider or follow up with them should complications arise. If you have a telemedicine encounter, you may want to obtain the name and license number of the clinician providing services to your child. You may also want to ask them for their direct phone number so that you can contact them again if you need to. Be sure to give them our name and fax number so that they can send us a copy of their records in order to keep your child’s records complete, and so we can follow up with you regarding pending studies or other evaluations that may be necessary.
Closing thoughts
No parent thinks their child is going to be the one with the unusual diagnosis. Some things may not be as simple as they appear. Given the characteristics of a smart phone camera, some conditions may not appear at all. Conditions that look like ear infections can affect the brain. Conditions that look like pink eye can lead to blindness. It would be difficult, if not impossible, to make these diagnoses with a smartphone.
Although one day it may be possible for virtual clinical encounters to possess the same precision obtained in person, that time has not arrived. When your own doctor is able to use improved technology that allows collection of physical findings that are of equal or greater quality than is presently the standard with a conventional physical examination, the time may then have arrived. But that is not today, and that is certainly not now.
These encounters are economical for insurers, but those dividends are made with risks to your child’s health. Your child deserves better.
We appreciate the trust parents place in the care we provide, and continue to work to remain worthy of that trust.
Source: Rose City Pediatrics