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The Mixed Blessing of Telemedicine

The pandemic will change the face of medicine. This recent article in the New York Times describes the rise of telemedicine. In many corners, this is seen as a great advancement. Perhaps it is. However, having been a medical malpractice lawyer for more than 30 years, I look at this situation somewhat warily.

While remote patient visits provide better patient access and the technology is constantly improving, there are areas of medicine where it is much more appropriate than others. Psychiatry and mental health are the most obvious ones. My wife runs a large mental health practice. Their adaptation to remote patient visits has been quick and effective. Patients who might otherwise not have gotten the care they needed because of the various quarantine measures have been seen and effectively treated. Is it “as good” as face-to-face encounters? Perhaps it is not optimal, but in the current context, it is clearly good enough. I have no doubt that the attention the patients are receiving complies fully with the standard of care.

When we look at the world of primary care, the picture gets a bit murkier. There are certainly many situations where telemedicine would be adequate, but the potential problems are not hard to see. For example, a patient is evaluated for respiratory issues – something that sounds like garden variety flu or a cold. However, the doctor obviously cannot listen to the patient’s chest. Could a pneumonia then be missed? That’s not a frivolous concern.

From my perspective, I think the biggest danger of telemedicine is complacency. Part of what primary care doctors do – or should do – involves a subjective evaluation of the patient. A doctor can be presented with two patients with similar histories and presentations. However, a doctor’s assessment of one might be markedly different than the other. The reason for that goes to the doctor’s clinical judgment. One of the patients just seemed “sicker” than the other. I am just not sure that will be picked up as well in video conferences. Doctors will have to be careful to have a deliberately low threshold for bringing patients to the office after video conferences and in the busy world of modern medicine, I am just not sure that will happen as often as it should.

The potential for missed or delayed diagnoses is real. From a malpractice perspective, a new issue will be the determination of whether a remote visit with the patient was adequate. To avoid problems, doctors will need better documentation of the encounter. Even before the pandemic, the quality of primary care documentation was not great, so I am dubious about seeing much improvement now.

Clearly, we are entering a new world. The impact on malpractice claims and cases will be extensive. Exactly where all this goes remains to be seen.


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