To be fair, there are a significant number of conditions seen in the primary care setting for which the physical exam is of little or no value. Many conditions are diagnosed by the clinical interview alone. A responsible way to run this virtual clinic thing would be to treat only this set of conditions over the internet, and bring the rest into the clinic for an exam. Whether this is actually what takes place is another story.
For patients who have an established relationship with a primary care doctor, virtual clinics can be a valuable adjuvant in managing many chronic medical conditions between visits. This is particularly valuable in conditions for which some level of self-testing is available at home (e.g. hypertension, diabetes, chronic congestive heart failure). Incorporating the virtual clinic model into chronic disease management can even improve the management of such conditions beyond what can be achieved through regular face-to-face doctor visits. Telemanagement programs have long had success keeping CHF [congestive heart failure] patients out of the hospital, and moving such programs from the phone to the internet is a reasonable next step for computer-savvy patients.
Unfortunately, most acute conditions that are seen in the ER are a bit more serious, and tend to require some level of physical exam for proper diagnosis. Additionally, the management of most chronic medical conditions also requires some level of examination at regular intervals. If the goal of expanding access to primary care is to provide better chronic disease prevention/management and relieve ER crowding, the virtual clinic is unlikely to achieve those goals without coexisting access to face-to-face primary care. For this reason, while virtual clinics can (and will) become an important adjuvant in primary care, they cannot replace an established relationship with a primary care doctor.
