The year is 2025. On the heels of yet another global pandemic, the world again has been tossed into an unknown reality with a renewed round of virtual attendance for social gatherings. The social arena once more has forever changed but this time the healthcare industry is prepared with an incredible innovation.
Picture a world where access to healthcare is one click away, by both computer and phone … a world where physical exams, patient diagnosis, prescription and medication delivery are all completed over a virtual medium. In this world, the physical interaction between patients and their primary care professionals has diminished while medical care is more accessible. So much so, patients need only to reach into their pocket …
As futuristic as this sounds, the question is how do we get there from today? How can we kick-start the Virtual Care (VC) we have today and what can we expect along the way?
In these uncertain times, physicians and healthcare providers have continued to find novel ways to provide care while protecting the health of those involved. Having to meet increasing demands with limited capacity, while maintaining social distancing policies, has led to a focus on VC where “remotely” refers to care that is not delivered in person.
Although Canada launched Telemedicine (TM) more than 40 years ago for rural and isolated communities, adoption of VC for all communities since then has been in fits and starts. COVID-19 has forced a rapid acceleration in its development as virtual visits went from being a small fraction of healthcare delivery to a primary means of connecting patients to practitioners in 2020.
The VC taskforce led by the Canadian Medical Association, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons has called on all governments to make VC a priority.
“We need to demonstrate to clinicians, patients and to payers that this is a good solution. That means changing some minds,” Simon Hagens, who leads performance analytics at Canada Health Infoway (CHI), an independent digital health organization funded by the federal government, told CTV News recently.
Although there are clear advantages to VC – quicker access to specialists; care for older patients with comorbidities while allowing them to stay home; better access to primary care for those who live in remote area; dispensing and delivering drugs directly to patients free of charge – there is an impression that it may negatively impact the “therapeutic alliance,” the relationship, between patient and physician.
Patients who receive patient-centred care from physicians are found to be less likely to report depression symptoms and more likely to report better health outcomes due to direct daily contact with the physician. However, at the same time, virtual communication decreases levels of stress and increases patient satisfaction scores.
Establishing a bond is embedded in human nature. It leads directly to our great strength or deep sorrow. While the visits are done remotely, with VC physicians don’t need to wear a face mask and shield. Verbal communication plays a critical role in establishing a physician-patient relationship. Since TM and VC allow for the use of a translator, better communication may be established by switching to an online method.
But let’s take a moment to address the unavoidable concern. You accept the fact that VC is the new reality for all of us and ask yourself: “How good could this possibly be? This is all new…”
The concern of diagnostic accuracy in virtual visits is a valid one. Based on limited evidence, diagnostic accuracy in virtual visits is 71-91 per cent, similar to in-person visits. However, this study does not address continuity of care or patient outcomes. LiveHealth Online, a health plan telehealth provider, found that patients were less likely to have a regular source of primary care and nearly half reported easier and quicker access to a physician.
Sight, touch, hearing, taste and smell … In an ideal world we would have all of our senses to assess the world around us. Although VC limits the use of all of our senses, it offers a unique proposition for audio care. In the geriatric population, clinical liaisons are used to help patients, especially in long-term care institutions, to communicate with their healthcare providers and families as hearing loss, visual and cognitive impairments or decreased mobility may impact an older person’s ability to set up and communicate in a call.
Visual imaging may be required for physical examinations and establishing diagnosis and VC cannot deliver chemotherapy, stitch wounds, perform surgery or take X-rays. Thus, the onus will still be on the physician to ensure adequate access to the patient through appropriate means.
Now let’s travel again to 2025 and a fully developed VC health system. You receive a notification to discuss the results of your investigations at 12 p.m. Your virtual pharmacist has received an updated prescription from your doctor. Another notification has been sent to your phone that all updates to your prescriptions have been made and the medications were sent to your home address. Knowing that you may have some questions regarding your management, your virtual doctor has been notified to discuss all health-related changes in a question/answer session to ensure your comprehension.
This is the world to come, a world of abundance to the access of healthcare, virtually.
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VC is an undeniable part of healthcare’s future, it is just a matter of when it will become part of the routine healthcare system. To answer that we should first see what are the barriers and limitations here. I think there are two barriers here: first, it is a new thing and by law always new things no matter how good they are, they will always have a hard time being accepted. There might be even some concerns about the routine and classic role of a physician at the clinic, and it might be thought by moving from the traditional task of a physician at the clinic to VC, we can not have the same old image of the physician at the clinic. But here we have to wait and see what is our goal here? is it just a matter of the traditional image and nostalgia role of the physician at the clinic/hospital or is bringing the best possible healthcare service for patients? I think the answer is obvious, but why I think that VC will bring a better healthcare service? I will answer that in the explanation about the second limitation, which is the lack of physical exam. As was mentioned in this article “diagnostic accuracy in virtual visits is 71-91 percent, similar to in-person visits”.Therefore, looks like physical exams do not make a significant difference in the rate of accurate diagnosis. I think we can even take it one step further. We can consider using a home medical device like nowadays smartwatch which can measure vital signs to some extent and hopefully in the future they become more advance and can gather more info about the physical exam, and their findings might even be more accurate than the clinic physical exam.
Bottom line, our goal is to bring the best possible healthcare service, and to achieve this goal, we need to optimize our healthcare system and a big portion of this optimization is to make the VC a more routine part of our healthcare system.
This was a very thought provoking read! I am an advocate for change and acceptance of new technology to improve our everyday lives. That being said, I believe that VC definitely has promise in the future of medicine, but should not completely eliminate the delivery of physical care. During the pandemic, my father required a referral from a physician but was told he could not physically see one and had to resort to a phone consultation. This was difficult for him as his english is not proficient enough to explain his symptoms with fine detail and he prefers to physically show where he feels certain discomforts. This is a major limitation in my opinion because it reduces the possibility of physicians to make an accurate diagnosis and could lead to further complications of certain conditions that are not attended to accordingly. I believe VC delivery should be more focused on minor discomforts that do not require the physical assessment of a physician such as a common cold. VC can also be a promising method for patients to obtain prescriptions without having to endure long waiting periods at walk-in clinics or a family doctor’s office. All in, I believe VC should be integrated as an acceptable form of care, but in moderation depending on the severity of a patients’ symptoms.
A well-done piece! Virtual care presents many benefits to the patient as well as the healthcare system. Being confined to a waiting room in a doctor’s office for hours, only to be seen for 15 minutes, can be a frustrating experience for both parties. Safety concerns are at an all-time high with the current pandemic. The innovation of virtual care creates freedom and flexibility, and indeed “promises a future of abundance”! As with most things in medicine, this comes with limitations and should be considered on a case-by-case basis.
Although VC is very useful in cases such as pandemics, patients in rural areas, patients with disabilities, and others, the limitations that accompany it are really challenging. I do not know if an audio-only encounter will be sufficient to build a good doctor-patient relationship, in addition, how physicians will be able to provide a sufficient physical examination. I think that when doctors are not able to perform a physical exam, this will lead them to order more tests and images and that will have a bad impact on the health system in general and on the patients specifically. I still think VC will be a good addition to the medical system in Canada and the world, but it must have specific limitations and regulations.
It is possible now… we have the technologies… and it should be made a priority. I have just ‘attended’ a virtual webinar sponsored by InfoWay… and other countries in Europe have been doing this for years.
Yet here in Canada/Ontario, we’ve already spent hundreds of million$$$ trying to re-invent the e-health wheel — when we could simply have ‘bought’ existing national IT/e-Health systems that are proven to deliver effective results.
I know the answer is: “It’s the CONSTITUTION stupid!!” … and that’s not the only thing that’s stupid — LOL!
Our enthusiasm for virtual care should not deny the very real advantages of of patient touch and the value of physical examination of the patient. Our early , as yet unpublished, experience suggests that virtual care increases the use of imaging, other investigations, and specialist consultation as the reassurance provided by the physical exam is not available. This increases cost to the system but can also increase patient anxiety: “why do I need those extra tests, it must be serious”. The fragmentation of care mentioned is a symptom of decreased trust. I see my role as a family physician as being rooted in the doctor-patient relationship, what Ian McWhinney called “being present” with the patient. We need to better understand how to maintain our human relationships effectively through virtual contact with patients. While lots of energy is going into technical and financial solutions we should not neglect our fundamental interpersonal interactions as a key component of the a future that includes more virtual care. Access is one component, but access to what?