Video telemedicine: an anomaly in Western countries
And why 2021 will be the year of consultation via instant messaging
Video telemedicine has been available in Western countries for about ten years. It was offered only privately at first, but the French social security system began to reimburse the cost of this new form of remote patient care service in September 2018. Its use remained relatively limited until the spring of 2020, when there was a more than 100-fold increase in the number of teleconsultations.
Today, general practitioners conduct the vast majority (80%) of these video teleconsultations.
But this is no revolution. The doctor saves no time; only the patient benefits from not having to travel. Teleconsultations have absolutely no impact on our overall medical time, and therefore, no impact on our healthcare system.
A teleconsultation is a simultaneous video exchange between a doctor and a patient:
• The advantage for the patient is avoiding travel time and any additional time lost in the waiting room. However, the quality of medical care is not the same as an in-person visit (and ultimately, nothing can replace an in-person visit), but this is considered acceptable due to the patient’s significant time saving. What doesn’t change is the need to make an appointment and then to be available for about 15 minutes.
• There are no direct benefits for the doctor. And there are no savings in terms of time or money. Therefore, doctors are only conducting teleconsultations in response to patient demand. The result is that, with or without offering teleconsultations, doctors are taking care of exactly the same number of patients and their fees are exactly the same.
However, there is a considerable amount of strain on our health care system. There are fewer and fewer doctors (all Western countries are impacted). Medical time is decreasing. According to calculations published in 2016 by the Order of Physicians, we will experience « the loss of one out of every four general practitioners between 2007 and 2025 ».
If video teleconsultation has no impact on this medical time and does not help to relieve the strain on our primary care medical services and therefore the strain on our healthcare system in general, then why was it implemented? What was the real underlying problem that video telemedicine was meant to address?
Here in the “old” Western countries, we are convinced that we have the best health and medical care systems in the world. This may have been true until the end of the 1990s, but it is no longer the case. This arrogant stance has not led us to reinvent ourselves. As the current health crisis has demonstrated, the return to “normalcy” holds a lesson for us: the health systems of Western countries are no longer able to adequately respond to the current situation.
A number of highly populated countries on the other side of the world are teaching us lessons in health management. These are the former “developing countries,” such as China and Indonesia. These countries have only recently, within the space of a few decades, created the foundations of their health systems, their number one constraint being their demographics: there is approximately one doctor per 1,000 people in these countries, compared to 3.4 doctors per 1,000 people in France.
Instead of video consultations, these countries have chosen to address this problem via instant messaging. Companies such as Ping An Good Doctor in China and Alodokter in Indonesia are able to handle extreme patient volumes with very few doctors.
Anything that can be done with video telemedicine can also be done with instant messaging. But the way that doctors use their time is very different. A doctor who can conduct five video teleconsultations per hour can handle four or five times as many patients with instant messaging. There is no danger of an “Uberization” of healthcare, because the treatments are of the same quality and medical time is optimized, without exhausting the doctors.
Patients also benefit greatly: there are no more limitations caused by the need to provide “simultaneous” video consultations and no more distraction caused by noise or other environmental factors. With instant messaging, you can consult your doctor while commuting, at your workplace or while away from home.
Nowadays, general practitioners are increasingly using SMS, WhatsApp and email as a means of providing care because they no longer have the capacity to respond to all requests for in-person consultations.
This method of providing care by messaging is essential to the survival of our healthcare system. Messaging allows doctors to manage and lighten their daily workload. It enables the provision of efficient and rapid medical care for everything that can be done without the need for an in-person consultation.
Our authorities have a duty to begin thinking about solutions that will save medical time and relieve the burden on our healthcare system in the future. The provision of medical diagnoses and treatment by instant messaging must be implemented as soon as possible.
This practice already exists, and it works: companies like 98point6 in the United States are using this instant messaging approach as their main strategy.
A membership-based model that removes the financial trade-off to accessing care early and often and via the preferred mode of communication (text) inspires patients to actively engage in their health care and through the proper channels: getting diagnosis and treatment from board-certified physicians practicing evidence-based medicine.
Searching symptoms online is not the answer to convenient, quality care. An AI-assisted, mobile-based experience is also the ultimate way to understand social determinants of health; much of the data about a patient’s habits and life experience is lost in traditional social determinant measurements.
Here at Biloba, we are also convinced that this is the way to move forward. Video telemedicine is not a bad idea, but it doesn’t offer a solution to the problems we are currently facing. It is not scalable and does not drastically increase the number of consultations without affecting their quality. The video consultation model is also based on an outdated, transaction-based economy (a fee-for-service economy).
We believe that 2021 will be the year when Western countries make the switch to instant messaging. And we also believe that merely offering a medical chat is not enough; everything needs to be reinvented.
We want quality medical care. It has to be immediate, and part of an unlimited plan. It has to include the ability to write prescriptions. It has to be available regardless of the country in which you live. And it has to be accessible to millions of people.