- Can a consultation with a telemedicine doctor
cause diarrhea?
- Say what?
- Let's talk about it on this week's Wednesday Checkup.
Beewhoop!
(subtle techno beats)
Just in case you were wondering what telemedicine is,
it's when you get a consultation from a doctor remotely.
Meaning through the phone, internet,
video chat, app, what have you.
Now, this is rising in popularity like crazy.
We're gonna get back to the diarrhea
from the opening shortly,
but let's talk about what this study
that I'm very excited to tell you about is all about.
To summarize, the study was published
in The Journal of Pediatrics.
That showed children who had
a consultation with a telemedicine doctor
had a much higher rate for a prescription of antibiotics
than if they were to be seen at a
primary care office like my own.
Now, why is this problematic?
Well, I'll tell you.
The huge majority of respiratory tract infections,
basically colds, don't require antibiotics.
This is because antibiotics don't work on viruses.
You've heard me say this literally a million times.
Why is that such a big deal?
So they got more antibiotics.
Doesn't that mean they got better care?
No, not necessarily. In fact, definitely not.
Respiratory tract infections, by the huge majority,
are caused by a virus.
Meaning, that they don't require an antibiotic.
Antibiotics only work on bacteria.
And I'll briefly run through the list
of why overprescribing antibiotics is bad.
One, cost.
You shouldn't be paying for a medicine you don't need.
Two, antibiotics are not benign medications.
They have true adverse effects.
Diarrhea, like we talked about in the opening.
Rashes, allergic reactions, your throat closing up.
And finally, resistance.
That Super Bug I'm always talking about.
About that bacteria that can get into your system,
Where antibiotics can't even fix it. That's scary stuff.
I understand why telemedicine is so popular.
I mean, us millennials we treasure
convenience almost above all else.
We want to save time, we may be traveling,
we don't have access to a doctor,
the cost is less when we use a telemedicine consultation
as opposed to going to a doctor's office.
But it truly is alarming to hear that
telemedicine may be hurting the outcomes
for these people who want better convenience,
who want more access for lower cost.
And I think the reason why telemedicine doctors
are overprescribing antibiotics are as follows:
First and foremost, there is usually no relationship
with the doctor and the patient.
Now if one of my patients come to see me,
I know what they're like.
I know if they're really sensitive
That if they have a stuffy nose they can act very dramatic.
Or, I have some patients that if I see that
they have some pain,
they have such a high pain tolerance.
I really worry and get an X-ray early on.
But if you don't have that sort of
doctor patient relationship,
you may come to an incorrect conclusion.
Second, if you're doing a telephone consultation,
there is no physical exam.
Think about that for a baby.
If a mother calls and says her child is fussy,
has a fever, it's hard to decide whether it's
viral or bacterial without a proper physical exam.
I mean you need to look in that baby's ear.
But without that physical exam,
you may be practicing what's known as
C.Y.A Medicine: Cover Your "Butt" Medicine.
That's when you're so worried about being sued by a patient,
by them becoming worse
and you not treating them with antibiotics,
that you just overprescribe antibiotics
in the hopes of covering your butt.
Now I've seen this happen one too many times
even in primary care offices.
So I can only imagine how much more often
it's happening in a telemedicine consultation
where there's no existing relationship,
where there's no proper physical exam done,
it's obvious that you're not going to
have great outcomes in this case.
One of the more concerning things
that I've actually read in a study
that was done in late 2018, last year,
was that doctors who practice telemedicine,
who are generally just scattered throughout the country,
those doctors had higher satisfaction rates
and shorter visit times.
And guess what doctors get compensated on?
Shorter visit times and higher patient satisfaction scores.
That's the problem right there.
If doctors are more motivated to get you out the door
and keep you happy, they're going to give you
whatever it is that you want.
Just because you want an antibiotic
it doesn't mean that it's the right treatment plan.
Sometimes the visit may need to take longer
because the doctor should educate you
on why you don't need an antibiotic.
On what lifestyle things you can do
to maybe speed up your recovery,
maybe to prevent you from having
the same symptoms next time.
It's kind of crazy to me as a doctor,
that by doing the wrong thing, overprescribing antibiotics,
you can have higher patient satisfaction
and shorter visit times?
That's wild.
As a young doctor it really gets me excited
when technology and healthcare combine.
So when I hear this story about telemedicine
not giving quality care to patients, it truly upsets me.
Because I see how advantageous telemedicine can be.
You can have lower cost, better access to care.
You have consultations with specialists
who may be in a totally different city than you
but can give you really great advice.
It's just in this case,
the standards of care are not being maintained.
We need to hold telemedicine docs
accountable for overprescription of medications,
change the incentive system,
so that we don't just focus on patient satisfactions
and shorter visit times, but instead
focus on quality medicine in addition to those factors.
I'm excited for the future of telemedicine,
and frankly, you should be too.
Telemedicine antibiotics seem to be struggling.
But here's another instance where telemedicine fell short:
check out my video here, click it.
(low electronic beats)