The way that medicine is practiced has been changing in Canada for decades. We’ve seen a long trend moving away from family practice to walk-in clinics. With the COVID-19 crisis, telemedicine has become the new normal for many patients.
Accessibility, cost, and quality of health care are often the measurements that are used when discussing modern medical systems. Under normal circumstances, access will always be a challenge as medicine is still fundamentally a person-to-person service that can’t scale with technology in the way that manufacturing electronics can. When it comes to specialists, access becomes even more of a challenge. With COVID-19 hitting the world in 2020, many systems faced a severe challenge with accessibility early in the pandemic as hospitals shut down access to non-emergency cases.
Even where medical care is universal, patients often need to wait hours, days, weeks, or even months for an appointment. The medical concern, the availability of specialists, and many other factors play a role in wait time. Online consultations have long been considered a potential pathway to increase accessibility. It can speed up the time for an appointment and help patients living in remote locations access doctors. In some cases, retired doctors may provide help on a limited basis and increase the number of available health workers. There are many advantages to telemedicine.
Dermatology is an area of medicine that lends itself well to online consultations. Most skin concerns are diagnosed visually, and many conditions can be recognized instantly without any special tools. Teledermatology is a topic we’ve discussed before, but the COVID-19 crisis has made adoption a higher priority. Just as QR-coded menus became standard at many eateries, more online technologies have been adopted out of necessity, and these changes are likely to become permanent in many cases.
Convenience has become more of a priority, long before COVID-19 hit, and as of 2019, Statistics Canada reports that 14.5% of Canadians do not have a regular health care provider.1 Health care has been decentralizing for decades now, away from the family doctor who knew patients personally to impersonal but convenient drop-in clinics. Part of the reason is self-selection. Medical students increasingly opt for specialties that pay more or have more flexibility in schedule.
The other reason is that care became spread out more. Drugstores began to provide services like flu shots, and small clinics also chipped away at routine visits to the family doctor, which can be time-consuming and inconvenient. Walk-in clinics provided a more convenient experience for busy patients, especially in heavily populated cities. The expansion of walk-in clinics is expected to continue as long as it allows for further convenience.
Telemedicine fits in nicely with priority on convenience and speed. COVID-19 may have inadvertently accelerated telemedicine’s adoption, as clinics have had to adapt rapidly to the emergency. A drop-in clinic that I recently visited changed procedures due to COVID-19 concerns, and this was my experience:
- I called in for a phone consultation to determine whether an in-person visit was necessary.
- I took pictures of my skin concern (hand eczema) and sent the images to a secure e-mail address provided. The e-mail address isn’t used to communicate further.
- I called in after receiving e-mail confirmation with instructions.
- The doctor sent a prescription to a local pharmacy near me for pick up after a phone consultation.
The new process was incredibly convenient, and this sure beats physically dropping in and potentially waiting for an hour or longer to get a consultation.
We need to remember that while there are many upsides to online consultations, there are still many challenges. Some of these include:
- Regulations both from the government and medical associations
- Limitations in doctor and patient interaction – no palpation (touch)
- Both parties require technological familiarity, and Internet access may not be universal
- Liability, insurance, security, and privacy concerns
- Reimbursement (for the United States)2
Security and patient privacy, in particular, are a serious concern for everyone, and these are legitimate challenges to providing medical care online.
Walk-in clinics and teledermatology have been on the rise, often displacing family doctors in metropolitan areas. The convenience isn’t without considerable drawbacks, like the lack of tailored care, a weaker doctor-patient relationship, and doctors being less able to anticipate potential problems in the future.3