Why direct to consumer mobile video visits with physicians is a bad idea

photoxpress_1858376Last week Boston-based American Well made its telehealth service available as a direct-to-consumer offering. Now anyone with a camera-equipped smartphone, tablet, or computer can conduct a video visit with a physician for $49 — assuming you live in a state that doesn’t prohibit it.  Is a mobile visit with a physician a good idea ?  I don’t believe so and here are my reasons.

In putting patients first it’s essential, I believe, to treat the whole patient not just the specific condition.  This means an evaluation in person where the physician can visually identify patients for troubling signs like weight gain or depression.  Ask a question online and you’re liable not to get an accurate response when you ask about things like a patient’s weight or a list of current medications.

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Of course it works both ways.  Patients have to establish a relationship with physicians that is based on trust and a willingness to share information for better outcomes.   In person physicians can also order tests, like blood work, to get a clearer picture of what’s going on.  How are they supposed to do that via a computer ?

The other issue is cost.  At $49 for an online visit the cost is not inexpensive and a lot higher than most co-pays.  What I see is a startup using technology for technology’s sake but there are still some possibilities if a patient can connect with a doctor that has seen them and has a medical history of the patient.  Imagine the litigation if an online physician incorrectly diagnoses a patient and prescribes a medication that could be dangerous because the patient didn’t truthfully answer all the doctors questions ?

Mobile health is going to play a bigger part in medicine, make no mistake about that.  However mobile health is not a replacement for personal one on one health with a great doctor.

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