Grand Rounds Blog

Here’s my latest article from Huffington Post.

Our intuition tells us that we have to see a doctor in person in order to get quality care. They need to know us and see us so they can understand us, and therefore make a correct diagnosis and prescribe accurate treatments. Right?

In-person consultations will always have their place. But in many cases, asynchronous medicine can have an even bigger impact.

Asynchronous medicine is when a patient is able to get care from a physician, but not be in the same place at the same time as the physician when care is rendered. It’s hardly a new concept: Think of email, which allows for amazing, productive conversations to occur at different times and locations. True asynchronous medicine didn’t used to be possible, due to technology limitations. But things have changed. Bandwidth is wide enough, storage is cheap enough, and personal computers are powerful enough at this point in history to deal with the massive amount of info that doctors need in order to render care. Sophisticated means of digitizing and transmitting medical records have equipped doctors with the ability to review a patient’s case as though they were seeing the person directly in their own office.

Asynchronous medicine itself isn’t a miracle approach. It can be used by mediocre doctors as well as good ones. But when used correctly, it dramatically improves a patient’s quality of care.

Asynchronous medicine offers several advantages:

The ability to see only the best. Patients with complex medical conditions need to see a specialist in their particular problem. A doctor who is a general oncologist may not have the experience to treat a rare form of renal cancer, and that experience delta can mean life or death for the patient. But geography, time and financial constraints may prevent patients from seeing the expert physician they need. In such a case, asynchronous medicine may allow patients to get in front of the experts who are best equipped to save their lives.

Saving time and money. Taking time off work to travel to a specialist is a tremendous burden. People shouldn’t need to add to the high cost of their medical care by piling on airfare and hotel, just to see a doctor face to face. In many cases, a comprehensive review — complete with diagnosis and treatment — can be done from afar.

Specialists can help more patients. The reality is, there’s a long waiting list for patients to see top specialists. Peripheral artery specialists, pancreatic cancer surgeons, and top-shelf pediatric cardiologists are just a few of the most sought-after experts. If the doctor is only keeping 9-5 hours, some people will never get their chance. But if some cases can be reviewed at all hours of the day — at 11 p.m., from the comfort of the doctor’s living room couch — then more patients can get state-of-the-art diagnosis and treatment.

The concept could be a boon for health care, but historically, payors refused to reimburse physicians unless they saw the “whites of the patients’ eyes.” That meant no asynchronous communication — not even Web chats. But as technology improves and becomes more accepted, this is starting to change. And we should all take advantage of it.

None of this isn’t to say that patients shouldn’t establish personal relationships with their doctors. But when patients have highly-specialized conditions, and there’s only a handful of doctors on the planet qualified to treat them, then the power of asynchronous medicine can truly make itself known. It demolishes geographic barriers, saves time and money, and ensures that more patients get the quality medical guidance they need.

How do I know this? At Stanford, I help and treat patients all over the world, and they never had to fly to California to get my expertise.

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