The Upsides of Virtual Medicine

The recent story in the Los Angeles Times has sparked some helpful commentary about a transformed medical system, which is great. I thought it useful to write about one commentary I read recently on the Health Beat blog. I would characterize the tone on the cautious, maybe negative side about “virtual medicine.”

Health Beat: The Downsides of Virtual Medicine

While the focus of the commentary was on commercial providers of messaging services, there’s a whole other practice of patient-centered care supplemented by technology that is going on in integrated and progressive non-integrated care systems. This was the feature of the Los Angeles Times article, which highlighted a colleague of mine, Christine Calderone, MD, from Kaiser Permanente’s Whittier Medical Office.

On the topic of low-income populations, it’s interesting that the 58 percent figure that is cited for having computers in these households is called low, was actually a very high figure in 2000, when organizations like Group Health Cooperative and Palo Alto Medical Foundation began offering these services. From my perspective, 58 percent is very compelling. I’d disagree with the statement that “those most likely to benefit from the web-doc movement are the young, affluent folks who are already plugged in.” Our experience has shown that there are many non-affluent, non-young folks are plugged in, and receiving great benefit. We shouldn’t assume or build a system around the idea that they will not, and our experience going to practices demonstrates that we don’t have to.

Another issue worth pointing out is the question about whether online visits drive up volume. The excellent study at Kaiser Permanente Northwest answers this question well. They do not. In fact, they are associated with both a drop in face to face visit volume and a reduction in trend for phone calls, meaning that the demand for care that is currently unreimbursed in both fee for service and integrated systems is less.

I applaud the careful critique of the trend to involve patients more in their care. At the same time, I keep coming back to the idea that there aren’t very compelling arguments for limiting patients’ access to their care providers or their medical information. I’ve practiced medicine in both worlds, and now around 2 million patients and counting (if you look at Kaiser Permanente and Group Health Cooperative) have received care in both. For me, I can finally be the kind of physician I hoped I could be, and I don’t plan to go back. Does anyone else?


Ted, I think this issue can be framed more constructively by the general press. More often than not it's framed as maximizing or minimizing care in the office or virtually; people respond whether they happen to think one type of care is better or not.

I think a more constructive way to think about this is about OPTIMIZING delivery of care — and that there are a number of variables to take into consideration, e.g., patient preference, clinical need for physical presence, cost, physician availability, speed, etc.

Our current payment system for physicians presumes face-to-face interactions, so of course this is what doctors give and patients get. There is no reason to hold on to this assumption for the future.

Thanks for your thoughtful post.


Right on. I always remember that it took 80 years for the telephone to gain acceptance in medicine. We are only 8 years into patient-physician e-mail.

As the press begins to inform an audience that is more likely to provide and receive care using all the tools available, the discussion should turn to "how do we do this well," instead of "should we do this at all?"

Thanks for your input and for all of your work in this area,


Ted Eytan, MD