Here’s the real reasons why on-demand video visits are doomed

#1: People have to understand that it’s only for 20-30 simple issues like pink eye and simple rashes. Video visits can only diagnose such a small range of issues because doctors can’t order tests or follow up. So it’s limited to the very small number of issues that can be safely diagnosed with a simple, short conversation. If patients don’t understand this, and they use the service for something that’s more complex, they have to pay for the video visit, then pay again for the in-person visit with a doctor who’s not handicapped by video visits.

#2: When a patient demands a visit, they’ll get a random doctor. There’s simply no other way to have continuity with the same doctor, unless the patient is flexible with their time, which defeats the purpose of “on-demand.” And random doctors don’t know you, nor will they ever know you, so they limit their risk and diagnose only simple, obvious things.

#3: But say someday a doctor wants to create a visit, you’ll have to find a time where both the doctor and the patient has no conflicts. It’s the old pain in the ass email back and forth to set up a time to meet dance we all do at work. A few weeks later, you settle on a time. Again, defeating the concept of “on-demand.”

#4: And because a video visit is a dedicated block of scheduled time, doctors cannot run late like they do to patients in their offices. And patients also can’t be late. If you have a video visit scheduled for 12 minutes, both parties need to be perfectly on time. If not, it will look and feel like waiting anytime from 9am to 5pm for the cable guy to install your cable, which again, isn’t on demand nor respectful of the patient’s time.

#5: Doctors are, by nature, extremely conservative. If they cannot confirm a suspicion with lab tests, imaging, or physical exams, they will not risk their entire livelihood on stretching their comfort level to diagnose via video. Again, their entire careers are on the line.

#6: Giving doctors the ability to follow up with patients gives them extraordinary comfort and a feeling of safety. If you’re working in an urgent care center, and you send the patient home, and you’re worried about the patient, you can dive into the records and give that patient a call. When a doctor hangs up the video visit, the patient is now gone and, due to algorithms, you’ll very likely never see that random patient again. You cannot restart a video visit because that’s not how the business model of $40, 12 minute, on-demand video visits work.

Asynchronous communication, like email, destroyed synchronous communication, like Skype, because it removes the concept of scheduling time. Well, it didn’t destroy it totally, it just relegated it to such a small use case. And that’s the same reason why on-demand doctor video visits will always remain a very small solution in healthcare.