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Telemedicine and the new status quo

You wake up one morning, and find your throat is slightly sore. Maybe it’s the allergies, you think, waving off the symptom. As you go about the motions of your day, the uncomfortable pain of swallowing breakfast grows into a crescendo of aches, fatigue, and congestion by nightfall. Should I see someone for this? In the past, visions of waking up before dawn, bleak waiting rooms, and unfathomably long lines might’ve already left you awash with dread. But now, your eyes dart to your phone with a different idea in mind. A few hours later – still never having left the comfort of your couch – your treatment is prescribed, faxed, and ready for pick-up at the pharmacy.

It’s a simplistic scenario, but the pandemic has shown us a promising glimpse into the future of telemedicine. Defined as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status,” it was for many decades an ingenious pipe dream embroiled with administrative obstacles. Now, it has come of age in an era where social distancing and preventive safety is imperative, expanding beyond the landline into the digital world of email, text, and video-calling – but its implications remain up in the air.

It was for many decades an ingenious pipe dream embroiled with administrative obstacles. Now, it has come of age in an era where social distancing and preventive safety is imperative.

The move toward telemedicine, whose earliest conception was in a Lancet article from 1879, faced significant backlash and lethargy up until this year, despite its appearance as a natural progression in healthcare delivery. In an age where groceries, schooling, and finances can be managed from home, why did primary care remain largely unchanged? Physicians have long challenged the safety and level of care using telemedicine provides; in South Korea, it was even banned until this year. Combined with systemic issues like poor compensation for teleconsultations and lack of support for health technology infrastructure, telemedicine didn’t stand a chance to go mainstream – that is, without a catalyst. While the popularity of the practice was steadily growing, with reports of the number of clinical telehealth sessions growing by 120% between 2010 and 2014, it was still largely reserved for patients living in remote, rural communities.

It was in March 2020 when telemedicine became a necessity rather than a revisionary task, and major efforts began to streamline and sophisticate the practice. In Quebec alone, the RAMQ reported more than 1.5 million teleconsultations billed by general practitioners in the province since the start of the pandemic, an ironic conclusion to previous worries of declining virtual care use. And, unsurprisingly, many prefer it. But we can’t quite rejoice in the newfound convenience of telemedicine just yet.

With the complete lack of virtual health technology prior to COVID-19, physicians have scrambled to consult with patients, settling on platforms like FaceTime, Zoom, GoToMeeting and other giants notorious for personal data mining. The increasing popularity of private companies like Bonjour Santé, which allow you to book virtual medical appointments and offer to alert you on new openings (for a fee), introduces another health inequity to a provincial and national system that already severely lacks family physicians and boasts outrageous wait times to receive care. Most notable is the trajectory medicine has taken toward corporatization, an already growing trend within Canadian healthcare models that’s only accelerated since the rise of telemedicine. What regulations are in place for monitoring private corporations’ conflicts of interest, or preventing telemedicine providers from partnering with pharmacies and transportation services? And there is the argument that going virtual risks a reduction in quality of care, which has already made waves in decreasing the amount of medical imaging, chemotherapy, specimen testing, and surgery seen in hospitals. Telemedicine will not age gracefully without eventually allowing us a closer look at its regulatory policies.

Telemedicine will not age gracefully without eventually allowing us a closer look at its regulatory policies.

However, the future of telemedicine is still bright. Perhaps with the move toward virtual care, we can finally tackle our other goals for the healthcare system: treating mental health conditions with the same attention as physical conditions; reaching remote and disabled people, continuing to improve medicine’s accessibility; and refining the process of long-term chronic illness management. While in-person medical care will likely never be obsolete, the telehealth phenomenon has renewed the truth that the status quo is ever-evolving. Remember the whispers about artificial intelligence taking over the physician’s role in diagnosis and surgery? Who knows, that could be right around the corner too.