The Telemedicine Dilemma

The goal of telemedicine or E-Visits is that “doctors could spend less time on simple requests, patients would get frictionless access to their provider.”  A new study…not so much:

E-visits lead to more office visits and more phone consultations without measurable improvement to patients’ health. And maybe most damaging for physicians’ practices, they’re associated with fewer new patients.

The study author thinks he knows why. He says that patients can reach out with even the smallest concerns which  puts doctors in a bind. “There’s an issue of obligation and if you ignore the signal, who knows what’s going to happen next”.

As the article in MedPage goes on to say:

After adopting e-visits — in this instance, essentially an email with a subject line and generic box of text — office visits increased by 6% as physicians met with patients who had reached out online. Physicians also ended up spending 45 more minutes each month on those visits. The extra work of responding to patients requests did not bring extra compensation.

The author went on to say, “God knows what happens if you start paying doctors for these.”

I agree that e-medicine is not for the industrialized model.  It is also not for those companies trying to capitalize by having patients pay out of pocket to speak to a doctor they don’t know and get their antibiotics, etc.  It leads to more treatment to satisfy the patients because they docs don’t know the patients.

But how about if the game was turned on its head like with direct primary care?  Doctors know their patients.  There is no worry about “fewer” new patients because they are already are your patients.  You have great follow-up because they can always come in if things are worse or call again if things are worse.  Spending time on these patients is fine because that is part of the job and your customer likes that.  And there is no expectation of extra compensation because it is built into the monthly fee model already.  In other words, this study looked at the wrong doctors. It works great for direct primary care and proves again this system is a great solution that researchers need to look at.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]