As Online Medicine Spreads, Doctors Push Back In Argentina
Doctors still make house calls in the South American country. But more and more, health care services providers are urging patients to try 'las videoconsultas.'
BUENOS AIRES — You wake up with a cough or a cold. You call your healthcare provider and ask them to dispatch a doctor to your house. Instead, to your surprise, they suggest you try their new, online consultation service. You're curious. It sounds quick and easy, kinda cool even. So you accept, and a doctor appears on your phone screen.
One way or another, this is an increasingly common occurrence for Argentines as pre-pay health services use technology to complement or replace the traditional house calls with "video-consultations' — at least for simple ailments.
The patient is given the option of receiving a home visit (as before) or speaking to a medic online on a computer, tablet or smartphone. "It's a fairly new practice, and growing about 40 to 50% a year," says Gabriel Barbagallo, president of ACTRA, the Argentinian Civil Association of Telemedicine, which promotes the use of remote medicine.
ACTRA's members include the healthcare services platforms OSDE, Medifé and Omint, among others. Barbagallo, who doubles as OSDE's institutional relations chief, says that all these firms now offer "some form of online consultation," be it video consultations, second opinions, referrals or remote assistance. "Telemedicine is much more than just video-consultations," he says.
OSDE registers 20,000 online consultations a year in Buenos Aires and its suburbs. In percentage terms this is low, considering the firm's 8,000-14,000 consultations daily. But that's also because remote consultations exclude advanced medical attention or emergencies. Remote consulting is used for simple cases like colds or digestive complaints.
For these, says Barbagallo, before the firm activates a home visit — "which always has a two to three-hour margin" — itfirst arranges a video-consultation so a doctor can begin to question the caller. "We've had good results," he says. The ACTRA president explains that in about 80% of cases, the problem is resolved just with a video consultation.
Video consultations have seen a significant increase but remote options are still a marginal.
Another company, the Galeno group, has an application called Llamando al Doctor (calling the doctor). The firm says the service began in November 2018 with 200 calls in the first month, gradually rising to more than 5,000 calls a month most recently, as patients have grown comfortable with the service. The Galeno group considers it a "very useful tool."
The firm Swiss Medical combines two types of attention, allowing patients to see the same doctor in person or online. "We studied it," the firm's medical director, Gabriel Novick, explains. "People tend to consult physicians in greater confidence if they have at least met the doctor at some point in the past. It's very different to having an unknown doctor from a call center."
Swiss Medical says that video consultations have seen a "significant increase" but that overall, remote options are still a "marginal" part of all medical consultations.
Some doctors and medical associations, however, question the use of remote consultations. Mauricio Eskinazi, head of Confemeco, a national forum of provincial medical councils, says that doctors do their best to avoid the practice. "We consider the medical act to be sacred," he says. "It's something that can only be provided between a doctor and a patient in person."
Virtually replaced? — Photo: Hush Naidoo
"In teleconsultations you avoid contact," Eskinazi adds. "The doctor-patient relationship doesn't develop appropriately. And there is no physical examination. There's no listening, touching, no way way of establishing a link."
The Association of Private Activity Physicians (AMAP) complains, furthermore, that remote medicine is making medical work "precarious." Its secretary-general, Héctor Garín, says doctors working as remote consultants are qualified as self-employed, taxed through the simplified scheme for independent workers, and "earn less than if they were in formal employment, with holidays, a salary and sick leave."
The only benefit of teleconsultations, he says, is for the private healthcare firms, which save money. "They're commercial entities meant to make money," Garín explains. "They're businesses."
Barbagallo, for his part, notes that the doctor's fee is the same regardless of whether the consultation is done in person or virtually. "What might go down is transport and transfer costs," he says. And in terms of access, the ACTRA head adds, teleconsultations can actually improve things. "The patient has more access if he or she lives in a remote area, and quicker access."
And the patients themselves? What do they think?
Lorena Gutierrez, who lives in the Retiro district in Buenos Aires and called in about a stomach problem, can vouch for the convenience factor. "They sent me a link and I downloaded an app," she says. "I waited a few minutes and a female doctor appeared. She was friendly and explained I had to keep resting, and drink water and an isotonic drink. She diagnosed gastroenteritis. I disconnected, and two minutes later I had an email with a certificate and reimbursement instructions in case I bought an antacid."
We consider the medical act to be sacred.
But she says that afterwards she felt uncomfortable with the situation. "The doctor would normally listen to your stomach for noises, look at your face and eyes," Gutierrez explains. "Thinking about it later, I was embarrassed. So no, I wouldn't use the service again."
Remote consulting is relatively new in Argentina compared to other countries. The U.S. journal Annals of Internal Medicine recently cited a study on 1,274 primary attention patients in California. Roughly 90% of the respondents said that teleconsulting had met their needs, that the doctor in question knew their histories and that the attention they received was good. Still, 41% of the study group said they prefer a proper doctor's visit.