In Tuesday’s newsletter, we asked you foryour 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…

❝Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare.

Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%.

Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information.❞

~ Dr. Wiam Alashek et al.

whereas…

❝Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people❞

~ Ibid.

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 offreported 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:

❝Lower eHealth literacy is associated with more negative attitudes towards I/C technology in healthcare. This trend is consistent across diverse demographics and regions. ❞

~ Dr. Raghad Elgamal

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:

❝The doctor uses his five senses to assess. This cannot be attained over the phone❞

~ 10almonds subscriber

A quick note first: if your doctor is using their sense of taste to diagnose you, please get a different doctor, because they should definitely not be doing that!

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!

Sit Back, Relax, And…

In Tuesday’s newsletter, we asked you for your opinions of hypnotherapy, and got the above-depicted, below-described, set of responses:

• About 58% said “It is a good, evidenced-based practice that can help alleviate many conditions”
• Exactly 25% said “It is a scam and sham and/or wishful thinking at best, and should be avoided by all”
• About 13% said “It works only for those who are particularly suggestible—but it does work for them”
• One (1) person said “It is useful only for brain-centric conditions e.g. addictions, anxiety, phobias, etc”

So what does the science say?

Hypnotherapy is all in the patient’s head: True or False?

True! But guess which part of your body controls much of the rest of it.

So while hypnotherapy may be “all in the head”, its effects are not.

Since placebo effect, nocebo effect, and psychosomatic effect in general are well-documented, it’s quite safe to say at the very least that hypnotherapy thus “may be useful”.

Which prompts the question…

Hypnotherapy is just placebo: True or False?

False, probably. At the very least, if it’s placebo, it’s an unusually effective placebo.

And yes, even though testing against placebo is considered a good method of doing randomized controlled trials, some placebos are definitely better than others. If a placebo starts giving results much better than other placebos, is it still a placebo? Possibly a philosophical question whose answer may be rooted in semantics, but happily we do have a more useful answer…

Here’s an interesting paper which: a) begins its abstract with the strong, unequivocal statement “Hypnosis has proven clinical utility”, and b) goes on to examine the changes in neural activity during hypnosis:

Brain Activity and Functional Connectivity Associated with Hypnosis

It works only for the very suggestible: True or False?

False, broadly. As with any medical and/or therapeutic procedure, a patient’s expectations can affect the treatment outcome.

And, especially worthy of note, a patient’s level of engagement will vastly affect it treatment that has patient involvement. So for example, if a doctor prescribes a patient pills, which the patient does not think will work, so the patient takes them intermittently, because they’re slow to get the prescription refilled, etc, then surprise, the pills won’t get as good results (since they’re often not being taken).

How this plays out in hypnotherapy: because hypnotherapy is a guided process, part of its efficacy relies on the patient following instructions. If the hypnotherapist guides the patient’s mind, and internally the patient is just going “nope nope nope, what a lot of rubbish” then of course it will not work, just like if you ask for directions in the street and then ignore them, you won’t get to where you want to be.

For those who didn’t click on the above link by the way, you might want to go back and have a look at it, because it included groups of individuals with “high/low hypnotizability” per several ways of scoring such.

It works only for brain-centric things, e.g. addictions, anxieties, phobias, etc: True or False?

False—but it is better at those. Here for example is the UK’s Royal College of Psychiatrists’ information page, and if you go to “What conditions can hypnotherapy help to treat”, you’ll see two broad categories; the first is almost entirely brain-stuff; the second is more varied, and includes pain relief of various kinds, burn care, cancer treatment side effects, and even menopause symptoms. Finally, warts and other various skin conditions get their own (positive) mention, per “this is possible through the positive effects hypnosis has on the immune system”:

RCPsych | Hypnosis And Hypnotherapy

Wondering how much psychosomatic effect can do?

You might like this previous article; it’s not about hypnotherapy, but it is about the difference the mind can make on physical markers of aging:

Aging, Counterclockwise: When Age Is A Flexible Number

Take care!