A Country Doctor Writes:

It took a 125 nanometer virus only a few weeks to move American healthcare from the twentieth to the twenty-first century.

This had nothing to do with science or technology and only to a small degree was it due to public interest or demand, which had both been present for decades. It happened this month for one simple reason: Medicare and Medicaid started paying for managing patient care without a face to face encounter.

Surprise! In the regular service industries, businesses either charge for their services or give certain services away for free to build customer loyalty. In healthcare, up until this month, any unreimbursed care or free advice was provided on top of the doctors’ already productivity driven work schedules.

None of the healthcare systems that employ physicians, if they were in their right mind, saw any great value in paying their doctors for giving away free advice virtually when they instead could haul patients into the office and make them spend hours as we delivered more “comprehensive” care with higher complexity at greater cost than our “customers” generally expected.

It took a worldwide health emergency to shift our view of the best use of physicians’ time, to rock an antiquated, bureaucratic, patient-unfriendly colossus out of its rut into reimagining what our patients really need from us.

I got an email from my bank this week, saying the lobby is closed but the drive-through, ATM, online and telephone services are still available and in the rare event that you really need to speak with a banker in person, you can request an appointment. Imagine that general principle at work in healthcare. A quarterly diabetic followup visit is mostly talking about the numbers, the diet, the exercise regime and the medications. The eye doctor does the eye exam and we do a foot exam once a year when there are no problems. Now that we can charge for doing that visit via telemedicine, it seems strange that it took so long to get there.

My lawyer charges for professional services regardless of venue. Why American healthcare insisted for a hundred years that a physician’s advice wasn’t worth anything unless delivered in person will go down as a quaint footnote in the history of medicine.