SHIFT: Is virtual care bad for patients?

Despite the cost-savings and convenience, online doctor's appointments miss things — a lapse that can mean the difference between life and death.

Lisa Machado 6 minute read October 12, 2021
illustration of doctor on phone

The pandemic has brought virtual care to patients, but is telehealth a good thing? GETTY

“Not going to be seeing you any time soon!”

The yelling woman and her messy braid were bounding across the grocery store parking lot toward a grey family van that had its back hatch open. The rusted cart she was pushing kept veering to one side, making her lean in the opposite direction to compensate for the annoying swerve. She was pushing a pile of white plastic bags, and as she lurched to one side, a family-sized box of organic granola lurched too, bouncing off of her elbow to land at her feet.

She was the nurse practitioner on the family health team in my doctor’s office. Maybe 25 years old, she looked so fresh and unblemished — I wondered how it could be that people who were old enough to be my children were suddenly in a position to give me medical advice.

I walked over as she packed her car. One of the bags had torn, so she was quickly stuffing the spilled items into the other bags — two large bottles of diet coke, Neapolitan ice cream sandwiches, a bag of avocados and a box of baking soda. She told me that the medical team had decided to continue online appointments, preferring not to see any patients in person.

“Only if it’s really urgent,” she said, ducking underneath the hatch that had started to close. “And even then, only after a phone consult.”

Her words made me a little anxious.

After all, it has been more than a year of cancelled surgeries, delayed tests and delayed diagnoses, and patients who are not considered urgent being squeezed out of overcrowded hospitals. How much longer can we wait?

“We have no idea when we’ll be back to normal,” she said, climbing into the driver’s seat and sliding on a pair of white sunglasses that had been sitting on the dashboard. “You know, virtual appointments are still safer.”

Safer for who?

As I watched her drive away, her words reminded me of a story we posted this week from The Conversation written by Dr. Sheila Singh. A pediatric neurosurgeon, Singh writes about the devastating deluge of delayed diagnoses among children with brain cancer caused by strained hospital resources and “alarmist” public health messaging around COVID-19 that made families apprehensive about visiting doctors’ offices and hospitals. As a result, she is now seeing children in the end stages of their disease — children whose lives, she says, could have been saved if they had been diagnosed just six months earlier.

Frighteningly, the epidemic of diagnoses that come too late is not isolated to children with brain cancer. Countless lives have been lost or seriously compromised — these are the victims of a healthcare system that’s too burned out to provide the very things we rely on it for: access to diagnostic tools, timely referrals to specialists, prompt treatment and a hospital bed if we need one.

But perhaps what’s more disturbing, as Singh points out, is that the delays that are killing people are caused by more than just a paralyzed healthcare system, and our lack of enthusiasm for hanging out in potentially germ-laden waiting rooms. In fact, for some of us, the path to poor outcomes began the minute we sought medical advice the way the pandemic has pushed us to: virtually.

“Seeing a patient on a screen is nothing like examining a child in person,” she writes, noting that online appointments provide a lot less information to a doctor. She talks about missing important clues, like “muscle tone, eye clarity and subtleties in breathing” that can uncover potentially serious issues in time to be treated. The lapse can mean the difference between life or death.

But this isn’t the conversation that we are hearing most about virtual healthcare. What we hear is how convenient it is: you don’t have to leave your house — which is especially helpful for those with mobility challenges. The ease of use is also great news for people in rural communities who may have to drive hours, or even days, to reach a doctor. Plus, you can do it without getting out of your PJs — you don’t even need pants.

And then there are the cost savings. According to Saskatchewan-based Lumeca Health — virtual care is good for the wallets of not only patients (think the money spent on transportation), but it also financially benefits doctors (remote communications save 16 per cent in operating costs) as well as employers (ease of access to medical care can bring down the more than $16.6 billion that employee absenteeism costs businesses every year). In the United States, the savings that result from virtual care are a little more in your face: an in-person visit can cost around $146, whereas a telehealth visit runs you about $79.

Singh isn’t talking about this side of virtual care, though. What she sees is far more ominous. She wants us to know that things can get missed when healthcare is done online. Potentially very big things. It takes a lot of really smart questions — and accurate, honest answers — to distinguish between a bad headache and a brain tumour, for example. And the cost of making a mistake is huge, for both the patient and the doctor.

John Seabrook writes about the diagnostic limitations of online care in The New Yorker, quoting his own doctor, Martin Beitler, who isn’t a fan of virtual visits: “You can’t have a belly exam via a screen.” Beitler also adds that telehealth at its worst promotes a “knee-jerk, ‘give them antibiotics for every cold that they get’ attitude.” Another doctor worried that virtual care will “delay proper exams and get in the way of deeper interactions between people and their doctors.”

There’s no question that virtual care has helped us get through a pandemic that has brought our healthcare system to its knees. But stories from the frontlines, like Singh’s and Seabrook’s, are worrying reminders that as much as we may want virtual health to work, and despite all that’s good about it, there are big wrinkles that need to be ironed out before patients can — and should — feel confident that their health is in good hands.

Until then, isn’t it time to heed Singh’s warnings? Perhaps, like she suggests, we need to rethink the public health messaging that has kept people out of clinics and hospitals and encourage Canadians to start prioritizing their health instead of letting fear stop them from seeking medical care. And maybe we’ve come far enough in this pandemic that it’s time to welcome patients back into doctors’ offices — for their health.

After all, if we can hike down to the local restaurant for a pint, surely we should be able to talk lumps and bumps face-to-face with our doctors.

This story originally appeared in the Healthing Weekender. Subscribe here.