Virtual Health Care Will Undermine the Doctor-Patient Relationship

In horrible economic times such as these, the tendency in every area of our lives is to look for less expensive ways to get the services we need. Thus, we keep hearing about “doing more with less” in our enterprises, and we are faced with the threat of U.S. jobs being outsourced in the name of saving money.

As we consider such measures, however, it is important to realize that every such move we make has a cost, and that often the cost cannot be measured in dollars. For example, BlueCross BlueShield of Western New York (BCBSWNY), BlueShield of Northeastern New York (BSNENY) and American Well Inc. recently announced an agreement to deploy American Well's Online Care platform and services in upstate New York to eligible members and employers beginning this summer.

According to Alphonso O'Neil-White, president & CEO of BCBSWNY/BSNENY, “Online Care is an innovative solution that will allow us to bring high-quality, informed and timely care to our members when and where they need it.” The Online Care service will allow eligible members to engage in “live” encounters with credentialed physicians from the Blues plans' established provider networks. Patients will be able to make these connections from their home or workplace at any time, using the Web or a regular phone.

During each live interaction, physicians will be able to review the patient's clinical information, speak with and see the patient, prescribe medications as appropriate, and suggest follow-up care. The initial launch of Online Care will occur in the Western New York area with service to Northeastern New York anticipated by fourth quarter 2010.

This is being sold on the basis that it gives “access” to physicians to folks who might have a more difficult time getting such access locally, and that’s fine as far as it goes. But really, are we going to be satisfied with medical services that take place via webcam or, worse, on the phone? When I go to my doctor for a physical, part of what happens is that he examines me—physically. Short of hooking a heart monitor up to one’s computer, I find it difficult to imagine how that might happen—much less how the doctor is going to do the other physical tasks that make up an exam, or are part of treating a complaint. On the phone, I would think this is darn near impossible.

More importantly, however, the doctor-patient relationship—already strained by time pressures on doctors who need to move patients through quickly in order to maximize profits—is bound to suffer. I remember hearing about one physician whose waiting list for patients is years long, because this guy makes a point of getting to know his patients and spending time with them. Perhaps this isn’t the best profit model, but then again he saves a bundle on advertising because word-of-mouth has made him wildly popular.

The point is that when it comes to the health of our bodies and minds, we want someone to actually engage with us on a human level, and to care for us without regard to time constraints. In the mental health field, for example, studies have demonstrated that the most potent predictor of a successful treatment outcome is the quality of the provider’s relationship with the patient. It’s not hard to imagine that the same might be true with other medical specialties.

Online and telephone medical services certainly have some good uses when it comes to providing education and general guidance to those who might not otherwise receive it. To pretend that these services can somehow take the place of human contact with a health care provider, however, is absolutely ludicrous. To be sure, someone will save money, but patients who have no real connection to their providers, and whose health is likely to suffer as a result, will pay the price for this paradigm.

I’m all for saving money on health care, but using technology to reduce or dilute services only makes people more disaffected and less healthy. This is an outcome we cannot afford.

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