July 8, 2019
Every-time a new way of practicing comes to life in medicine, we have to question what is the reason behind the change. This is no different for telemedicine and urgent care. Both of these new modalities are springing up in increasing numbers in the medical world in order to meet the new driver of medical changes, convenience.
Medical consumers are now demanding convenience of time and location of their healthcare experience. On first blush, this is not a bad idea.
Why not have a convenient time or location to receive care? The only hiccup is are you receiving high quality care to go along with that convenience?
This is very consistent with many convenience culture changes that have occurred over the last 50 plus years. Fast food is convenient, but is it as healthy as a home cooked organic vegetable heavy dinner? Is your high-end sports-car best treated by the best mechanic or the closest, assuming that person is not the best?
In the Journal Pediatrics in 2019, Dr. Ray and colleagues looked at this question of quality versus convenience by testing the volume of antibiotics prescribed for a given upper respiratory infection.
From the Article: There were 4,604 DTC telemedicine, 38,408 urgent care and 485,201 primary care provider, PCP, visits for acute respiratory infections in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits) Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at the settings (59% at DTC telemedicine visits versus 67% urgent care and 78% PCP visits). (Ray et. al. 2019)
Why do we care?
In the age of medicine where it is very clear that each inappropriately prescribed antibiotic has a long term negative effect on human health via the impact on the gut microbiome, we need to take this information seriously. One could say that I am biased as I am the PCP side of this equation. That would be entirely accurate. I am 100% biased towards the best outcome for your child. How that occurs is irrelevant to me as long as it does. Anyone or any mode of medicine delivery that does not deliver high quality is in my mind a problem.
I have long felt that telemedicine should be only available as a last resort for very remote areas of the country where adequate medicine is not available because of the inherent difficulties of delivering high quality medicine without visually seeing, touching and concluding what is amiss based on a physical exam. Most consumers are woefully unaware of the difference in quality between the differing types of medicine as delivered.
I applaud all modes of delivery that appeal to the convenience culture as long as not an ounce of quality is lost in translation. Your child is a high quality sports-car and as such needs the best medicine available not just the most convenient.