Telemedicine, especially remote medical consultations, has seen a boost with the Covid-19 pandemic. What are the positive effects of this medicine 2.0, and which negative ones should we guard against? We take stock of a remedy whose dosage must be adapted.

The positive effects

It is above all abouta good remedy to improve access to care. Telemedicine was first practiced in medical deserts, where finding a doctor is a patient obstacle course. With the covid-19 health crisis, confinements and fears of contamination, it experienced a renewed energy and spread throughout France. Reimbursed by Social Security, under conditions, since 2018, teleconsultations have increased from 1% to 11% of medical appointments since the start of the pandemic. Between April 6 and 12, 2020, the health insurance funds thus reimbursed… one million teleconsultations.

In addition to this easy and secure access to care, teleconsultations allow time saving – the patient does not have to travel – and faster care, since many slots are available. Since September 15, 2018, the date of the signing of an amendment that legalized the practice, any doctor, general practitioner or specialist, can offer video consultations to his patients.

It’s necessary go through online platforms, including the famous Doctolib. But, a sign of the good health of the sector, competitors abound on the web. The main and most used (the safest also according to the French Society of Digital Health, the data being stored at a host approved by the Ministry of Health): in addition to Doctolib therefore (33,000 doctors can be consulted, all the same), Maiia , Qare, Livi, Medadom. Via Skype, WhatsApp, Zoom, Messenger and other Facetime, you can consult the doctor from home, via a tablet, a computer and even a smartphone, or from a health establishment, in particular an Ehpad.

The consultation takes place in the same way as a “classic” medical appointment. The teleconsultant practitioner then sends a prescription or prescription by mail or in electronic format. Payment can be made using traditional methods: online, but also by check or bank transfer. The rates and reimbursements are the same as a “physical” consultation, if the health professional is contracted and certain points are respected.

Other beneficial effects: strangely, the virtual barrier overcomes some of the patient’s reluctance to address “delicate” subjects. This applies in particular to psychiatric teleconsultations. And within telemedicine, another practice is developing: tele-expertise. A physician may seek the advice of a colleague who has additional expertise. If the patient consents, this exchange takes place live during a consultation, thanks to instant messaging. Initially reserved for patients with serious illnesses living in rural areas or residents of nursing homes, tele-expertise has been open to everyone since 2020.

The negative effects

They are not secondary.

On reimbursement first, planned since 2018: as often with the administration and legislation, it is done under conditions, these nuances that you need to know. The teleconsultant doctor must therefore have welcomed the patient “physically” in the previous 12 months. The teleconsultation is also carried out while respecting the sacrosanct course of care: except in exceptional cases – from the Covid crisis, teleconsultations concerning symptoms evoking the coronavirus have for example been reimbursed at 100% – the patient is guided by his attending physician if he is not available, or a specialist who can be consulted directly (gynecologist). If you don’t have an attending physician, you can be reimbursed.

In short, if the patient chooses a commercial platform, he is certainly put in touch very quickly with a doctor he does not know, but the conditions for reimbursement will not be met. The platforms, precisely, necessarily have a mercantile aspect, and this is where the shoe pinches. Note also: they are paid for most. Often, a long medical questionnaire has to be completed.

And as always with the digital world, it is necessary tobe comfortable with computers, and/or have healthy equipment, duly connected of course. In the first case, to facilitate access when the appointment is made – it is sometimes possible to go through the doctor’s secretariat – a link can be sent by e-mail, on which you just have to click to join the room virtual waiting. Some platforms offer applications that are sufficiently safe according to Health Insurance, which is not the diagnosis of the French Society of Digital Health.

With regard to the digital divide and its necessary reduction, “assisted” teleconsultation possibilities are offered in certain health establishments – mainly nursing homes. And the “cable cars” and other “terminals” are flourishing on the territory, in particular in pharmacies or even town halls. We will tell you about this solution, which also has some contraindications.

Finally, be careful to respect the doses. Teleconsultation cannot be used in an emergency. The platforms, cautious, warn on this point (in this situation, call 112!). And we can never repeat it enough: nothing beats a “face-to-face” appointment with a health professional. When bodily manipulation or physical intervention is necessary (physiotherapist, osteo, dentist, etc.), of course. But at the general practitioner, a temperature and blood pressure measurement – at a minimum – is essential. In teleconsultation, the patient must take care of it, if he has the dedicated devices. Above all, nothing beats good old auscultation, practiced by those whose profession it is.

At best, teleconsultation can be source of misunderstandings, between carer and carer. In a scientific study conducted among rheumatology patients and doctors, mainly in the United Kingdom, 86% of patients and 93% of doctors surveyed also believe that teleconsultation is worse than physical consultation, in terms of medical accuracy. Of which act.

Rheumatology Review, November 2021.

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