Since the 1970s, physicians have communicated with patients consistently via telephone, and not until recently the term telemedicine came about to allow for insurance billing. A few years later, only in the past 3-4 years, Virtual Primary Care gained popularity.
In 2017, I recall interviewing for a clinical position with a popular telemedicine company that was piloting a Virtual Primary Care program and was looking for physicians with telemedicine experience.
Only after the pandemic did we discover that quite a few digital nomad patients had been engaging in virtual visits with their primary care doctors. For now it appears that the Virutal Primary Care is the future of healthcare – what’s uncertain is how it will be executed.
The Rise of Telemedicine
Technology hasn’t been able to keep up, which speaks to the highly regulated field of medicine. Hardly any of our patients have access to digital stethoscopes, wearable technology, CGMs, or digital otoscopes, which would likely have made the practice of Virtual Primary Care easier.
Even video visits are often difficult to complete due to delays, low upload speeds, and local hardware power.
Despite this, telemedicine has risen and grown into specialty care and is being utilized by specialists all over the world.
Benefits of Virtual Primary Care
There are a few aspects of Virtual Primary Care that make it stand out from the competition. Things that the in-person visit can’t compete with.
1. Access
Regardless of geographic location Virtual Care breaks those barriers and allows those in remote locations or frequent travelers to have access to their private physician.
When a patient has an urgent medical issue and doesn’t know where to go or what to do, and as long as it’s not a health emergency, having access to a Virtual Primary Care doctor who knows them and can help triage their needs is perhaps one of the most important aspects of such a patient-doctor relationship.
2. Convenience
As the joke goes, patients rush to get through the check-in line to get then stuck waiting for the doctor.
In a Virtual Primary Care clinic there is hardly any waiting and no check-in process or forms to fill out. You are conveniently seen when you made your appointment.
The time and effort saved is substantial.
3. Safety
During the flu season or fires or high access in the Urgent Cares and ERs, having timely access to your Vritual Primary Care physician is a safety issue.
Fortunately, it’s rare that such event occur but it’s in those moments that the patient-doctor relationship really shines.
4. Continuity of Care
We don’t anticipate a centralized place for health data storage. This, unfortunately, means that the promise of the EHR connecting all clinical patient data to all US physicians won’t be realized.
Having your private Virtual Primary Care physician means you have all your health data in one place. All the visit summaries and discussions, labs, and imaging studies safety stored virtually and in backup servers should that information ever need to be retrieved.
5. Cost Reduction
A physical office requires rent, insurance, employees, cleaning, inspections, furniture, parking, and utilities. These costs are passed down to the patient who profit little from it.
To access a physical clinic the patient has to arrange a ride, commute to the site, park, interact with several staff members, all before having a visit with their physician.
Many of our patients run their own businesses or are medical professionals who don’t want to take time away from what they love doing for routine health checkups.
6. Education
In the physical office I could never show my patients a video or infographic of something educational often because the computers are on a network with limited internet access.
In our Virtual Primary Care practice we can share digital content and even our own courses to help our patients improve and maintain their health.
Addressing Common Concerns
Let’s not forget that a virtual practice is something new and it has plenty of drawbacks worth addressing.
1. Limited Physical Exam
Though our physicians can solicit the help of their patients to perform some maneuvers to elicit a physical exam, it’s quite limited.
We have found that there have been few physical exam findings that have changed our decision matrix over the years. When in doubt, we always refer patients to partner clinics for a full physical exam.
Several studies we reviewed to write this article made claims that the patient-doctor relationship is harmed without a physical examination and that certain diagnoses could be missed – however no definitive proof was provided for this.
It’s certainly a topic that warrants further investigation but assuming that how we did it in the past is the only right way of doing things doesn’t work well in a rapidly evolving world.
2. No Procedures
We aren’t able to perform skin biopsies, drain abscesses, perform pelvic exams, rectal exams, or a slit-lamp exam of the fundus of the eye.
However, we have decided that those may not necessarily be the most effective use of resources even in a brick-and-mortar practice. That perhaps they are best left to our specialty colleagues when deemed necessary.
3. No Injections
Virtually, we aren’t able to inject antibiotic, IV fluids, or immunizations.
Fortunately, we have built some workflows to, again, partner up with local clinics to provide those services if they are necessary.
4. Impersonal Touch
As mentioned above, a main criticism of a Virtual Primary Care practice is that there is no patient touch. And this one we have to agree, is a major drawback of our practice.
Looking into each other’s eyes, sitting elbow to elbow, talking, and being in the physical presence of another person is probably more valuable than we think in healthcare.
It’s an aspect of the practice we are keeping a close eye on. If necessary, we may open times during the year to see our patients in-person to form those physical bonds.
5. No Onsite Labs
Many clinics offer on-site labs. Unfortunately, due to the difficult nature of obtaining laboratory certification and the need for extra staff and supplies, this isn’t something we would consider even if we had a physical clinic.
Our partner labs are experts at blood draws and can collect tissue samples, cultures, urine, and blood. We get results back as soon as 24 hours for STAT labs.
Case Studies
Over the years, a few great examples come to mind in which our patients benefited greatly from having a Virtual Primary Care doctor. Often, the alternative was not feasible.
- An elderly but quite agile patient not only lived far from our clinic but also wasn’t quite as confident driving anywhere except on his own property. He wanted to maintain his independence and because of our regular phone calls he always felt taken care of.
- A case of a new mother who had a complicated C-section demonstrates the importance of having a Virtualist who can not only make sure she doing well emotionally but that her child is also safe. Her post-partum depression was quite obvious and her desire to avoid all contact, even with us, alarmed us and allowed us to intervene quickly.
Conclusion
This digital frontier, this wave of Virtual Care, will be an absolute asset to some but likely may not be the best option for others.
The in-person clinics are more understaffed than ever before which has limited access. Virtual Primary Care seems to be able to fill this gap if executed properly.
It’s best to reflect on how best you receive care and in which environment you will likely have the most success with your Primary Care physician.