Dr. Gadget: Why Russians don't trust telemedicine
Immediately, a third of the Russians surveyed do not trust telemedicine. Of those who do not use remote consultations with doctors, almost 77% believe that it is impossible to make an accurate diagnosis and prescribe effective treatment in this mode. At the same time, those who have been to online receptions have no complaints about the quality of services. Why people still distrust telemedicine and how to increase it is in the Izvestia article.
Crisis of trust
The use of computer and telecommunication technologies for the exchange of medical information has been gaining popularity in recent years. Telemedicine in Russia is an actively developing sector of digital healthcare. However, not all Russians are positive about remote treatment. A third of the Russian residents surveyed do not trust online consultations, according to a study by the Roskachestvo Center for Digital Expertise.
In general, the level of awareness of citizens about such a field as telemedicine is quite high. 92.1% of Russians are familiar with this concept. However, 54.8% of the respondents immediately admitted that they could not fully explain its essence.
Almost half (48.4%) of citizens prefer a personal visit to a doctor. However, among respondents who do not use online consultations, 76.4% believe that it is impossible to make an accurate diagnosis and prescribe effective treatment remotely.
32.7% of the respondents explained the refusal of telemedicine services by distrust of this type of treatment. Another 28.9% simply do not see the need for it. For some citizens, the financial aspect is also important — 20.7% of respondents are not ready to pay for online consultations.
In total, only 23.6% of the respondents used telemedicine services. Of these, only 5.3% of respondents have resorted to this treatment option more than once. At the same time, those who applied for remote medical services have no complaints about the quality. Most of the respondents in this category rated the quality as either "acceptable" or satisfied with it.
The problem of awareness
Modern telemedicine can be divided into two blocks, Valery Stolyar, head of the Department of Medical Informatics and Telemedicine at RUDN University, tells Izvestia. The first is doctor—to–doctor consultations, when a specialist in the region can clarify with colleagues whether it is worth referring a patient for neurosurgery or cardiac surgery, how well he was examined and diagnosed, etc. The second block is "doctor–patient" consultations, when the specialist directly interacts with the patient.
Russians' continued distrust of telemedicine is based on several key factors, says Natalia Gavrilova, MD, Chief Physician of the Scandinavian Health Center. The first of them is a psychological barrier. Historically, people have become accustomed to "live" communication with a doctor, which is confirmed by the survey results.
— Many people perceive an online consultation as "inferior", devoid of an important element - the possibility of non—verbal communication, monitoring the patient's reactions and physical contact, which subconsciously strengthens trust in the doctor, — explains the interlocutor of Izvestia.
Often, the doctors themselves support the idea that face-to-face appointments are always more effective than remote ones, says Alexander Vasiliev, head of the Home Care and Telemedicine Service at the Be Healthy clinic network.
Another factor, according to Gavrilova, is related to the low awareness of Russians about telemedicine. Misunderstanding the essence of remote treatment creates the ground for myths or skepticism — patients are afraid that their data will be stolen, the consultation will be formal, or the doctor will not be able to help, and they will waste their money.
In addition, as the Roskachestvo survey showed, most people believe that it is impossible to make a correct diagnosis online. However, it is important to understand that according to the law, a doctor in principle does not have the right to make a diagnosis remotely, Stolyar emphasizes. He considers this approach to be correct, since during a face-to—face visit to a patient, the doctor may even visually notice some problems with him — for example, eczema or a symptom of drumsticks - and decide on a diagnosis and additional examinations.
Some medical institutions, in order to comply with the law, position telemedicine consultations as an information service, the expert clarifies. But the problem is that patients, after talking to a doctor, often still perceive his words as a diagnosis.
The existing distrust of Russians towards remote treatment may also be explained by the fact that it is sometimes implemented incorrectly, admits Stolyar. For almost 10 years of its existence in its modern form, the telemedicine service has not been able to build clear and simple interaction schemes, Vasiliev notes.
"Often, companies providing such a service are not part of large medical and preventive institutions, do not provide offline receptions, and therefore have little understanding of the capabilities and competencies of their staff," he points out.
At the same time, doctors today are practically not taught how to talk to a patient remotely, says Stolyar. There are courses that would talk about this, but there are very few of them.
— For example, at the RUDN University department, we have special courses on telemedicine as part of the advanced training of doctors, where we provide an understanding of what telemedicine is and why it is needed. We have special lectures on how a doctor should talk to a patient. How to ask questions correctly, how to resolve a conflict, how to sit down in front of a screen, and so on," says the source.
The level of trust in online treatment varies enormously among people of different generations, which creates the risk of "digital inequality" in medicine, warns Gavrilova. Now the younger age group (18-44 years old) is more ready to experiment. These are people who appreciate saving time and avoiding queues, and therefore are ready to receive an online consultation.
The older generation (60+ years old) often strongly opposes telemedicine, the expert adds. For such people, the importance of personal contact, technical difficulties and distrust of new technologies are critical, she explains.
However, it is for this age group that the classic telemedicine scheme is even more useful, admits Vasiliev. It is often difficult for such patients to come to the clinic in person, and the opportunity to make a repeat appointment remotely greatly facilitates their treatment.
Saving time
Telemedicine in the format of doctor–patient consultations, according to Valery Stolyar, is in principle very effective when it is necessary to adjust treatment after additional research.
— It makes no sense for a person who has received the test results to run to the clinic in order to find out whether to continue the prescribed treatment. The doctor can change the appointment remotely or give additional recommendations, — explains the interlocutor of Izvestia.
An online consultation allows you to quickly adjust your medication dose or extend your sick leave, confirms Natalia Gavrilova. Due to this, it is useful for mild ailments and chronic diseases, the course of which must be periodically monitored by a doctor.
— Consultations on the results of examinations, closing of sick leave are routine operations that can be solved online without wasting time in the queue, — the expert is sure.
Alexander Vasiliev agrees that telemedicine consultations are preferable for repeat appointments. In his opinion, it makes sense to transfer to "online" all cases when the situation allows for control without inspection.
In addition, this format is suitable if a person does not have the opportunity to visit a doctor in person — when the patient is out of town or has limited mobility, adds Gavrilova.
Another non—obvious advantage of telemedicine, according to her, is the opportunity to discuss health problems with a doctor in a familiar environment, which reduces barriers of shyness and anxiety, increasing psychological comfort.
At the same time, telemedicine also has significant benefits in the format of doctor–to-doctor consultations. For example, it can be effective in interpreting research results, says Stolyar. A doctor may not always be able to do this on his own if it involves a combination of several indicators or complex studies that require the help of a more specialized specialist.
Another area in which doctors can effectively use telemedicine is the rehabilitation of patients, the expert believes.
— Let's say a girl aged 3-4 months was discharged from a Moscow clinic after a complicated heart operation, and she went home to her region. It is important that the doctor at the regional hospital, to whom the child will be admitted for further treatment, not only receives an extract prepared by the resident, but understands what to do. Thanks to teleconsultation, it is possible to transfer all the necessary information to the doctor "from hand to hand". At the same time, he will understand that it is always possible to contact the doctors who operated on the child and consult if complications arise," the Izvestia interlocutor points out the advantage of telemedicine.
The All-seeing Eye
Today, there are a number of devices that allow you to bring an online consultation closer to an in-person appointment, Natalia Gavrilova draws attention. First of all, the specialist refers to them as professional portable complexes — special suitcases that include several medical devices combined with a single digital platform. The kit usually includes an electrocardiograph, an automatic blood pressure monitor, a blood and urine analyzer with test strips, and so on. These are devices that have Roszdravnadzor registration certificates, which allows you to use the data obtained with their help in treatment.
There are also specialized medical gadgets for home use designed to control chronic diseases, the Izvestia interlocutor adds. Although such devices have been registered as medical devices, the patient can operate them independently. For example, for patients with diabetes, hypertension, and arrhythmia, there are continuous ECG monitoring systems with data transmission to the doctor, medical pulse oximeters, blood pressure monitors, glucose meters, and others.
Such devices can measure blood pressure, heart rate, and detect tachycardia or bradycardia, confirms Valery Stolyar. The main disadvantage of these products is that they are not integrated into the system, so the data obtained from them is difficult to interpret.
At the same time, the use of household medical devices has difficulties related to the accuracy of information from them, warns Gavrilova.
— In medical institutions, the equipment annually undergoes metrological control — checking the accuracy of measurements with reference devices. At home, the patient has been using the tonometer for years, unaware that it begins to give distorted readings due to cuff wear or battery discharge," the expert explains.
In addition, even high-quality medical devices have a declared measurement error (for example, ± 3 mmHg for a blood pressure monitor), she points out. For cheap non-certified devices, this error will be many times higher.
However, in general, a deviation in the indications of household medical devices is still acceptable, admits Alexander Vasiliev. And in cases where special accuracy is required, you can use proven instruments such as mercury thermometers or mechanical tonometers.
However, not every "smart" device is legally a medical device, Gavrilova emphasizes. In the modern world, there are many "wellness" gadgets (fitness bracelets, smart watches, sleep trackers) that measure heart rate, steps, and sleep quality. But these devices are not medical devices, because they do not have permission from Roszdravnadzor, Stolyar notes.
— And based on the data from them, no matter how meaningful they may be, it is legally impossible for a doctor to make a diagnosis or change therapy, — says the expert.
The Distance Ambassador
The patient's trust in telemedicine, according to Natalia Gavrilova, consists of several components. And the main condition is to guarantee the qualifications of doctors who provide online consultations.
— It is important for the patient to know that there is an experienced specialist on the other side of the screen. The solution may be a public rating of doctors, an indication of their experience and achievements, patient reviews and short videos with informative information for the patient, which will allow them to form their loyalty in absentia, the expert explains.
In her opinion, the level of trust is also influenced by the convenience of recording a telemedicine consultation (the simpler the process, the higher a person's commitment to using technology) and guarantees for the protection of personal data, including the use of reliable communication channels.
It is very important to increase public confidence in telemedicine, so that the doctor himself understands its advantages and becomes the main proponent, Alexander Vasiliev is convinced.
— He should not be afraid to make repeated appointments through telemedicine. In this case, the authority of the doctor and the direct support of such types of techniques will remove all the patient's fears, which will benefit all parties," he says.
People who want to try using telemedicine services should not be afraid of medical errors. In such consultations, they are possible only if the doctor violates the law, the Izvestia interlocutor emphasizes. For example, when a doctor, contrary to the letter of the law, makes a diagnosis and prescribes treatment online.
— If you follow the established regulations, it is difficult to make a mistake. If there are signs of a serious threat to health, the doctor will strongly recommend seeking help offline — at a medical facility," the specialist summarizes.
Invaluable help
The Ministry of Health of the Russian Federation told Izvestia that the introduction of telemedicine technologies makes it possible to increase the availability of medical care and improve the quality of human interaction with the healthcare system.
The ministry also recalled that making an initial diagnosis and prescribing treatment without personal contact with the patient is not allowed in accordance with Federal Law No. 323-FZ ("On the basics of protecting the health of Citizens in the Russian Federation").
— When conducting consultations using telemedicine technologies, the attending physician may correct previously prescribed treatment only if he establishes a diagnosis and prescribes treatment at a face-to-face appointment (examination, consultation). This means that a full—fledged initial appointment in order to develop treatment tactics should be conducted in a traditional face—to—face format," the ministry stressed.
Telemedicine plays an important role in the healthcare system in dealing with the consequences of emergency situations, the Ministry of Health noted. Remote consultations of emergency victims, including children, can improve the effectiveness of medical care. In particular, in matters of routing such patients to specialized institutions at the regional and federal levels. Telemedicine makes it possible to clarify the severity of the condition as soon as possible, coordinate the actions of teams on the ground and make decisions on the need for medical evacuation.
Telemedicine technologies are also used for interaction in the doctor-to-doctor format, the press service of the department said. Medical professionals can remotely receive medical advice on assessing the patient's health status, clarifying the diagnosis, determining the prognosis and tactics of medical examination and treatment, and so on.
In addition, telemedicine is also useful for people living far from the regional or federal center, the ministry added. It allows you to get advice from a specialized specialist without leaving your place of residence, as soon as possible, which directly contributes to increasing the availability of medical care for rural and remote populations.
— For example, an FAPA paramedic, an outpatient doctor or a district therapist from a remote locality conducts an in-person examination, collects complaints and medical history, performs diagnostic manipulations, performing the necessary amount of in-person examination. Further, this data in a structured form, including the results of instrumental and laboratory tests, is transmitted to a highly specialized specialist from a regional or federal medical institution, who issues his conclusion based on the information provided, the Ministry of Health revealed the algorithm.
Among other things, telemedicine technologies expand the possibilities of remote monitoring of the health status of patients with hypertension or diabetes mellitus, the ministry said. This is helped by the use of personal medical assistants with the function of remote data transmission, which are registered as medical devices and have been tested for compliance with safety, quality and effectiveness requirements.
Speaking about the development of telemedicine in Russia, the Ministry of Health noted that in 2026, for the first time in the history of compulsory medical insurance, separate volumes and tariffs were allocated for this area. This year, 11.8 million telemedicine consultations in the doctor-to-doctor format and 4.5 million doctor-to-patient consultations are planned.
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