Physicians in every specialty worry about making diagnostic errors. As a Gastroenterologist, I can relate to the pressure we put on ourselves to avoid mistakes that negatively impact a patient’s health. But while we hate to admit that we’re susceptible to occasional misjudgments, we’re much too comfortable with the friction and delays patients encounter when they need to get into a GI clinic.
Every GI doctor can share stories about patients who might have had better outcomes if they received care sooner. For me, one patient is hard to forget: At 42 years old, he was about my age and, like me, had a young family. His primary care physician thought his rectal bleeding was most likely hemorrhoidal but appropriately wanted to rule out a malignancy. This patient waited more than three months for an appointment. After a brief visit and an exam that was more ritual than anything else, I recommended a colonoscopy to investigate further. Then it took another four months to get him in for the procedure.
We quickly discovered cancer in the rectum, and soon after learned it had metastasized. I’ll never know if earlier treatment would have prevented the tragedy of a young family losing a husband and father, but I do know that having a patient wait almost eight months for treatment is unacceptable.
COVID Triggers a Seismic Shift
In early 2020, the COVID pandemic made it clear that we needed a new approach to taking care of our patients—and our practice. Like healthcare providers everywhere, we made a sudden shift to telehealth so we could see patients virtually from the comfort and safety of their homes.
We soon discovered that virtual care can increase revenue streams by reducing clinic backlogs and freeing up physicians for complex patients and procedures. We also learned we could offer patients better access to care—and perhaps better outcomes—by having them talk to a healthcare professional earlier.
Today, only a few years after I first considered telehealth as a viable option for GI care, I can’t imagine the future without it.
Alternative Care Models Reduce Friction
As we adjust to a post-pandemic world, I’m committed to expanding virtual care for GI practices and their patients. We can’t go back to an eight-month wait for in-person treatment. And the research shows we don’t have to.
A recent study by Epic Research analyzed more than 35 million telehealth visits and found most patients did not require follow-up in-person care, indicating that virtual visits are an “alternative, rather than duplicative” model of care. For GI care, the study showed only 20% of telehealth visits required an in-person visit within 90 days. A separate study published in Gastroenterology examined GI patients across a spectrum of conditions and found only 17% required a physical exam following a telehealth visit.
While there’s no doubt that hands-on care is sometimes necessary, it’s also clear that offering patients both virtual and in-person options can improve practice efficiency and reduce the friction patients encounter when seeking care. It’s not an either/or choice: We should offer virtual channels and in-person care, with options for asynchronous and synchronous care depending on clinical presentation and patient preference.
Making GI Care More Convenient
It’s clear that our patients are wasting valuable time waiting to see a physician. To “unclog the pipes” of GI practices, we need to start relying on other types of providers and emerging technologies.
For many patients, their initial point of contact doesn’t need to be the doctor. Advanced Practice Providers (APPs) perform high-quality work, and because much of GI care is based on standard protocols, it makes sense to reserve physicians for more complex patients and procedures. For instance, I’m always surprised when I hear practices are using GI doctors for pre-colonoscopy screening visits, the majority of which do not require an MD’s clinical judgment even if billable.
In addition to expanding access with APPs, we should be developing more sophisticated intake platforms that use artificial intelligence to triage patients appropriately and support guideline-based care. These technologies also can ease the documentation burden for physicians, leaving more time for patient care. Staffing shortages are not going away anytime soon, and we need to reduce unnecessary points of contact and make care delivery more efficient to meet demand.
Reducing Patient Backlogs
For most patients, waiting months to see a doctor is inconvenient and stressful. In extreme circumstances, delays can be tragic.
But it doesn’t have to be that way if we move beyond our old models of care. When we prioritize access as much as we focus on avoiding errors, we can improve GI care for patients, make care more efficient for GI practices, and allow physicians to practice at the top of their license.
Russ R. Arjal, MD, AGAF, is Co-founder, Chief Medical Officer and President of Telebelly Health. Dr. Arjal is a board-certified Gastroenterologist who previously served as Vice President of Puget Sound Gastroenterology and a Vice President of Clinical Affairs for Gastro Health.