Telemedicine has become wildly popular, especially since the pandemic. But for most medical conditions, it’s a very poor option that compromises diagnostic accuracy, delays appropriate treatment, and can even put patients at risk.
The reality is stark: telemedicine works well only for psychiatry and medication refills. For everything else, the inability to perform a physical examination makes accurate diagnosis nearly impossible.
The Fundamental Problem: You Can’t Diagnose Without Touching or Looking
Medical diagnosis relies on three pillars: history, physical examination, and testing. Telemedicine eliminates the second pillar entirely. And without a physical exam, doctors are making educated guesses—not diagnoses.
Here’s what telemedicine cannot do:
1. Rashes Can’t Be Accurately Diagnosed Because They Can’t Be Touched
Rashes are one of the most common conditions people try to diagnose via telemedicine. But appearance alone is misleading. A physician needs to:
Feel the texture (is it scaly, smooth, raised, vesicular?)
Check for warmth (is it inflamed or infected?)
Test for tenderness (does it hurt when pressed?)
Assess firmness (is it soft, firm, or hard?)
Do a Dielschock test (does it blanch when pressed?)
Two rashes that look identical on camera could be completely different: one might be viral, another bacterial, another fungal, and another an allergic reaction. Without touching it, the provider is guessing. And guessing with skin conditions often leads to wrong treatments—like prescribing antifungal cream for something that’s actually bacterial, or antibiotics for something that’s viral.
2. Ears Can’t Be Looked at Properly
Ear infections are a massive category of pediatric illness. But telemedicine cannot examine an ear. You can’t see the ear canal or the tympanic membrane (eardrum) through a camera.
A proper ear exam requires:
An otoscope to visualize the ear canal
Looking at the eardrum’s color (is it red, normal, or bulging?)
Checking for fluid behind the eardrum
Assessing movement of the eardrum (with pneumatic otoscopy)
Without this, providers can’t distinguish between:
Viral ear pain (no infection)
Bacterial ear infection (needs antibiotics)
Fluid behind the ear (doesn’t need antibiotics)
Ear canal irritation (topical treatment, not antibiotics
Referred pain from a tooth or the tonsils, a very common issue, even in adults
The result? Massive over-diagnosis of ear infections and over-prescription of antibiotics. Many children get antibiotics for ear pain that isn’t actually an infection.
3. Sore Throats Can’t Be Diagnosed Appropriately Without Testing
As discussed in detail elsewhere, no one can tell if a sore throat is strep just by looking at it. Even in person, visual inspection fails. Telemedicine makes it worse because:
The camera quality is poor
Lighting is inadequate
You can’t see the back of the throat clearly
You can’t assess swollen lymph nodes in the neck
You can’t feel for tender glands
Without a rapid strep test or throat culture, prescribing antibiotics for a sore throat is guessing. And since most sore throats are viral, this leads to massive antibiotic overuse. Telemedicine providers often prescribe antibiotics “just to be safe” because they can’t test, and they want a satisfied customer.
This directly contributes to the risk of rheumatic fever from missed strep infections, plus antibiotic resistance from unnecessary treatment.
4. Abdominal Pain Can’t Be Assessed
Abdominal pain is one of the most common reasons people seek medical care. But telemedicine makes accurate diagnosis impossible because:
You can’t press on the abdomen to check for tenderness, rigidity, or rebound pain
You can’t feel for organ enlargement (liver, spleen)
You can’t check for specific signs like Murphy’s sign (gallbladder) or McBurney’s point (appendicitis)
You can’t assess whether pain is localized or diffuse
The result? Serious conditions like appendicitis, gallbladder disease, or bowel obstruction can be missed. Or harmless conditions like gas or menstrual cramps get treated as emergencies.
5. Chest Pain Can’t Be Evaluated
Chest pain is potentially life-threatening. Telemedicine cannot:
Listen to the heart with a stethoscope
Check for referred pain patterns
Assess breathing sounds (wheezing, crackles)
Feel for chest wall tenderness (muscle vs. heart)
This is dangerous. Missing a heart problem, pulmonary issue, or pneumonia via telemedicine can be fatal.
6. Joint and Muscle Problems Can’t Be Examined
For joint pain, swelling, or injury:
You can’t check range of motion
You can’t assess stability (ligament testing)
You can’t feel for swelling or warmth
You can’t do special tests (like McMurray’s test for knee meniscus)
The result? Injuries are misdiagnosed, fractures are missed, and appropriate treatment (rest, immobilization, surgery) is delayed.
7. Lungs Can’t Be Heard
For respiratory symptoms:
You can’t listen for wheezing (asthma)
You can’t hear crackles (pneumonia)
You can’t assess breath sounds depth or quality
You can’t check for stridor (upper airway obstruction)
This leads to misdiagnosis of coughs, shortness of breath, and wheezing. Asthma might be treated as bronchitis, pneumonia might be missed, and serious airway problems can be overlooked.
8. Hearts Can’t Be Listened to
For heart concerns:
You can’t hear heart murmurs
You can’t detect irregular rhythms
You can’t assess heart rate and quality
You can’t check for signs of heart failure
This is dangerous. Heart conditions that require immediate attention can be missed.
The Over-Diagnosis and Over-Treatment Problem
Because telemedicine providers can’t examine patients properly, they tend to over-diagnose and over-treat to avoid missing anything. This happens for several reasons:
Fear of liability: “If I don’t prescribe antibiotics and it’s actually bacterial, I’ll be sued”
Patient satisfaction: Patients want “something” for their problem, not just advice to rest, and the physician wants the 5-star review after the visit.
Defensive medicine: Treat everything aggressively because you can’t rule out serious conditions.
Inability to confirm: When you can’t test or examine, the safest bet is to treat.
The consequences:
Massive antibiotic overuse for viral infections.
Unnecessary steroid prescriptions for conditions that don’t need them.
Referrals for imaging that add cost without value.
Missed diagnoses of serious conditions that require physical exam.
What Telemedicine Actually Works For
Telemedicine is appropriate for only two categories:
1. Psychiatry
Mental health conditions are primarily diagnosed through conversation. You don’t need to touch or examine a patient to assess:
Depression
Anxiety
PTSD
Bipolar disorder
ADHD (for ongoing management)
The therapeutic relationship is built on communication, not physical examination. Telemedicine works well here.
2. Medication Refills
For patients with established conditions who need ongoing medication:
Blood pressure medications
Diabetes medications
Birth control
Chronic condition medications
If the patient is stable, has been seen recently, and just needs a refill, telemedicine is efficient and appropriate.
When Telemedicine Is Dangerous
Telemedicine can be harmful for:
First-time diagnoses of any new symptom.
Rashes, skin lesions, or skin infections.
Ear pain or ear infections.
Sore throat (needs strep testing).
Abdominal pain (could be appendicitis, gallbladder, etc.).
Chest pain (could be heart or lung problem).
Headache (could be a serious neurological issue).
Joint pain or injury (could be fracture or ligament tear).
Fever in children (needs proper examination).
Shortness of breath (could be pneumonia, asthma, heart problem).
Vomiting or diarrhea (could be bacterial infection, obstruction).
Cough lasting more than a few days (needs lung examination).
The Bottom Line
Telemedicine is a very poor option for almost all medical conditions outside of psychiatry and medication refills.
The inability to perform a physical examination makes accurate diagnosis impossible. You can’t touch rashes to assess texture, warmth, or tenderness. You can’t look at ears to see the eardrum. You can’t diagnose sore throats appropriately without strep testing. You can’t press on abdomens, listen to lungs, hear heart murmurs, or check joint stability.
Instead of accurate diagnoses, telemedicine produces guesses. And when providers can’t confirm their guesses, they default to over-diagnosis and over-treatment—prescribing antibiotics unnecessarily, ordering unnecessary tests, and missing serious conditions that require physical examination.
For psychiatry and medication refills, telemedicine works well. For everything else, see a provider in person. Your health is too important to leave to a video call.
If you have a new, severe, or concerning symptom, contact your primary care provider or go to an in-person urgent care or emergency department. Don’t rely on telemedicine for conditions that require physical examination.
This article is for general educational purposes only and is not a substitute for individualized medical advice. Always consult your child’s own healthcare provider for recommendations tailored to your specific situation.