Perspectives: Are virtual appointments effective?

photo illustration by Hedi Skali

Yes – Ahona Dam

No – Michael Sun

The pandemic has changed how we live, forcing us to adapt how we connect with family and friends. Nearly all major events, meetings and even celebrations have gone virtual for the first time. Even crucial interactions, namely doctor visits, have transitioned to virtual platforms. 

In early August, I experienced skin allergies and went through two allergy tests and many virtual appointments to  resolve my health issue. Through my own experience, I found that virtual appointments with my doctor were a more convenient and safe solution to my non-emergency health problem than in-person visits. 

NASA ran a telemedicine trial in the early 1970s to give remote medical consultations to the Papago, a Native American tribe in Southern Arizona. The trial found that virtual appointments were convenient for those who were normally marginalized seeking healthcare in person: people who lived in remote areas, people who had disabilities, people who were house-bound and older people with mobility issues. Though telemedicine was not widely used after the trial, the coronavirus pandemic accelerated the adoption of telemedicine, allowing a larger percentage of the population to embrace this convenience. 

When my allergies were particularly bad, I called my allergist who then suggested a video visit. The visit was scheduled in under an hour of my initial call. In-person appointments, on the other hand, must be scheduled ahead of time, which, depending on the urgency of the situation, can result in month-long wait times. The time it takes from scheduling the appointment to the appointment itself is time-consuming and unnecessary.

Doctors and patients largely agree that convenience is one of the biggest benefits of telemedicine. Dr.Wei Zhao, the vice-chair of operations at the Children’s Hospital of Richmond, said, “The actual visit time will be the same, but if you add the drive to get there, waiting in the waiting room, filling out forms and waiting in the exam room, you could spend more than two hours on an in-person visit.” With telemedicine, physicians can also provide consultations at multiple locations. Defeating geographic barriers to healthcare is crucial to ensure patients can access information and services even when they are ill and mitigate social determinants of health. Everyone deserves the equal opportunity to receive proper health care services, but barriers such as distance and lack of public transportation can act as a challenge for many patients.

Not only do virtual visits save time, they also allow patients to avoid the risk of contagion typical of an enclosed hospital waiting room. Virtual visits are a crucial form of added safety for patients and providers who would otherwise be meeting in person. A recent survey report published by DocASAP found that 47% of survey respondents said that concerns regarding the coronavirus were one of the largest factors when deciding to schedule a telehealth visit. In addition, 88% of respondents said they wouldn’t feel safe visiting healthcare facilities during the pandemic.

When I experienced both an in-person and a virtual visit I actually connected with my doctor much better through the screen. In person, my doctor’s protective equipment hid their face and limited our sense of connection. During the virtual visit, I saw my doctor’s facial expressions and felt  more comfortable. Masks hide the kind smile a doctor has when seeing each of their patients. Fortunately, with telemedicine, patients are able to safely connect with a doctor while still feeling heard and supported. 

Telemedicine can also benefit emergency patients who must be treated in a hospital. With virtual visits covering patients’ more common health problems like allergies, mild nausea or headaches, doctors can focus their attention on emergency patients who require urgent care at a hospital. Thus, giving an adequate amount of time to both patients.

The drastic changes caused by the coronavirus have taken a major toll on many during this pandemic. However, necessary innovations like telemedicine have made nonurgent doctor visits more convenient, safe and comfortable. Telemedicine has the potential to transform the healthcare system, increase efficiency and create a brighter path for the future of medical consultation.

While under lockdown, my dad began to experience chest pain. Left with no alternative, he called the doctor to receive a virtual diagnosis. The doctor thought my dad said he felt “bad” when lying down, but really he felt “better” when lying down. Later, when my dad read the doctor’s report, he found out that he had been incorrectly diagnosed with heartburn, explaining why the pills the doctor prescribed didn’t improve his condition at all. 

Indeed, virtual doctor’s appointments are rife with miscommunication. Economist Steve Blank said that video meetings are “the equivalent of having your head in a vice, of having been brought to a meeting with blinders while being attached to a chair.” People using Zoom for any purpose, let alone for virtual appointments, may find it hard to keep track of body language cues that are necessary for successful communication. Virtual doctors appointments are too high-stakes to be carried out over Zoom, which is flush with miscommunication.

My dad’s story is just one of many proving that virtual doctor’s appointments are not as effective as physical appointments. Further, they are unable to replicate the strong bond between doctors and patients made possible by face-to-face interaction. Amidst the coronavirus, virtual appointments and telemedicine have become increasingly prominent; unfortunately, it’s remained just as flawed. 

Virtual appointments can lead to misdiagnosis by doctors. In telemedicine, doctors are usually unfamiliar with the patient and don’t have enough time to do an accurate reflection. Because telemedicine standards aren’t as well-established as in-person standards, doctors can be incentivized to rush through appointments and give generic prescriptions. 

A RAND Corporation study from 2015 showed that 86% of telemedicine calls end with a prescription for antibiotics, while only 56% of in-person appointments end with prescription of antibiotics. Another study from 2018 in the Annals of Internal Medicine found that 67% of calls led to antibiotics and averaged only 6.6 minutes in length. With telemedicine use increasing in 2020, during the COVID-19 pandemic, these problems will only get more obvious and intensified. 

Virtual appointments also face the obstacle of technology accessibility. Some patients, especially the elderly, may experience difficulties using technology. And if people can’t afford internet access, the quality of telemedicine is worsened. Furthermore, Dr. Kim Huang, a radiation oncologist at Veterans Affairs Boston Health Systems, said “I have not used videos because the internet speed at my work is not adequate, and it is too laggy.” Even if patients are able to access telemedicine, hospitals may not have adequate WiFi or the broadband necessary for virtual appointments. 

Lastly, virtual medicine can’t offer physical tests and exams. Patients may need lab works, vaccinations, imaging, x-rays or other procedures that can only be done in person with hospital equipment. Extra safety precautions can be taken during in-person appointments to avoid the further spread of the coronavirus. Hospitals enforce qualified ventilation, cleaning surfaces and social distancing. Additionally, patients also follow precautions such as wearing a mask and gloves and using hand sanitizer to minimize the risk of transmission. 

Even after the pandemic has passed, virtual appointments and telemedicine will continue to be used due to their convenience. However, just like in the debate between online shopping and in-person shopping, the newer option is not always the better one. Rather, each option has its own strengths and weaknesses. Until technology develops a solution for the problems that virtual appointments face, they will not be as effective as in-person appointments.