Doctor or Device: The Challenges of Telehealth in Treating Chronic Conditions

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There is no doubt that medicine has been an ever-evolving field. Throughout the decades, there has been a sizable increase in the pressure that both doctors and aspiring doctors feel. As standards for medical and residency acceptance rise, and the pressure to see more patients continues, many institutions are starting to take notice of the increasing fragility of the medical system. Yet, while the pressure to produce more has increased, so has the need to partner with the patient and take the extra time to truly connect with each individual. The growing trend has eliminated the power differential between the doctor and patient, replacing it instead with patients who have conducted their own research, and often, have ventured to self-diagnose. As an adaption to these changing trends, the medical field gave rise to telehealth. A platform where patients gain instant access to their health needs via sending images to specialists, remote monitoring, and seeking care over the phone or Internet. These new modalities of medicine are, once again, changing the dynamic between providers and patients, catering to a technology-centered society and producing variable outcomes.

Especially popular in treating long-term health outcomes is the combination of telephone counseling and “remote monitoring” division of telehealth. Telephone counseling, where health professionals reach out to educate patients who have chronic health issues has been heralded as a way to decrease the obstacles of cost, time constraints, and physician uncertainties. These services can be preformed proactively, where a group contacts patients who are known to be at-risk or facing particular morbidities, or reactively, when a patient has already reached out to their healthcare team. In relation to improving the physical and dietary behaviors of individuals with type 2 diabetes, this method has already been shown to slightly improve their outcomes. However, these improvements are widely variable. The system is most widely used by very distinct demographic, such as higher-educated white women and is most effective at promoting adherence to screening and testing. So, while there may be improved outcomes, the effectiveness of the system as a whole is still questionable.

However, the factor that concerns many individuals about telephone counseling is the separation between doctors and patients. Any organization that decides to proactively call patients has the ability to affect their health. This group can contain highly trained individuals, or other groups who are working with the limited information the patient chooses to provide. This provides a two-fold issue: both the quality of counsel given to the patient and the quality of information given to the provider.

Remote monitoring, on the other hand, has become fairly commonplace in society. Many apps have become popular for examining and recording weight, nutrition, and exercise. These have turned meeting healthy goals into a game-like structure, where instantaneous feedback allows individuals to compete with themselves and modify their behavior on an instant-to-instant time frame. This concept has been transitioned to the medical field to highlight other important variables of health, including HBA1c levels, heart physiological data, and blood pressure. Each mode of recording led to improved outcomes for the patient. Patients with diabetes were able to more effectively monitor their glucose levels, and patients with hypertension were able to lower their mean blood pressure over time. For patients with heart conditions, the constant flow of data transmitted to their physician led to more accurate recognition of problems that occurred outside of clinical visits.

From the outlook of the physician, however, incorporation of this flood of data is the biggest obstacle. While constant feedback is often helpful for the patient, doctors are forced to sort through mountains of data to decide what is relevant to the patient. Often, the most successful programs have the transmission of data linked to an established electronic medical record as well as a warning system for certain trends of data. This way, the doctor can easily know when to reach out to select individuals without making an appointment or reviewing a mountain of data points.

Overall, like much of the telehealth field, the impact on the health of patients with chronic conditions has yet to truly be observed. The infancy of the field necessitates that the next few years will be crucial in striking the balance between the role of health professionals and technology. Both how and when these methods are used will gradually shift towards a new norm that creates the best outcomes for the patients, much like the power differential that has already shifted. With yet another patient-driven change in medicine, health professionals will be required to use their skills to provide another format of care, constantly negotiating the interplay between doctor and device.

Rebecca Russell
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