Redefining Telemedicine as the Antidote to Transactional Medicine

Last week, Bloomberg published an overview of the state of telemedicine today. The illustration that ran with the piece featured a disheveled, PJ-clad doctor plopped across her bed like a teenager, video chatting with a sick patient while a snoring cat curled up on her back.

The implication of the artwork, and the thrust of the article, is that technology is enabling a new kind of transactional medicine that benefits “gig economy” doctors.

I understand how the author arrived at her view. I only wish she would have spoken to those of us in the industry who could have shared a more inspiring vision.

The great promise of telemedicine is not that it will give doctors the opportunity to supplement their income by rubber-stamping requests for Viagra, as the article suggests. Nor is telemedicine’s crowning achievement its ability to generate more fee-for-service visits, as legacy telemedicine companies currently do.

Instead — when done well — telemedicine offers a game-changing model of health care that puts patients’ needs first. By creating personal interactions between doctors and patients, real telemedicine accomplishes what patients, doctors, and health insurance companies all want: accountability, trust, efficiency and quality.

A few weeks ago, I was chatting via [secure] text with a patient through the CirrusMD virtual care platform. Questions and answers flowed naturally — until they suddenly stopped. The patient disappeared. After about 40 minutes, I checked back in to make sure everything was all right.

“Oh, sorry,” she texted back. “I was in a meeting.”

To me, that encapsulated all that is right with telemedicine: The patient reached out to her doctor when it was convenient for her, and she dropped out when she had something else to do. Where else does medicine function according to the patient’s schedule?

If you have a close friend or relative who is a physician, you might already enjoy this perfect version of “telehealth.” Maybe you are one of the lucky few who could text a picture of your child’s back along with the question, “Is this chicken pox?” And have a qualified, experienced physician reply back quickly, “No.”

For those of us who don’t have a medical expert in our inner circles, the ideal telemedicine service compliantly replicates this invaluable relationship. No appointments to schedule. No questionnaire to fill out. No chat bot or pay wall. Just high-quality communication with deeply experienced experts. Reliable, helpful and prompt.

It is a level of patient-centric care that I feel is missing not only from brick-and-mortar medicine, but from legacy telemedicine, as well. In many ways, the established, heritage players in the telemedicine space simply took the old notion of doctor’s office visits and put them online. Rooted in video conferencing and telephone calls, legacy telemedicine interactions are usually fee-for-service, with physicians receiving payment for every “customer” they treat.

This means that when the visit is over, it’s over. There’s no follow up 40 minutes after the patient’s business meeting gets out. Also, by requiring video conferencing or phone calls, these companies place the onus on the patient to find somewhere to divulge personal medical information away from unwitting eavesdroppers.

In answer to this old “new” model, other direct-to-consumer telemedicine companies have emerged that are essentially “restaurant menu” pill millswhere it is quite easy for doctors to quickly crank out paid requests for specific medications. Using a computer algorithm to filter out complicated medical concerns, many new telemedicine companies leave doctors with little else to do but approve prescriptions for Viagra, antibiotics or male pattern baldness shampoo.

That’s not doctoring. It isn’t rewarding for physicians, except financially. And that is why, I suspect, patient advocates and reporters who cover health care can be skeptical about the value of telehealth.

That is also why more health insurance companies are looking to platforms like ours as the antidote. CirrusMD, for example, has created white-label benefits for health plans and has made our nationwide provider network available to them. We pay doctors by the hour and not by the encounter. As a result, the doctor never thinks of a conversation with a patient as “$30.”

When telehealth companies prioritize quality over quantity, patients get the care they need — not just the quick-fix prescriptions that they want or a non-satisfying bot conversation. And when platforms are fully human, not reliant on a computer filtering program, interactions become the stuff trust is built from.

So, forget the PJ-clad doctor, replicating a fee-for-service visit online or authorizing prescription drugs based on correctly checked boxes. Forget the impersonal, computerized patient intake form. The antidote to transactional medicine empowers patients to truly communicate with doctors and receive high-quality, meaningful medical advice whenever and wherever they need it.

Blake McKinney, MD