I've started doing a LOT of telemedicine this year, even before Covid-19 was in the US. Over the last 30 days, I've seen close to 600 patients via telemedicine.

I've been surprised by a few things...

First, I'd estimate that about 30% of outpatient (ie, clinic based) visits are better accomplished via telemedicine than in person. The problem is knowing who those 30% are ahead of time, because the other 70% are NOT helped (and potentially hurt, especially with a non-expert).

For example, a patient who wants a skin cancer check simply cannot be seen via telemedicine. There are services run by non-dermatologists (eg, nurses and PAs) that seek to offer this service, and it is just a matter of time before they realize they are hurting people. How?

Let's say that a patient is concerned about a "mole" on his arm. The mole is benign, and let's assume the nurse practioner is right in their assessment. The patient feels reassured, so skips his check-in with his dermatologist.

Many problems here:
1. Usually the spot that the patient is concerned about isn't the skin cancer that the dermatologist finds. "Oh, it's that one? I didn't even know it was there"
2. Non-experts are a dead end way to scale medicine, because mistakes become MORE likely online.

3. No procedures can be done online, obviously. So, if a patient needs a skin biopsy to prove benign vs malignant, they still need to see a dermatologist and this telemed visit was a waste of everyones' time and money.

So this brings up when telemedicine is a good idea:
1. When the "provider" is qualified: typically a physician board-certified in his/her field. Telemedicine is harder than in person.
2. When the patient is pre-selected (eg, acne makes sense but skin checks don't).

What about the hospital setting? The role of telemedicine is more limited here. The patient's primary team needs to be in person to talk with the patient and family, to do necessary procedures and an exam. Consultants can sometimes offer advice to the primary team remotely.

Something I want to emphasize is that when telemedicine is done right, it's REALLY good for the patient and the doctor.

I'm in a field that is historically inaccessible (dermatology). Private Equity have tried to "scale" my field by offering low value care from mid-level providers who can do more harm than good (a separate topic). But...

With the power of telemedicine (with appropriate patient selection), I am suddenly able to offer the same level of care as seeing me in person to patients across the many states that I have a license in.

Well designed telemedicine with appropriate patient selection makes my workflow so efficient that I can see hundreds more patients every month without feeling like I'm working more. This is a huge win for patients, who are getting accessible, quality care.

It's also a huge win for doctors who can get burned out working in broken systems and fixing the mistakes of non-professionals.

So anyway, I'm very long telemedicine when it's done in a thoughtful manner: with appropriate patient selection, credentialed experts, and a slick UX.