Telemedicine use exploded when the onset of the COVID-19 pandemic made in-person care difficult. Now, two years later, providers and policymakers must decide what role virtual visits still play. The discussion should center first and foremost on a single question: what’s best for each individual patient?
Telemedicine allows clinicians such as me to evaluate patients and help them manage long-term care needs. In fact, the expansion of telemedicine has – and continues to – help clinicians reach more patients, reducing the impact of growing clinician shortages.
This capability has been especially useful in my field, geriatric psychiatry, where experts are few. Patients who normally cannot access a geriatric mental health expert now have the opportunity to see a specialist via video chat. Telemedicine also helps patients overcome geographic challenges. Patients who might otherwise have to travel to see a specialist, such as those living in rural areas or those with certain disabilities, can get care more easily via telemedicine.
But it all depends upon the patient, the condition and the circumstances. There are other instances in which telemedicine isn’t ideal for a patient.
Technological literacy, for example, sometimes poses a hurdle for older patients in my practice. Operating and accessing the technology needed for telemedicine appointments can be a challenge for patients with cognitive decline or auditory or visual impairments in particular. Frustrations with technology needed for virtual visits have led some patients to stop receiving care altogether.
Another important consideration is a patient’s disease or condition.
A major part of my evaluation as a psychiatrist is to monitor the movement, behavior and emotional state of my patients. For psychiatric patients, in-person visits allow a health care provider to give a full assessment. This cannot always be done successfully through a camera lens, however. And not seeing the full scope of a patient’s condition could lead to misdiagnosis.
There’s also the relationship with my patients. Some patients experience the same rapport through video visits, while other patients find telemedicine impersonal. In-person visits can establish greater trust by allowing for a more personal connection. Some patients sense a lack of empathy during telemedicine visits.
Offering personalized, patient-centered care is always the top priority for clinicians such as me. For many patients, telemedicine will be an important part of that care. For others, in-person care will be the primary format for visits. Many may prefer a balanced combination of the two.
But as policymakers, insurers and health systems decide what the future looks like for telemedicine, they must allow for clinicians to make determinations on a patient-by-patient basis.
When it comes to telemedicine, the focus should remain where it has always belonged, on each individual patient and what works best for them.
Dr. Andrew S. Rosenweig is a geriatric psychiatrist in Providence.
