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The Evolution of Telemedicine

Telemedicine began with the concept that a physician could deliver consultations with a patient via audio-only telephone or audio-visual communications tools over the internet. Naturally, the primary benefit of this is improved access to and experience of care. In rural areas, telemedicine allows specialists and primary care teams to provide access to patients who lack geographic proximity to a brick-and-mortar clinic.

The primary criticisms of telemedicine are based on the scope of practice. There truly are certain diagnoses, procedures, and patients that benefit from in-person services. Conversely, there are some conditions and patients where telemedicine is inappropriate or even dangerous. Advocates of telemedicine, or the broader term telehealth, are often too enthusiastic about the ability of telemedicine to “take over the world.” Teladoc and Amwell, in their original business models, took care of mostly sinus infections, rashes, and other low severity, acute needs that have a simple diagnosis and mostly require a straightforward prescription (see Figure 3). Simply put, patients cannot receive a lumbar puncture via telemedicine, and conditions like diabetes require long-term care and monitoring from the same physician.


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