Category: Telemedicine

New Causes Of Malpractice Concerns For Physicians

I just got off the phone with a Family Physician discussant who was participating in one of my On Doctors’ MindsSM conversations. He had a lot of interesting things to say, but one really stood out in my mind. More specifically, he told me in no uncertain terms that he had NO interest in participating in medical care delivered via telemedicine. None! He feels that he cannot deliver proper care without “putting a stethoscope on the patient,” and that the malpractice concerns attendant to telemedicine are consequential. 

Then I read this. An actual case study involving a “wearable,” i.e., a medical device that permits remote monitoring of patients. In this case, a device that was supposed to keep track of a patient’s heart function. Only thing is, the patient didn’t put the darn thing on for several weeks after receiving it, and never got it to function. Punchline? The patient’s doctor got a report from the wearable’s manufacturer, that he shared with the patient, that the gadget had determined that the heart function was “normal” during this time frame. Whoops!!!

Bottom Line. New technologies are opening up new “roads to risk” for physicians relying on them. Medicus Emptor (Let the doctor beware)!!!

Telemedicine Doesn’t Eliminate Healthcare Inequality!!!

Check this out. No you don’t have to read the whole thing. Just the abstract will be fine. Especially because its message is pure common sense. That is, a large-scale study of patients lined up for telemedicine visits found that certain demographics reduce access to telemedicine during the COVID-19 pandemic. Old age, low income, minority ethnicity, etc. reduce the probability that a patient will use telemedicine.  

The reasons for this? DUH! Old people are far less comfortable with technology, and value the social interaction obtained through a personal visit to the doctor’s office. Poor people can’t afford the computer equipment and Internet access required to participate as a patient in a telemedicine encounter. Latinx patients are less comfortable with English, and are thus prone to feel uncomfortable conversing online with an HCP. Etc.

Bottom Line. SO. Even though we might have hoped/expected telemedicine to decrease disparity in healthcare, there are a lot of reasons that this doesn’t happen automatically. Rather, we will need to develop special programs to incorporate each of these demographic subgroups if telemedicine is supposed to help us in the important task of reducing health disparity!  

Telemedicine Requires New Approaches To Credentialing And…

Check this out. What you will see is a writeup pointing out that physician credentialing needs to be rethought in the pandemic era, and beyond, when a physician’s ability to treat patients, via telemedicine, in States other than her own requires her to be licensed in the State where the patient lives. That’s just stupid, and certainly needs to be straightened out to optimize the delivery of patient care in a time of growing physician shortage and skyrocketing reliance on the telemedicine platform.  

BUT. Is that the only cog in the telemedicine machinery that needs to be greased? Nope. I would argue that there are at least two more.

The first of these is modernizing malpractice insurance coverage for the telemedicine era. I have spoken informally with a number of physicians who have told me that their malpractice insurance carriers have told them that if they use telemedicine to treat patients in States other than where they are licensed, they are on their own if they get sued. Whoops.  

Second, the monthly conversations that I am having with physicians in a number of specialties as a part of my On Doctors’ MindsSM project have demonstrated to me that there is a genuine learning curve for doctors in the use of telemedicine platforms. Expertise in telemedicine, in fact, is not just about a doctor learning to use Zoom. It’s about her learning new clinical skills to rely more on a patient’s verbal cues, as one Cardiologist explained to me so clearly yesterday in an ODMSMconversation, to replace physical findings that she would normally get from an in-office visit, in making diagnosis and treatment decisions.  

Bottom Line. I am thinking that there is a tremendous opportunity for us to step in here to develop programs to skill physicians in the practice of telemedicine. There are doctors who are ahead on this learning curve, and they should be provided with an opportunity to share their “tricks” with colleagues who are less advanced in this area of expertise. Note. There are generalizable tricks that can be shared, but each specialty has its own particular nuances to be mastered. Such a program should share both. 

Want to do something that will benefit our physician customers, their patients and your company? This may be it!

Both Sides of Telemedicine

Check this out.  What you will see is the enthusiastic response of a physician having his first Zoom visit with a patient. Throughout the early months of the pandemic, he had limited his telemedicine to telephone medicine. Not surprising that this has left him feeling, well, in the dark.  

But the Zoom encounter left him energized. He actually got to see the patient and her canine companion that plays such an important role in her physical and emotional support. He even took the patient for a little virtual tour of his house. In brief, he became an instant fan of Zoom.

Funny. Yesterday I had two conversations (Yes, on Zoom!) with physicians, one a Card and one a Rheum. I am just starting a ThinkGen study that I dreamed up myself. Its’s called On Doctors’ MindsSM. I decided to do this project when I realized that I had no real idea what was going on in physicians’ practices during the pandemic. No, I am not talking about front line Intensivists. We know their lives are a living hell right now. I am talking about specialists and generalists in office practice. I needed to just turn on the recorder and let them talk about what is on their minds. I will be doing this every month for the next year. And providing the results to our clients for free. 

It’s my study, so it is on my dime. (If you want to enroll to receive the monthly update that will result from this work, send an “Enroll Me” email to and you’re in!). 

I learned a lot from those two conversations yesterday. Most germane to this post is the fact that I learned that both of these doctors absolutely hate Zoom patient visits. The Card can’t titrate medications worth a damn without access to little pieces of information like the patient’s blood pressure, and the Rheum feels that he is robbing  patients by not being able to give them the personal attention they deserve. Both doctors believe that Zoom visits will drop to zero in their practices when the pandemic winds down.

Bottom Line. It’s all relative. One doctor finds Zoom a breath of fresh air in comparison to phone appointments with patients, and two others feel it is totally inadequate in comparison to in-person visits.  

Does this vary systematically by specialty? I’m betting that I will find that it does!

Procedural Telemedicine

Check this out. What you will see is yet another line item to put under the heading of “telemedicine.” This is rather straightforward. In the middle of a pandemic, about the last thing a surgeon wants in his OR is a salesperson for a device company, even though the representative’s expertise in using the device might still be needed. Bingo! Perfect application for a teleconferencing platform.

Bottom Line. AND. As the page to which I have referred you points out — infection avoidance is not the only benefit here. As is usually the case with telemedicine applications, efficiency (this time for the salesperson) is greatly enhanced by relying on virtual rather than in-person visits.  

Amazing that it took a pandemic to hasten this transition along!

The Doctor Will Zoom You Now

Check this out. What you will see is the report from a breast-focused Medical Oncologist on the adoption of telemedicine in her practice. Sort of fascinating, actually. She talks about the obvious logistical advantages of telemedicine, and how the use of the Zoom platform has been able to keep physicians and patients alike healthier during the pandemic.

The other plusses of telemedicine she discusses are less obvious. For example, the need for the physician to be better prepared to enter into a telemedicine session than she would need to be for a personal visit, thus holding her feet to the fire for advanced planning. 

Additionally, she reports that a telemedicine patient feels that the physician is entirely “focused” on her throughout the visit, with the computer screen being the facilitator of this focus rather than a diversion for the physician.

However. There are three things that she feels are missing in telemedicine encounters that she really longs for. First and most obvious, the opportunity to do a physical breast exam, so important in this therapeutic area. 

Less obvious but equally important, the other two things that she misses most are really two sides of the same coin. One is the ability to provide patients with “reassurance” that they are receiving the best possible care. Relatedly, she misses the opportunity to provide “comfort” to patients in troubling times.  

Bottom Line. No doubt about it. As this doctor points out, telemedicine is here to stay. It is safe in a pandemic, and efficient any time. BUT. The physician and the patient both need to recognize that some really important elements of medical practice fall by the wayside when telemedicine is substituted for in person medicine.

Two questions. First, how do telemedicine’s advantages and shortfalls vary by physician specialty and disease type? Second, is there anything we can do to help to “make up for” these shortfalls???

Healthcare Practice “Waiting Rooms” In 2020

Check this out. Fascinating website, actually. What you will see is a company dedicated to improving the “waiting room” experience, whether it be live or virtual.

Why? Three reasons. First, study findings indicate that issues with the waiting room experience, rather than issues with the actual delivery of the medical care that they received, constitute the most frequent reasons for patients leaving a medical practice.  

Second, the COVID-19 pandemic has made it totally unsafe and unsatisfactory to “store” multiple patients in one closed room while awaiting in-person medical care. The new approach, having patients wait in their car until the practitioner is ready for them, requires some significant adaptations. Screening for Covid symptoms, filling out registration forms, etc. all are now getting handled from the patient’s phone.

A final consideration, but far from the least significant, is the realization that  even telemedicine requires a “waiting room.” The virtual space where medical histories, insurance information, etc. are gathered before the practitioner logs on.  

Bottom Line. All of this leaves me, as usual, pondering. Pondering whether there is an opportunity for those of us in the pharmaceutical vertical to get involved in filling the dead air that characterizes waiting rooms with messages that we want to get across to patients. There aren’t any old magazines lying around in a patient’s car or a virtual waiting room, so it would be a great opportunity to keep a patient amused while telling her something important. 

30 Madison and A Strange Kind of Telehealth!!!

Check this out. What you will find is a very strange form of Telehealth. BUT. While strange, this company’s offering is interesting and important enough to garner investments form the likes of JNJ.

Several novel things going on here. First of all, 30 Madison has three separate subcompanies, one for each of the three conditions its offerings treat. Hair loss, migraine and gastric reflux. Second, for those medications requiring an Rx, the consumer can get channeled directly to a consultation with an appropriate physician. Third, while appearing to be “telehealth,” the real business model here is mail order pharmacy.  

Bottom Line. I’ve said it before and I will say it again. We have only scratched the surface in terms of truly novel ways in which “telehealth” can be employed. 30 Madison certainly brings a novel approach to the marketplace. The notion of a patient self-diagnosing and tapping directly into a portal specifically designed to service that diagnosis is a model we haven’t seen before.  

It will be interesting to see how this develops!  

Want A Telehealth Psychiatry Freebee???

This is actually pretty darned clever. Check this out. Scroll down. What you will see is that this Psychiatrist is offering 15-minute complementary consultations, “one time only.” You can sign up using her automated scheduling calendar.  

Bottom Line. I will admit Dr. Abu Ata has raised my interest level. I want to know outcomes here. More specifically, I want to know what proportion of people that she spends 15 minutes with pro bono wind up becoming paying patients.  

What’s your guess? 

More Telemedicine Consciousness Raising

Check this out.  In the previous blog, we discussed ways to expand our consciousness in terms of the ways in which we should be conceptualizing of telemedicine. New patient groups, new business models, etc.  

This piece provides more fuel for this reconsideration. For example, survey data are demonstrating that patients are increasingly using telemedicine for convenience, not out of desperation bred by COVID avoidance. The meaning of this is clear. Telemedicine is here to stay.

As we have previously discussed, telemedicine is especially key in behavioral health. Isolated, anxious and depressed patients can readily access help. Many of these patients would never have considered going to a psychiatrist or psychologist in “normal” times.

Reimbursement for telemedicine care is a “genie that is out of the bottle.” Previously uncovered by many insurers, telemedicine is now being reimbursed by most. BUT. Since telemedicine visits are typically shorter than in person sessions, the rate at which they should be reimbursed will be a work in progress.  

Bottom Line. Put the previous blog together with this one and you get a clear picture that telemedicine is not just “same old.” The available platforms open up significant opportunities for exciting new business models. 

We need to think this through AND begin to contemplate how pharmaceutical marketing can be integrated into telemedicine. It’s a brave new world!