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Balancing Telehealth and In-Person Care

By David Charles, MD

“I’m never coming back into the office again!” That’s how one of my patients responded after his first virtual doctor’s visit last year.  

I hope he’s wrong.

Don’t misunderstand me. Telehealth is a powerful and important tool. Its value during the pandemic can hardly be understated. Going forward, it will always be a great option for some patients and some medical visit needs – but not all.

As a result of the pandemic, telehealth use rapidly expanded like never before. I saw the trend in my own practice. Between March and September of 2020, my center saw more patients via telehealth per day than we did the entire prior year.

Telehealth allowed patients to continue being treated without risking COVID-19 exposure. And while post-visit surveys show most patients liked the convenience and safety, the approach has its shortcomings for some medical situations.   

Telehealth is not a one-size-fits-all solution. Nor is it meant as a complete replacement of in-person care. Not all patients will have the same comfort level or success with telehealth. Physicians like me must be thoughtful about how we approach the issue and how we guide our patients toward optimal care.

So how do we strike a balance between virtual and in-person visits? In addition to reflecting on the individual patient and the goal of the visit, we might consider a couple of other factors.

  • Subtle symptoms. Certain clues about a patient’s condition, lifestyle or response to a new medication may be hard to see via video and nearly impossible to perceive over the phone. For this reason, periodic in-person evaluations can be vital for some patients’ long-term health.
  • Racial and economic disparities. Studies have shown that low-income patients, patients from communities of color, and patients who don’t speak English as their first language have less internet access and lower technology literacy.

Medical societies are best positioned to take the lead on defining the standard of care for telehealth visits with practice guidelines and treatment pathways.

Patients and physicians are uniquely suited to determine when an in-person visit or a telehealth visit is needed. As policymakers and health insurers debate the reimbursement approaches that will shape telehealth moving forward, they must embrace the value of telehealth and forthcoming practice guidelines to ensure patient-centered care.

Telehealth’s popularity isn’t a case of “out with the old, in with the new.” It’s about having more opportunities to tailor care to our patients’ needs.

David Charles, MD, is a neurologist and medical director of a telehealth program in Nashville, Tennessee. He is founder of the Alliance for Patient Access.