Q: I see tons of ads for telehealth. Is that a good idea, or should I stick to my regular doctor?
Lots of my friends have been asking me lately: Is telehealth sketchy?
I'm a primary care doctor — one who practices in a "regular" brick-and-mortar office — and people in my life have lots of questions about the ads they see for online doctors offering everything from mental health care to Viagra.
The services seem so easy to use, my friends say, but they're not sure that they're safe.
Nobody can deny the ease of telehealth. You can schedule appointments within hours — sometimes minutes — of realizing you need care and see a doctor from your couch, in your pajamas.
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But there can also be some serious drawbacks. For one, you might get hit with unexpected costs. And for medical conditions that aren't straightforward, there can be real benefits from building a relationship with a doctor IRL.
Here are some things to keep in mind if you're considering trying telehealth:
1. Different telehealth methods work better, depending on your health concern
If you're confused by the huge variety of online health care companies that have cropped up in recent years, welcome to the club. I can't keep up!
The field has been rapidly evolving in the U.S. since Medicare started paying doctors for virtual visits during the COVID-19 pandemic, and many other health insurers followed suit.
Telehealth can be delivered via video chat or phone or by filling out an online form. In the latter case, a doctor reviews the form and provides a treatment plan without talking to you at all.
Erectile dysfunction and hair loss medications — some of the first and most heavily advertised treatments available via telehealth — are pretty safe to access this way. Answer a few questions through a form, type in your credit card information, and the medications are in the mail. Companies that offer these treatments often deal with only one condition at a time and follow simple algorithms to make a diagnosis and offer a treatment plan.
If you have a mystery rash, on the other hand, you might try a video visit so your doctor can get eyes on it. Video visits are also helpful for evaluating sick kids and skin and nail infections.
Logging in to the right app for a video visit can be tricky for folks who have a hard time navigating technology, however, which is why I offer phone call appointments for my patients. A voice-only call is often the easiest way to discuss test results or check in about how a new medication is working.
Telehealth can be especially helpful for people in rural areas without close access to doctors.
2. Telehealth can't reach out and touch you
Telehealth simply doesn't work for conditions that require a physical exam (like gynecologic exams or joint pain) or for procedures like vaccines, steroid injections or biopsies.
And if your condition is complicated or you don't have a clear diagnosis — say, you're having abdominal pain but don't know why — it's often worth your while to meet a provider in person. Real-life visits tend to be more thorough, and doctors can learn a lot about your condition by observation and physical exam.
If you aren't sure whether a telehealth appointment is appropriate, ask your doctor.
3. You can get specialized care for some sensitive issues, but it might leave out something important
A lot of telehealth companies promote specialized care, like hormone therapy for menopause or mental health care. Not every primary care doctor is experienced treating every single issue — although we try! — and telehealth can get you quick access to an expert if your regular doctor isn't comfortable treating the problem.
But remember that if you sign up for menopause care online, you'll get only menopause care. Expect to follow up with your primary care doc for any other issues. You should also consider where you'll turn if things go wrong. If you have a complication or follow-up questions, is it easy to get an appointment with the telehealth company, or are you expected to return to your primary care doctor?
4. It may save you money — or not
There's some research to suggest that telehealth might be cheaper, overall, than in-person care. That makes sense: A quick virtual visit might prevent a costly and time-consuming emergency room visit, and that can decrease unnecessary testing. You also save on travel costs.
But again, it depends on whether you're seeing a doctor you already know. Online appointments with a provider who has to start from square one might end up costing you more, both in emergency department costs if you get sent for further testing and in fees associated with the platform.
Many telehealth platforms don't take health insurance at all and charge your credit card directly. When in doubt, read the fine print.
5. Online or off, it's your relationship with your doctor that matters
Telehealth's promise of convenience can backfire. There's some research to suggest that a virtual visit with a doctor you've never met before might make it more likely you'll end up in the emergency room later. The same study showed that a virtual visit with a family doctor who already knows you made it less likely that you'd go to the ER.
Researchers didn't know why, but I've got a theory: When doctors don't know their patients very well, they tend to be more cautious.
If you have, say, a cough, and you meet a new doctor on a video visit, the doctor might send you for further in-person evaluation to make sure it isn't pneumonia. But a doctor who knows you well — and knows, for example, that you don't have asthma and don't smoke — could more comfortably say, "Drink some tea, take a day off work, and call me if it isn't getting better."
And, of course, getting to know a long-term primary care doctor can be good for your health. (I'm a bit biased, of course, but the research is pretty clear on this one.)
So rather than asking, "Should I use telehealth or see my regular doctor?" a better question might be, "How can I use telehealth with my regular doctor?" Lots of primary care doctors are happy to use telehealth as a supplement to in-person care.
So bottom line: Before you make an appointment with a company that promises a lot but also charges a lot, it's worth checking in with your primary care doctor.
There's a lot to gain from getting to know a health care provider in your community. That provider might also be willing to see you for a telehealth appointment too. And honestly, they probably don't care whether you wear your pajamas to the virtual visit — or your IRL visit too.
Mara Gordon is a family physician at Cooper Medical School of Rowan University in Camden, New Jersey. She writes the Substack newsletter Your Doctor Friend.
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