Telemedicine is Here to Stay! The Demise of the Doctor Visit?

In a prior post as a teaser, I promised to prove that the medical profession agreed with me that the physical examination is not a critical component of patient care.  In my medical training days, such a remark would have been considered heresy and the sinner would have found himself in a stockade in the public square.  

Proof that the physical examination in many cases is superfluous is the explosion of telemedicine.  The volume of these virtual office visits is rising by the month.  If the physical examination was so critical and indispensable, then telemedicine could not operate successfully.  But it is and it threatens to make traditional doctors' offices like mine quaint, if not obsolete.  

I anticipate that in the next 10 to 15 years that most patients will be seeing physicians or other medical professionals in digital arenas, not face to face in traditional offices.  By then, I may have gracefully exited the profession, but I will be an avid spectator.  The centuries old paradigm of how medical care is delivered is undergoing a metamorphosis that will transform the profession into a new entity, just as a butterfly emerging from a cocoon as a distinct creature.   Physicians will be interacting with a patient or groups of patients via some digital interface.  Physicians will no longer be hamstrung by the balkanization of medical record systems that cannot communicate with each other.  Every individual’s entire library of medical data will be accessible.  (Isn't this what electronic medical records were supposed to deliver to us?)

A Medical Metamorphosis is in Progress

Digital access should also permit quality health care to reach vulnerable populations and others who do not have reliable access to the health care that all of us deserve.

If you accept my premise that the physical examination is often unhelpful, then it stands to reason that a video chat with a patient, with access to laboratory and other medical data, would be sufficient.  And, if a physician on a virtual visit felt that a patient's circumstance necessitated a hands on approach, then the patient would be so advised. 

While it may be hard to fathom, perhaps technology will allow the performance of a thorough physical examination remotely.  Virtual visit advocates maintain today that many elements of the physical exam can already be performed.  Patients, after all, can take their own vital signs, palpate their own abdomens or feel for leg swelling.  Physicians can observe the breathing pattern, visualize a rash and assess the mental status. While these are of value, it does not seem equivalent to me to a hands on experience.  

I am not suggesting that the physical examination is not a valuable tool.  We all know that it can be a case cracker and a game changer.  My point is that in many cases, the physician does not need this tool to render sound medical advice.

I've largely abandoned virtual visits in my practice.  My patients and I have largely agreed that they don't feel the same.  The vibe is transactional, efficient and mechanical.  For us, there's wasn't much fun in it.

And if you're nostalgic for a stethoscope, a tongue depressor or the reflex hammers that used to tap on your knees, they'll all be waiting for you - i a medical history museum.