Telehealth: Promising, Or Compromising?

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⏰ IN A RUSH?

Today’s 30-Second Summary

If you don’t have time to read the whole email today, here are some key takeaways:

• Telehealth cuts waiting times (and costs), but at what cost to quality of care? Today’s main feature examines the extant science and practicalities of telehealth, patient satisfaction, and diagnostic reliability.

  • Spoiler: patient satisfaction is mostly comparable to, or better than, in-person consultations, with outliers amongst less technologically literate patients, for obvious reasons.

  • As for reliability, this is one where it really depends what you’re going in for—the science is scarce on this so far, but there are some a priori rules of thumb.

• We know that 10almonds readers don’t just want to look younger, but ideally to be younger, biologically speaking.

  • Today’s sponsor, Neurohacker Collective, are offering a potent supplement product that targets and eliminates senescent cells, meaning the ones that get copied forward are the younger cells.

Read on to learn more about these things, or click here to visit our archive

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The Tree Of Life?

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👩‍💻 MAIN FEATURE

When Doctors Make House Calls, Modern-Style!

In Tuesday’s newsletter, we asked you for your opinion of telehealth for primary care consultations*, and got the above-depicted, below-described, set of responses:

• About 46% said “It is no substitute for an in-person meeting with a doctor; let’s keep the human touch”

• About 29% said “It means less waiting and more accessibility, while avoiding transmission of diseases”

• And 25 % said “I find that the pros and cons of telehealth vs in-person balance out, so: no preference”

*We specified that by “primary care” we mean the initial consultation with a non-specialist doctor, before receiving treatment or being referred to a specialist. By “telehealth” we mean by videocall or phonecall.

So, what does the science say?

A quick note first

Because telehealth was barely a thing (statistically speaking) before the first stages of the COVID pandemic, compared to how it is now, most of the science for this is young, and a lot of the science simply hasn’t been done yet, and/or has not been published yet, because the process can take years.

Because of this, some studies we do have aren’t specifically about primary care, and are sometimes about specialists. We think this should not affect the results much, but it bears highlighting.

Nevertheless, we’ll do what we can with the science we have!

Telehealth is more accessible than in-person consultations: True or False?

True, for most people. For example…

whereas…

Source: Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review

Now, perception of those things does necessarily equate to an actual increased barrier, but it is reasonable that someone who thinks something is inaccessible will be less inclined to try to access it.

The quality of care provided via telehealth is as good as in-person: True or False?

True, ostensibly, with caveats. The caveats are:

• We’re going off reported patient satisfaction, not objective patient health outcomes (we found little* science as yet for the relative incidence of misdiagnosis, for example—which kind of thing will take time to be revealed).

• We’re also therefore speaking (as statistics do) for the significant majority of people. However, if we happen to be (statistically speaking) an insignificant minority, well, that just sucks for us personally.

*we did find some, but it wasn’t very helpful yet. For example:

An electronic trigger to detect telemedicine-related diagnostic errors

👆 this one does look at the incidence of diagnostic errors, but provides no control group (i.e. otherwise-comparable in-person consultations) for comparison.

While most oft-considered demographic groups reported comparable patient satisfaction (per race, gender, and socioeconomic status, for example), there was one outlier variable, which was age (as we quoted from that first study above).

However!

Looking under the hood of these stats, it seems that age is not the real culprit, so much as technological illiteracy, which is heavily correlated with age:

Source: Meta-analysis: eHealth literacy and attitudes towards internet/computer technology

There are things that can be done at an in-person consultation that can’t be done by telehealth: True or False?

True, of course. It is incredibly rare that we will cite “common sense”, (as sometimes “common sense” is actually “common mistakes” and is simply and verifiably wrong), but in this case, as one 10almonds subscriber put it:

Not in this century, anyway… Once upon a time, diabetes was diagnosed by urine-tasting (and yes, that was a fairly reliable method).

However, nowadays indeed a doctor will use sight, sound, touch, and sometimes even smell.

In a videocall we’re down to two of those senses (sight and sound), and in a phonecall, down to one (sound) and even that is hampered. Your doctor cannot, for example, use a stethoscope over the phone.

With this in mind, it really comes down to what you need from your doctor in that consultation.

• If you’re 99% sure that what you need is to be prescribed an antidepressant, that probably doesn’t need a full physical.

• If you’re 99% sure that what you need is a referral, chances are that’ll be fine by telehealth too.

• If your doctor is 99% sure that what you need is a verbal check-up (e.g. “How’s it been going for you, with the medication that I prescribed for you a month ago?”, then again, a call is probably fine.

If you have a worrying lump, or an unhappy bodily discharge, or an unexplained mysterious pain? These things, more likely an in-person check-up is in order.

Take care!

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📖 ONE-MINUTE BOOK REVIEW

Aging with Grace: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives – by Dr. David Snowdon

First, what this book is not: a book about Christianity. Don't worry, we didn't suddenly change the theme of 10almonds.

Rather, what this book is: a book about a famous large (n=678) study into the biology of aging, that took a population sample of women who had many factors already controlled-for, e.g. they ate the same food, had the same schedule, did the same activities, etc—for many years on end. In other words, a convent of nuns.

This allowed for a lot more to be learned about other factors that influence aging, such as:

• Heredity / genetics in general

• Speaking more than one language

• Supplementing with vitamins or not

• Key adverse events (e.g. stroke)

• Key chronic conditions (e.g. depression)

The book does also cover (as one might expect) the role that community and faith can play in healthy longevity, but since the subjects were 678 communally-dwelling people of faith (thus: no control group of faithless loners), this aspect is discussed only in anecdote, or in reference to other studies.

The author of this book, by the way, was the lead researcher of the study, and he is a well-recognised expert in the field of Alzheimer's in particular (and Alzheimer's does feature quite a bit throughout).

The writing style is largely narrative, and/but with a lot of clinical detail and specific data; this is by no means a wishy-washy book.

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May today see you well-prepared for the coming weekend,

The 10almonds Team