Various parties are cheerleading the emergence of "telehealth" options for consumers. Certainly, various professional organizations are promoting the practice. Hospital systems likely see it as a business opportunity to exploit.
What is the lure? A patient is able to consult with a physician (or physician extender) using a Skype-like application. It seems incredibly convenient. The patient speaks with the physician electronically; and the physician "examines" the patient, at least visually. Some have suggested various technologies or techniques may allow an even more detailed exam.
Certainly, for some specialty areas, a remote evaluation can be useful-- radiology, psychiatry, etc. These are typically specialties that do not rely heavily upon a hands-on physical exam.
But for most physicians, being able to examine the patient is critical. The tools are to inspect visually (in three dimensions), to listen, to palpate (or feel) and sometimes to tap or maneuver a body part. Sometimes we have to stick a finger into a body orifice, or look into it. We often perform various types of measurements, including but not limited to vital signs. We also order or perform certain types of testing. The cues from performing these activities help us formulate a diagnosis or assess a patient's progress.
When a physician cannot do these things, he (or she) is seriously handicapped. Treating a patient without a proper physical exam can be precarious. (It can be tricky enough sometimes to deliver care even under the most optimal conditions!)
Last week, I saw my first known instance of someone developing serious complications after having used such a service. I cannot establish causality, or share any kind of details. But this instance causes me to raise a red flag.
This type of medical care is relatively new, and I do not know to what extent we will see problems in the future.
But I do know a physician or physician extender who delivers care without examining the patient is playing with fire. Some of those employed by large health systems will likely be forced to do so. And some health care consumers will be lured by the convenience of the option. But they will not necessarily understand the risks involved.