Telemedicine vs. In-Person Visits: Which is Higher Quality?
There’s a predictable turning point in any debate about telehealth. Someone will concede that it can save money, provide clinical evidence, bring care to the underserved and even drive revenue. But inevitably they’ll worry that the quality of the virtual visit just isn’t as good as an in-person visit – that telemedicine is “impersonal.”
But how personal is the quality of a traditional visit? According to a study published in the Journal of General Internal Medicine, not very personal at all. In fact, 64 percent of primary care providers (PCPs) and 80 percent of specialists didn’t bother to ask the patient why they came in – and when they did, most of them interrupted the patient after a median of 11 seconds.
Can you explain all your medical symptoms and questions to a doctor in 11 seconds?
This pattern, which was observed at the Mayo Clinic and clinics in Minnesota and Wisconsin, shows appalling bedside manners and poor communication. Responsible medical care begins with providers finding out why their patients are seeking treatment – their problems and symptoms, their behaviors and self-care habits. Sure, patients might fill out office forms before their visit but that only tells a partial story.
Maybe the patient has already been to urgent care and completed a round of antibiotics – with no improvement. Maybe social stressors or financial challenges are influencing a complaint of abdominal pain. To make an accurate diagnosis, clinicians need to listen to a patient’s verbal cues and ask the right questions. Cutting patients short can easily lead to misinterpretations and worthless care plans.
Let’s be clear: it’s not that providers are callous or insensitive. It’s more that standard office visits are structured to create a sense of urgency and haste. A series of 15-minute visits churn patients in and out like a revolving door. Because that isn’t much time to devise a care plan and complete documentation, many providers want their patients to quickly get to the point of the visit.
Consider what the Annals of Internal Medicine found:
- Physicians spent 27 percent of their office day on direct face time with patients and 49 percent on EHR and desk work.
- In the exam room with patients, physicians spent 52.9 percent of the visit on direct face time and 37 percent on EHR and desk work.
- For every hour of direct face time spent with patients, providers spend nearly 2 additional hours on EHR and desk work during the day – and another 1-2 hours each night.
The initial impact is easy to see: provider burnout, rushed visits and patients who feel ignored. Yet the repercussions go deeper. Patients suffer longer and pay more when doctors miss key medical information and provide an incorrect diagnosis. Because they resent being interrupted, some patients seek alternative practitioners who may lack medical training but spend time listening to their problems – and pursue ineffective treatments like reiki, unregulated herbal remedies or the currently trendy “earthing.”
Beyond 11 Seconds
But does any of this mean that telemedicine visits offer a better patient-doctor bond or more meaningful visits? The answer is yes – for several reasons.
A Massachusetts General Hospital study found that patients reported strong personal connections with providers when using telehealth visits. 62 percent of patients said the quality of telehealth visits was just as good as in-person visits; 21 percent said it was even better. Lee Schwamm, MD, director of the MGH Center for Telehealth, said the findings confirm that “what patients value most is uninterrupted time with their doctor.”
Given that some new Medicare rules for reimbursement mandate a visit minimum of 20 minutes, it’s clear that telemedicine can help many patients enjoy increased attention. But virtual health offers more subtle benefits as well.
A big one: patients are often more relaxed and candid during a telemedicine visit. They don’t have to miss work, hunt for parking or sit for forty minutes in a waiting room, which can put them in a better mood and help them be honest about their self-care habits. As Schwamm said, “Telehealth gives them more of what they want most and gets rid of the stuff they don’t want. With a telehealth visit, 95 percent of the time spent by the patient is face-to-face with the doctor, compared to less than 20 percent of a traditional visit, in which most time is spent traveling and waiting.”
Virtual health can also improve continuity of care. Provider collaboration, remote monitoring and ongoing updates help primary care physicians follow the narrative thread of a patient’s story – fostering more consistent care and meaningful conversations.
The Slower Path to Smarter Medicine
How much of a trusted advisor can any doctor be when a patient only gets 11 seconds to speak? Providers need less pressure and more face to face time with patients, while patients need focused attention. Telemedicine can’t solve every documentation challenge, but it can facilitate deeper patient relationships – and accelerate effective medicine.
This article was originally published on GlobalMed and is republished here with permission.