Or Is It Simply a Band-Aid?
When I first started hearing about telemedicine in the 1990s, I was dubious at best. How can I treat a patient I can’t examine? Too many things ran through my mind. I couldn’t listen to their heart, I couldn’t listen to them breathe, I couldn’t even look in their throat or their ears. What if I needed an EKG? How could I check their blood pressure? I was worried that telemedicine might be “second rate medicine”.
I was worried about misdiagnosis and overprescribing antibiotics. If you couldn’t actually examine a patient, you might decide to play it safe and prescribe an antibiotic whether it was really needed or not. It might result in people being sent to the emergency room who might have been treated as an outpatient if you could have examined them in person.
As I looked into it, I discovered that the idea of telemedicine was not really new. As early as 1879, the British Medical Journal The Lancet discussed the possibility of using the telephone, then a revolutionary new technology, to reduce unnecessary doctors’ visits. It took the advent of the computer age and audio-video technology to make telemedicine a real possibility. But even then, I was still skeptical. I preferred to see my patients in person and did not get involved in telemedicine until the great societal upheaval of COVID.
I happened to retire from the emergency department three months before COVID hit. I was still doing primary care two days a week for an employee’s clinic. Like everyone else, we were shut down.
Reluctantly, we decided the only way to provide a service to our patients was to start using telehealth. Of course, we had none of the audio-video equipment we needed so we initially did it by telephone. That just confirmed most of my worries about providing poor care. We soon acquired the audio-video capabilities which gave us a little more insight into the patients we were dealing with. Over the next few months, I learned who was and was not a good candidate for telemedicine and how I could best care for patients that I could not physically examine. I’m going to share with you some of the things that I’ve learned over the past four years. Thankfully telehealth is now an exception rather than the rule as it was early in COVID. But it’s here to stay and we need to learn how to make it work.
Advantages of Telehealth
Convenience and Accessibility: Telehealth’s most immediate and tangible benefit is convenience. With the simple click of a button, patients can consult a physician from the comfort of their home. This is particularly helpful for those living in rural areas or those who are physically unable to travel to a clinic or hospital. According to a study by the American Medical Association, telehealth has increased access to care for patients who otherwise might not be able to receive it, whether due to geographical limitations, lack of transportation, or mobility issues.
For working professionals or parents who find it difficult to carve out time for in-person visits, telehealth allows consultations to occur from anywhere, drastically reducing travel time and missed work or family obligations. Patients also benefit from shorter wait times, as virtual queues tend to move more quickly than physical ones.
Cost Efficiency: Telehealth services can be more cost-effective for both patients and healthcare providers. For patients, the expenses associated with travel, parking, and time away from work are minimized. Healthcare providers, particularly in large hospital networks, can allocate resources more efficiently by integrating telemedicine into their workflow. Many telehealth services also offer more affordable consultation fees compared to in-office visits. A report from the National Bureau of Economic Research found that telemedicine visits are often less expensive for both insurers and healthcare systems.
Continuity of Care: Telehealth allows for more frequent follow-ups, which is critical for managing chronic diseases such as diabetes, hypertension, and asthma. Instead of requiring patients to come to the clinic for every minor adjustment or medication change, telehealth allows for regular check-ins from home. This facilitates better long-term disease management and patient compliance. It can also enable quick intervention in cases where a patient’s symptoms escalate, potentially reducing the likelihood of emergency room visits.
Disadvantages of Telehealth
Limited Physical Examination: The inability to perform a comprehensive physical examination is a significant limitation of telehealth. While many aspects of healthcare can be effectively managed through conversation, video, and shared data, some conditions require a hands-on exam. For example, a doctor might not be able to detect subtle signs of a skin condition, a heart murmur, or abdominal tenderness through a video screen. This limitation can hinder accurate diagnoses and delay proper treatment.
Privacy and Data Security: Healthcare data is among the most sensitive forms of personal information. The shift to telehealth introduces significant concerns about data security, especially given the increase in cyberattacks on healthcare systems. The Health Insurance Portability and Accountability Act (HIPAA) mandates strict guidelines for protecting patient privacy, but not all telehealth platforms may be fully compliant. In some cases, platforms may use third-party applications that could compromise patient information. The risk of hacking, data breaches, or improper data handling adds another layer of complexity to the telehealth debate.
Connectivity Issues: High-speed internet is a luxury that is still not available in many rural and underserved areas. Telehealth relies heavily on stable and fast internet connections to facilitate real-time communication between patient and provider. In regions where broadband access is limited, telehealth appointments can be riddled with delays, interruptions, or complete disconnections. This not only disrupts the flow of the consultation but can also compromise the quality of care provided.
Lack of Universal Standards: Unlike in-person healthcare, where the processes are well-established and regulated, telehealth practices can vary significantly between providers and systems. The lack of universal standards for telehealth can lead to inconsistencies in the quality of care. Some platforms might not integrate well with electronic health records (EHRs), making it difficult for physicians to access a complete patient history during the virtual consultation. Platforms may not function seamlessly across different devices (i.e., Android vs. iOS) or different browsers. Technical support may not always be readily available to address these issues, leading to delays in care or missed appointments.
Medical Problems Not Appropriate for Telehealth
While telehealth has proven to be effective for certain conditions, it is not a one-size-fits-all solution. There are specific medical problems that necessitate an in-person visit, where a physical examination and specialized equipment are crucial.
Acute Injuries and Trauma: Telehealth is not suitable for diagnosing or treating acute injuries such as fractures, deep cuts, burns, or other types of trauma. These conditions require immediate hands-on evaluation, imaging (e.g., X-rays or CT scans), and possibly surgical intervention. A telehealth consultation cannot provide the necessary tools to address these problems adequately, and any delays in care could worsen the patient’s condition.
Cardiovascular Emergencies: Conditions such as chest pain, heart attack symptoms, or strokes demand immediate in-person evaluation. The time-sensitive nature of these issues means that telehealth would not be appropriate for diagnosis or treatment. Patients experiencing these symptoms require rapid testing, monitoring, and possibly life-saving interventions that cannot be performed remotely.
Neurological Symptoms: Patients presenting with acute neurological symptoms such as sudden onset of weakness, slurred speech, confusion, or seizure activity require immediate in-person evaluation. These symptoms could indicate a stroke, transient ischemic attack (TIA), or another serious neurological condition that cannot be diagnosed or managed through a telehealth appointment.
Surgical Consultations: While telehealth can be a valuable tool for follow-up appointments post-surgery, the initial evaluation for surgical candidates should take place in person. Surgeons often rely on physical examinations and imaging results to determine whether surgery is necessary and to plan the procedure effectively.
Striking a Balance
Telehealth has transformed healthcare in a multitude of ways, providing unprecedented access to care for millions of patients. Its convenience, cost efficiency, and ability to promote continuity of care make it a powerful tool in the modern healthcare landscape. However, the limitations of telehealth, especially in cases requiring hands-on care or in emergencies, cannot be ignored. As healthcare systems continue to integrate telehealth into routine practice, it is essential to strike a balance between virtual and in-person care to ensure that all patients receive the level of medical attention they need. For now, I believe telehealth should be viewed as a complement to, rather than a replacement for, traditional healthcare.
Hijacked Healthcare- A System In Crisis
By John Turley
On February 8, 2025
In Commentary, Medicine, Politics
For more than 30 years I have watched our health care system become increasingly more politicized. As a physician I have become concerned with the direction it has recently taken.
Until the early 20th century healthcare was mostly private, and medical expenses were out of pocket. Early calls for national health insurance began with labor organizations and were quickly joined by progressive politicians. President Franklin Roosevelt wanted to include health insurance in the Social Security Act of 1935 but was unable to get it passed. President Harry Truman also proposed a National Health Insurance program in 1945, but it was denounced as socialized medicine. All these efforts were opposed by business interests, conservative politicians — particularly southern— and surprisingly, the American Medical Association.
Finally in the 1960s as part of his “Great Society” programs President Lyndon Johnson pushed for the passage of both Medicare and Medicaid. Rising costs of health care under President Richard Nixon led to the introduction of Health Maintenance Organizations (HMOs) as an attempt to encourage cost efficiency. President Ronald Reagan reduced federal health care spending and pushed for more privatization. In the 1990s President Bill Clinton attempted to introduce universal health coverage but it was met by fierce opposition from the insurance industry, business, and the Republican Party who labeled it as government “overreach”. Finally in 2010 President Obama’s Affordable Care Act (ACA) also called “Obamacare” became the most significant health care reform since Medicare and Medicaid. It also faced legal challenges and political resistance with the Republicans consistently attempting to repeal it. During his first term, President Donald Trump reduced ACA funding and repealed the individual mandate penalty that had required people who did not maintain health insurance to pay a fee. The elimination of the penalty weakened the law and reduced the number of people who sought coverage. We can expect further efforts to weaken the provisions of the ACA but given that it is well entrenched in the US healthcare system now is unlikely that it will be completely repealed.
While early health care programs faced significant controversy and strong debate, progress in providing expanded coverage and improved care was continuous. I’m concerned that we’re about to enter an era where many of our gains in public health are going to be reversed. The United States remains unique among wealthy nations as the only one without universal health care and I fear that we will begin to lose what gains we have made over the past several decades.
I’ve written previously about my concerns with vaccine resistance and the elimination of vaccination requirements for school children. I believe that this is an impending public health disaster and I’m afraid there are even greater disasters on the horizon.
Robert F. Kennedy Jr has been nominated by President Trump to be the secretary of Health and Human Services and by the time you read this he may well have been confirmed. During his confirmation hearings Kennedy has made a few positive statements. He’s expressed an intent to increase focus on chronic diseases such as diabetes and obesity. He has indicated support for rural hospitals. He would like to increase training for physicians in addiction care and increase access to treatment programs. He is also indicated plans to improve American diet by targeting ultra processed foods, contaminants in food, and placing restrictions on food additives. He also has proposed reforms to include stricter FDA oversight of the food supply.
However, there are several very troubling aspects to his nomination. He has a history as a vaccine denier although he is currently denying that denial. He said he is not anti vaccine but is pro safety. He has stated he will support polio and measles vaccines and that all his children have been vaccinated. (In 2020, while speaking on the podcast of his nonprofit organization Children’s Health Defense, Kennedy said that he would do anything, pay anything to be able to go back in time to avoid giving his children the vaccines that he gave them.) Given his history of anti vaccine statements and the fact that he profits from anti vaccine litigation it’s likely he will return to previous anti vaccine positions once confirmed.
He has proposed significant changes to both the CDC and the NIH including significant staff changes. He has proposed redirecting funding to preventative/alternative medicine.
Most troubling is his poor understanding of Medicare and Medicaid programs. During questioning he showed a lack of understanding of the funding sources and statutory requirements of the two programs.
The Centers for Disease Control (CDC) faces considerable threat. House Republicans have proposed a $1.8 billion cut (22%) to CDC’s budget. These budget cuts target programs that address opioid overdoses, firearm injuries and food safety monitoring. This budget conflicts with Kennedy’s statements about his priorities and it remains to be seen how this will be resolved. The Heritage Foundation’s Project 2025 has advocated splitting the CDC into two separate entities: one for data collection and another for limited public health guidance. The intent is to reduce its influence on social policies. The administration has already imposed communications restrictions, requiring that CDC announcements, social media posts and scientific reports undergo political review. There is currently a proposal to reduce the in-house reviews of medical research; there is even a proposal to “deputize the public” to challenge scientific findings used in regulations. This would leave medical research open to review by the least qualified. Unfortunately, he current nominee for CDC director, David Weldon, a physician and former republican congressman, has signaled his intent to narrow the agency’s scope and his support for administration policies.
Highly contentious issues such as gender affirming care and reproductive health have already been severely restricted. It is likely that these areas will come under continued attack by the current administration.
This administration also poses a threat to global health. By executive order the US was withdrawn from the World Health Organization. Additionally, the US Agency for International Development (USAID) has been significantly reduced with all major programs placed on hold. Not only does USAID support foreign aid programs, but it is also a major player in global health.
USAID sponsored programs identify and monitor disease outbreaks, provide treatment and preventive measures for local populations and provide global disease alerts that help protect United States citizens. We are already seeing the beginnings of a worldwide humanitarian healthcare emergency. Not only will this affect healthcare systems but eventually the economic systems in countries who have lost their access to modern medical assistance. We will lose the advanced notice about disease outbreak and spread. Without this remote surveillance, it is possible that we may be caught unaware by the next pandemic until it is ravaging our population.
This administration claims to support “the average American” yet it seems to be intent on destroying all our health.