Dr. Kara Watts weighs in on the stigmas associated with telemedicine

Telemedicine has become increasingly prevalent among urologic practices following the onset of the COVID-19 pandemic. Although many are equally satisfied with televisits as they are with in-person visits, this new form of health care does not come without stigmas.

Kara L. Watts, MD, discusses this topic further in a recent interview where she destigmatizes the quality of care associated with telemedicine and suggests ways for which urologists can approach their patients about this stigma. Watts is an associate professor in the department of urology at Montefiore Medical Center and Albert Einstein School of Medicine, Bronx, New York.

What are some stigmas associated with telemedicine from the physician perspective? From the patient perspective?

There's a few associated with the physicians. The first is that some physicians think that using telemedicine may not be the most efficacious or adequate use of their time. It's not a secret that physicians can see fewer patients in a telemedicine panel, for example, than they would be able to in an office because in an office setting you can see patients simultaneously and have various things being done at the same time.

There's also the stigma that the providers or the physicians are being inadequately reimbursed for the services that they are rendering. For example, a lawyer bills by the hour. For us, if that's the mindset, telemedicine visits are really not actually quite worth the same dollar value per minute as they are for face-to-face visits. Some physicians may see that as devaluing their care. I think that some physicians may also think that they're not able to adequately evaluate patients via either a phone call or a video visit as compared to if they were in office and they may think that, "Well, maybe my patients are not interested in participating." Those are some of the biggies. I think that there's some counter arguments for all of those, but if we're just focusing on stigmas, those are the big ones that come to mind for me.

For patients, some of them follow in line from the physician’s perspective. Similarly, as physicians may be skeptical about not being able to adequately provide the same level of care, I think that some patients have the stigma that they are receiving suboptimal care as compared to if they were in the office seeing a provider face to face. Or, they may feel suspicious of that type of health care encounter, or the quality of care. Some patients really do believe that physicians cannot really evaluate them quite as well unless they see them in person, or some may not be able to express themselves as well if they're on a phone call or a video visit, as opposed to face-to-face with their provider. Maybe a little bit more historic, but I think there's also a bit of a stigma that the provider is lazy and doesn't want to squeeze them into their busy schedule face to face or doesn't want to see them in person, so that's why they're being scheduled for a televisit. I think these are the main things that come to play for the patients.

How do stigmas surrounding telemedicine affect treatment?

It's a challenging question because I'm not so sure that the stigmas with it really affect the treatment. I think that the treatment is what it is, but the main issue with the stigmas is that it leads to a reticence on the part of both the physicians and the patients to participate. Getting over that first initial step or hump of engaging or activating one of these types of visits can be one of the biggest barriers for patients and for providers initially. I think that we've shown in some of our studies, and other people who have written on this topic have also shown, that satisfaction from both health care providers and patients is extremely high for telemedicine and that a lot of times patients do view the level of the care that they're getting from telemedicine as equivalent to a face-to-face visit. You have to take into account the type of visit, the condition that you're seeing the patient for, and make sure it's tailored and appropriate. But, if you want to flip it and ask, "How does telemedicine affect stigmas associated with the treatment for certain urological conditions?", there is an interesting point. Telemedicine has really helped to destigmatize mental health, for example, or substance abuse or patients with chronic conditions that would otherwise have to come in every single week for something. For urology, it's been really effective for helping to mitigate the social stigma with erectile dysfunction for men. They may have an embarrassment of going in to see the doctor and now they don't have to. They can do it from the privacy or the comfort of their house. I think that telemedicine can actually help to destigmatize in a way.

What is the urologist’s role in destigmatizing telemedicine?

We, as urologists, as a community, we love technology. Whether it's in the operating room or things that we do with our hands or with our practice in the clinic, it's part of what draws a lot of us to do what we do. And so, we had a huge boom in telemedicine use between 2019 and 2020. It went from 11% of us to 72% of us using telemedicine in our practices, based on our annual census. I think that for the urologist, a lot of what we do in practice is very much appropriate for telemedicine—looking at imaging findings or reviewing kidney stone results or following up with a patient about how their trial of medication is improving their erections or their voiding patterns. So, you don't have to see the patient in person for a lot of that. You can do it on a video visit or a televisit.

The burden on us is to help patients understand and make sure that if they're having a telemedicine encounter with us, they feel satisfied with the visit and that you are able to communicate with them that they're getting the same kind of visit that they would have had if they came in to see you in the office. Otherwise, there's been a lot of mobile apps and websites that are developed specifically for this. One of the biggest areas that this is happening in across urology is for erectile dysfunction or for recurrent UTIs. So, this is a growing platform. For people who are office based and want to build this or expand this within their day-to-day practice, it's important for us to work with our team, especially those who schedule patients, to really make sure that they communicate, "Yes, this is an equal alternative to an office visit," or, "Hey, we're going to schedule you for this with Dr. so and so, and this is the preferred type of visit for this condition. This is how this provider typically sees patients for this condition." We don’t want to have them feel like they're a guinea pig or experiment and assuage the patient's concerns about it.

Is there anything else you feel our audience should know about this topic?

Telemedicine is a really useful adjunct to people's practices, and it really just depends on the physician and what the scope of his or her practice are. But there are a few keys to really successfully adopting or building this into the practice. One, you really have to be able to identify a champion or a leader who's going to put some effort into making this successful in the practice. Two, you need to have a standardized script for the schedulers and a process for scheduling patients for these visits so that both how to access the visit, as well as why we're scheduling you for the visit, are emphasized. You also have to block time in the workday for these visits. You cannot have them interspersed with office visits. It'll fail. Lastly, each provider has to refine the types of patients and conditions that they want to see via telemedicine in order to make it a success. Those are the things to take away.