New research looks at how the dramatic jump in telemedicine due to the COVID-19 pandemic has led to changes in communication, patient care, and the potential for medical error.
Telehealth is here to stay. While the use of remote care was steadily growing prior to the pandemic, sudden urgency to socially distance, reduce infection rates, and make use of tight healthcare resources boosted the use of telemedicine for ambulatory care.
In a commentary published in the Journal of General Internal Medicine, study authors explore how the sudden rise in telemedicine impacts the practice of medicine and two common types of medical error—medication mistakes and misdiagnosis.
The article defines practice differences for healthcare providers and their patients who use telemedicine including:
- Patients take a larger role in their care. Because of the remote nature of the interaction, a physician cannot take a blood pressure reading, but a patient can use equipment to provide needed readings. If services like a blood test are needed, the patient will need to travel to a local lab, rather than have a blood draw in the office of their PCP or nearby.
- Telehealth impacts communication. Without a personal encounter, a provider may miss important nonverbal cues, behavior, or symptoms. As well, patients speaking over their computer or cell phone may be less likely to openly discuss personal or sensitive details or questions about which they are concerned. Telemedicine can impact patient engagement for the better, or for the worse, and can serve to dilute a medical message when delivered at a distance.
- In a review of literature addressing telehealth, the study authors note physicians have limited ability to assess their patients. While blood pressure readings can be made available, a complaint of back or abdominal pain would be difficult to clarify. That said, the limited available literature on telemedicine so far does not point to a rise in diagnostic errors. It may be that physicians defer diagnosis of difficult cases to an office setting.
- This study suggests remote discussion of medications with patients who are not elderly have met with success. There is less success, however, with elderly patients. Poor communication is a key roadblock to safely dispensing medication. If a patient does not understand how to use the medication, or if a complete review of their current drug regimen is not conducted, it could lead to an adverse drug event.
Bottom line, the authors of this commentary suggest standardized best practices for telehealth visits, including training for clinicians, reporting tools to register diagnostic, medication, or other errors that occur, identification of patients who may be placed at risk with a telehealth visit, and standardized follow-up procedures, among other suggestions.
Though growing fast, telehealth is in its infancy. Greater structure, reporting, and training is needed to increase the use of this mode of healthcare delivery—and reduce its risk.
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