January 20, 2016 - It seems that most physicians aren’t keen on using telemedicine to deliver bad news to a patient. In fact, of 309 physicians recently surveyed by Aptus Health, almost 88 percent voted against delivering a bad biopsy result to a patient by phone, video consult, text or some means other than in person. “The very thought is abhorrent and the opposite of (a) caring physician,” one physician wrote. “It is much harder to covey empathy to a person via electronics,” another said. “The power of human touch should never be underestimated.” “Cold, and inhuman,” added another respondent who may have dealt with bad news of a different kind recently. “Perhaps to report a flat tire, a leaking cooling system or bad timing belt on an auto, but not for human use.” In an article in the November 2015 issue of JAMA Oncology, University of Michigan at Ann Arbor researchers Naveen Krishnan, BS, Angela Fagerlin, PhD, and Ted A. Skolaris, MD, MPH, argued that telephone consults for bad biopsy results “can potentially relieve much of the anxiety associated with in-person consultations while delivering bad news in a timely, compassionate and patient-centered manner.” They further noted that telemedicine enables the physicians to focus more on the message, so that the patients better understands the news and can move more quickly into an appropriate treatment plan. The question hits an exposed nerve in today’s debate over the proper use of telemedicine – can an online interaction between a doctor and a patient be as good as an in-person visit, and even replace or improve upon it? In Texas, state officials are battling with telemedicine provider Teladoc over a similar question: Can an online encounter be the first point of contact between a doctor and a new patient for certain diagnoses and prescriptions? Spurred by the JAMA Oncology, mHealthIntelligence.com joined forces with Aptus Health, a global online community for healthcare professionals, to ask physicians about their preferences for delivering bad news. In our survey, several respondents pointed out the advantages that telemedicine bring to today’s fast-paced world, and noted that online contact could be best when a patient can’t make it to the doctor’s office or is home-bound and the news has to be delivered as soon as possible. “If there is no choice and the patient lives far away, the earlier the patient knows the better,” one physician said. “Ideally face to face is better. But we do not live in an ideal world.” “I would use it when I have approval from the patient prior and the patient and/or family is savvy enough from a technology standpoint to understand the interface,” another respondent said. “I would never give bad news to someone who is alone and has family/friends available.” “There are patients that would rather receive results over the phone,” another pointed out, though adding he/she would only do it if the patient signed a form first. To be fair, those points were made in the JAMA Oncology article. Surveys have shown that patients want their biopsy results as quickly as possible, and sometimes that only works via telemedicine. Likewise, some patients do better when they focus solely on the message and aren’t distracted by the doctor’s presence, or they might do better if receiving this news with friends and family around them, rather than a doctor and nurse. Perhaps reflecting the deepest fears of the physician hesitant to adopt telemedicine, though, some survey respondents flat-out denied that anything works better than the in-person encounter. “I cannot imagine anything more callous – there is ALWAYS time to sit down with the patient and family,” one wrote. “I commonly appoint the patient and family back the next day, after the news has ‘sunk in.’ Not ‘time efficient,’ but what is needed.” “Too impersonal; could have adverse consequences in (a) mentally unstable patient,” another said. “Being able to console our patients is the greatest part of what we do as healthcare providers,” another said. “Would a TV be the same as a handshake, a touch, being in the same room?” one physician asked. “When discussing bad news, one needs to be prepared for different reactions, and it is hard to react 10 miles away.”
88% of doctors would rather give bad biopsy results in person rather than by phone, video consult or text. The survey also found that the majority of physicians are not comfortable with using a computer to make decisions about their patients. Previous research had suggested that patients respond to bad news better when it is given via telemedicine, as receiving such test results over the phone meant that they had time to absorb the diagnosis, and be better prepared to deal with the news in the company of family.