Head to head: Is telemedicine the right route to employee health care?

Dr. Jennifer Wild, consultant clinical psychologist and associate professor at the University of Oxford

When we’re feeling ill, we want to be seen quickly by our doctors. Earlier access to treatment means less suffering, whether we’re dealing with a chest infection or something more debilitating like depression. Telemedicine eases access to assessment and treatment, which means earlier recovery and return to work.

According to research, upper respiratory tract infections are the most common reason people visit their primary care physician. Depression and anxiety is the third most common reason. These conditions can be well treated with telemedicine through the advancement of apps, which provide access to remote doctors via a smartphone. The services offer medical advice and prescriptions — and can even order lab work for blood and other tests.

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If the condition is treatable, telemedicine can tackle it. Success has been demonstrated in an increasing number of health problems, such as acne, bronchitis, insomnia, rosacea, hyperthyroidism, shingles, kidney infections, kidney stones and tuberculosis — to name a few.

Why succumb to half a day of sick leave to see a doctor in person when telemedicine makes it possible to talk to one over the lunch break, resulting in less time off and more time at work?

In terms of mental health, a 2018 systematic review by the Canadian Agency for Drugs and Technologies in Health demonstrated that telemedicine services, which offer evidence-based treatment protocols for depression and anxiety disorders, are as effective as traditional face-to-face modes of delivery.

When we’re ill, our main priority is to start quickly rolling the ball towards treatment. This means our ailment is diagnosed as early as possible and we’re taking action to get better sooner. Telemedicine is the logical choice for employee health, offering assessment and treatment — or easier access to it — for the most common conditions we’re likely to face in our lives.

Aude Motulsky, assistant professor at the University of Montreal’s school of public health

As patients, we all need the same thing when it comes to health-care services — access to the right resources at the right time.

There’s clearly a need to improve timely access to clinical expertise and care. And, in specific cases, technology has the potential to facilitate this access. For many of us, seeing our physician on a screen by simply clicking a button seems like a dream. However, we must be cautious; with technology, there’s always a risk of unintended or undesirable consequences.

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First, we have to determine whether there’s an added value for this type of service, because it isn’t always worth the cost. In many situations, for example, a smartphone is enough — it can be used to exchange data, such as images or videos, when an in-person examination isn’t required.

But we have to carefully define these cases and ensure the services aren’t creating access to an inappropriate, and costly, resource. Patients should only see a physician when it’s absolutely required, and have access to a nurse, pharmacist, social worker or psychologist when they need one.

It’s about health-care organization, not technology. But through virtual consultations, technology could increase the use of inappropriate resources.

Second, clinicians who offer virtual consultations are the same professionals we often struggle to see. So when they’re on a virtual consultation, they’re not available to offer other services. It seems risky to create silos of “anonymous” clinicians. The building blocks of the Canadian health-care system, which includes fully accessible medical consultations, might not resist this breach of a silo where accessibility depends on status, such as membership in a workplace benefits plan or ability to pay.

If virtual care is essential for a high quality health-care system, it should be accessible to everyone, when appropriate. As the rise of telemedicine continues, it will be key to define these conditions.

Read: Just 9% of employers offer virtual health care: survey