Analysis & Comment

Opinion | When Telemedicine Works, and When It Doesn’t

To the Editor:

Re “Be Skeptical of Virtual Medicine” (Opinion guest essay, April 30):

Elisabeth Rosenthal is absolutely right. There are some simple things that telemedicine can do but much that it cannot.

I practiced medicine for almost 40 years, and I cannot count the number of times that a subtle drop of the patient’s head or slight change in tone or aversion of the eyes led to revealing the true reason for the visit. Those cues are not visible on a screen.

Barbara Gold

To the Editor:

Skeptics like Elisabeth Rosenthal fail to appreciate the benefits of virtual medicine for rural and young populations. We have found that many prefer telemedicine as a means for preventive and often stigmatized health services like sexual and reproductive health care.

We have had successful national telemedicine programs to provide emergency contraception, sexually transmitted infection screening and pre-exposure prophylaxis for H.I.V. infection, reaching people who otherwise would not have received care. The American preventive health system is broken. While not a comprehensive solution and subject to misuse, telemedicine has greatly increased access for many, in particular for preventive services.

Jeffrey D. Klausner
Los Angeles
The writer is a clinical professor of preventive medicine at the University of Southern California Keck School of Medicine.

To the Editor:

Not only do I completely agree with Elisabeth Rosenthal’s concern about virtual visits leading to possible exploitation by less scrupulous commercial telemedicine services, causing unnecessary testing and drug prescription, but I also worry about the difficulty of training new clinicians when the interaction is always one on one, making it difficult to share tips, findings and uncertainties.

For the same reason, I would emphasize that telemedicine can best be practiced by seasoned clinicians, with enough experience and clinical judgment to make the most out of the visit, solve the problem and treat without generating more tests and visits. Virtual visits are best left for simple problems, for homebound patients, for follow-up after in-person visits and especially for patients well known to the practitioner.

Talia Nunes Herman
Chilmark, Mass.
The writer is a retired primary care physician.

To the Editor:

One of the greatest benefits of virtual medicine is the opportunity that it provides for a follow-up discussion about test results after an office visit. The report that a patient receives about blood tests is unintelligible to most of us. But a televisit with the doctor can clarify what it means. That televisit also offers an opportunity for the patient to ask a question that he or she would like to have asked (but forgot) in the in-person office visit.

Virtual medicine can improve a doctor-patient relationship if it supplements a traditional office visit.

Frederic B. Sargent

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