Benefits and shortcomings of utilizing telemedicine during the COVID-19 pandemic

Abstract

As the COVID-19 pandemic overwhelmed health care systems around the world, new strategies to mitigate its spread and provide patients access to health care have been employed. Although a critical component of this strategy, telemedicine is not a perfect solution for many scenarios and is often limited. Overall, telemedicine has been an invaluable tool to improve access to care and minimize the risk of person-to-person transmission of COVID-19.

The COVID-19 global pandemic has dramatically changed the health care infrastructure. Initial cases were described in Wuhan, China, followed by rapid spread of the novel coronavirus throughout the world, with the first confirmed case in the US on January 20, 2020.^1,2 The global pandemic radically overwhelmed health care systems, as most hospitals did not have enough resources and personal protective equipment (PPE) to defend against the surge of emergency room admissions and hospitalizations.

Strategies to mitigate the spread of COVID-19 have included social distancing and patient isolation. Telemedicine has been a critical component of this strategy. Clinical encounters are being increasingly transitioned to telemedicine appointments to reduce PPE usage, improve access to care, reduce the burden on health care systems, and minimize the risk of direct person-to-person transmission of COVID-19 between patients as well as to providers.^3–5 Nearly all specialties have been forced to embrace virtual appointments, and telemedicine has been useful in evaluating the severity and progression of a disease and other comorbidities, assessing the urgency of surgical treatment, and considering operative and anesthetic procedures for specific patient needs. It can also be used for effective screening and triaging of patients with suspected or established COVID-19, thereby protecting other patients, clinicians, and communities. Although telemedicine precludes the physical examination of a patient, it allows collection of a range of information and can be utilized for outpatient visits as well as before surgical admission and may therefore be used in preoperative assessment.^4–8

However, telemedicine is not a perfect solution for many scenarios. In the postoperative patient, there is no physical examination of the operative site, and thus important information may not be obtained. Additionally, in some clinical scenarios, it is difficult to evaluate and treat patients in the absence of an in-person evaluation and a focused physical exam. Although this is necessary for patient safety to reduce the risk of COVID-19, it also reduces the accuracy of diagnostics.

While there is certainly efficacy in a telemedicine patient encounter, especially with regard to minimizing disease spread, it carries the inherent increased risk of misdiagnosis since the medical practitioner cannot perform a physical examination. Misdiagnosis can lead to significant increases in morbidity and mortality, which highlights the importance of proper triage of patients. During the COVID-19 pandemic, physicians concerned for higher acuity of illness often ask patients to go to the emergency room for a workup with a physical examination and necessary laboratory tests.

The COVID-19 pandemic has forced providers to change the way they provide health care. Although telemedicine has been invaluable in improving access to care while minimizing disease transmission, we must stress the inherent shortcomings in evaluating and treating patients with a disruption of the natural patient-physician relationship.