One pediatrician’s case against telemedicine

While telemedicine is rapidly growing in usage and popularity, replacing doctor's office visits and saving patients and healthcare providers' time and money, one doctor says there are limits to what remote care can do, especially when it comes to a sick child.

Pediatrician Chad Hayes, MD writing in a blog post Monday in The Washington Post, noted that in many scenarios the visit to a clinician should not be omitted in favor of telemedicine.

"So while it may seem as though I'm bashing telemedicine, I'm really not," Hayes wrote. "It just needs to be used appropriately."

Hayes wrote that parents may use telemedicine to seek after-hours care for their children, often hoping to get started on medicine as quickly as possible. Insurance companies push such services, as cost saving benefit, where insurers, thanks to the low overhead costs, pay only a fraction of what they would pay for an office visit. Telemedicine visits are also quick and available 24 hours per day, he wrote.

"But while the convenience of a 2 a.m. virtual visit for a child with a fever might be tempting, sometimes a face-to-face visit is clearly superior -- and less risky," Hayes wrote.

He cited examples of strep throat, which should never be diagnosed in children without first doing a rapid strep test or culture, and urinary tract infections in children, which require sending a sample to a laboratory for diagnosis. And if a child is thought to have pneumonia requiring antibiotics, it's a good idea to examine the patient in person to ensure that hospitalization isn't needed.

"As a pediatrician, I'm obviously biased," wrote Hayes, "but my advice is to find a doctor you trust, hopefully one with some after-hours and weekend availability, and maybe even one who offers some supplementary care by smartphone, text or email.

"Finally," Hayes concluded, "if you believe that your child's pediatrician is no better than your smartphone, find a new pediatrician.