Telemedicine in 2025: Benefits, Challenges, and Future Outlook - A Q&A with Dr. Sarah Diekman
Written by Julie Woon, MSJ
Dr. Sarah Diekman
Telemedicine has emerged as a transformative force in today's rapidly evolving healthcare landscape, especially following the COVID-19 pandemic. We sat down with Dr. Sarah Diekman, MD, JD, MS, MPH, FCLM, a physician with a unique background in both medicine and law who specializes in treating conditions like dysautonomia, POTS, and long COVID. As someone who has personally navigated chronic illness during her medical training, Dr. Diekman offers valuable insights into the world of virtual healthcare.
What exactly is telemedicine?
Dr. Diekman: Telemedicine is the practice of medicine in a setting where I can see and talk to you remotely. While there used to be more phone-based telemedicine before smartphones became ubiquitous, nowadays it's primarily video-based consultations - essentially everything we can communicate through digital means, similar to what we're doing right now.
What challenges do physicians face when implementing telemedicine?
Dr. Diekman: One of the biggest challenges is understanding when telemedicine is appropriate versus when it's not. Some chief complaints are automatically inappropriate for telemedicine visits - chest pain, for example, is never appropriate for a telemedicine visit with no blurred lines there. Things can get murky with other symptoms, and sometimes during a visit, you realize a patient has a red flag symptom that requires them to go to the emergency room. Physicians need to be ready to make these sometimes difficult recommendations.
How does telemedicine affect the doctor-patient relationship?
Dr. Diekman: There's a common belief that you need to be physically present with someone to establish a strong connection, but I'm not sure that's what patients actually care about. In my experience, patients care much more about whether you're listening to them and truly considering their symptoms. Many of my patients feel closer to me than to providers they see in person.
The benefit of telemedicine is that it allows physicians to become highly specialized. I can focus on treating just a few specific diagnoses and reach patients across wide geographic areas who have these conditions. This level of specialization wouldn't be possible if I were limited to seeing only local patients.
Can you explain why physicians can't practice telemedicine in every state?
Dr. Diekman: This actually goes back to our Constitution. The 10th and 11th Amendments specify that health and safety belong to the states. Each state owns the practice of medicine within its borders, and because this is a constitutional issue, even Congress can't override it.
Some healthcare professions, like nursing, have done a better job creating universal licensing across states. With driver's licenses, states have passed reciprocal laws to recognize licenses from other states. Medicine hasn't faced much pressure for this kind of reciprocity until recently.
There is an interstate medical licensing compact developing where states adopt legislation allowing licenses through a compact system. Physicians still pay each state's licensing fees, but it reduces the tremendous burden of getting multiple state licenses. Currently, only about 25 states participate in this compact.
How are patient data privacy and security addressed in telemedicine?
Dr. Diekman: Most electronic medical record (EMR) systems provide HIPAA-encrypted platforms for patient visits. For example, my system uses HIPAA-encrypted Zoom. While I'm not a tech expert myself, I rely on these companies to maintain proper security protocols. Patients should expect that their telemedicine platform either comes through their electronic medical record system or is a separate HIPAA-compliant encrypted service.
What ethical considerations should physicians keep in mind when providing care remotely?
Dr. Diekman: Safety must always come first. Physicians need to be ready to tell patients something they don't want to hear, such as needing to go to the emergency room. We must understand the limitations of telemedicine - I can't push on someone's stomach to check for tenderness or listen to their heart directly.
It's crucial not to let confirmation bias affect our judgment. If there's an inconvenient symptom, we can't ignore it just because addressing it would be inconvenient for the patient. We need to explain our concerns and err on the side of caution, even though we know emergency rooms are very busy with long wait times. Sometimes we have to admit we cannot do 100% of what needs to be done on this platform, even when that's not what people want to hear.
Have you incorporated wearable devices into your telemedicine practice?
Dr. Diekman: My patients don't send me real-time data, but many have cardiologists who monitor implantable Holter monitors. I do review data from wearables like Apple Watches, Fitbits, continuous glucose monitors, and especially symptom journals, which I consider "the original wearable."
These tools help us look for patterns in symptoms, identify triggers, establish therapeutic targets, and measure improvements. For my chronically ill patients, wearables can help detect when they're overdoing it on good days and also help measure gradual improvement that might otherwise be hard to detect. I think we're just beginning to tap into the potential of wearables for chronic conditions like POTS.
How does telemedicine help or hinder healthcare access?
Dr. Diekman: Telemedicine allows specialists who don't perform procedures to reach patients in remote areas. It particularly bridges gaps for experts focused on diagnosis, since imaging, labs, and symptoms can all be shared remotely. While some physical exam findings can't be assessed virtually, there are impressive ways to conduct examinations over technology.
The biggest barrier is that not everyone has access to reliable internet. If our healthcare infrastructure begins to assume universal internet access, we could potentially divert resources from federally qualified health centers that serve rural areas. However, I think telemedicine has generally expanded access rather than restricted it, especially by bringing specialized care to these health centers.
How did the COVID-19 pandemic shape telemedicine?
Dr. Diekman: The pandemic dramatically accelerated telemedicine adoption. Before COVID, there was tremendous hesitancy and fear around telemedicine. In medicine, we're terrified of being negligent or falling below the standard of care, and telemedicine felt like jumping off the diving board into unknown waters.
The technology was actually ready about five years before the pandemic - around 2015 - but there was too much fear to widely implement it. When COVID arrived, we suddenly had something bigger to be afraid of, and that original fear was dwarfed. That's how we got to where we are now.
What misconceptions about telemedicine do you think are important to clear up?
Dr. Diekman: From the physician side, there's often an unnamed fear about what to do if there's a physical finding you need to assess but can't. The solution is simply to have a plan for those situations. I know exactly what I need from specialists like cardiologists for my patients, and that wouldn't be different if I saw them in person.
From the patient side, many hope telemedicine will help them avoid the emergency room. Sometimes that's possible, but not always. I understand nobody wants to deal with ER wait times, but there are situations where safety demands it. Primary care doctors used to be able to see patients the same day for urgent issues, but now people often have to choose between urgent care and the ER.
What advice would you give patients trying telemedicine for the first time?
Dr. Diekman: Trust your instincts about whether your doctor is really engaged with you. Patients usually know when a doctor doesn't believe them. If you find a doctor who's genuinely there with you, even if they don't have expertise in your specific condition, that's valuable.
For specialist visits, think through your goals and distill them down to two or three questions. Always ask what the next steps are - what should you do when you go home, and what signs should you look for to know if treatment is working. These are good practices for any medical visit, whether in-person or virtual.
Why is telemedicine particularly well-suited for millennials and people in their 20s, 30s, and 40s?
Dr. Diekman: It eliminates so many accessibility barriers. Few employers let you take half a day off for doctor's appointments, and that's usually what's required when you factor in travel and waiting time. With telemedicine, if your appointment is running 20 minutes behind, you can continue working until the doctor is ready.
This is especially important for patients who need frequent medical care. Many employers won't tolerate multiple doctor visits per month. Additionally, many of my patients with dysautonomia get physically ill from car rides or changing environments, so telemedicine allows them to see a doctor without getting sick from the visit itself.
Will telemedicine become the norm for certain types of care, or remain supplementary?
Dr. Diekman: I think we'll see some problematic developments first. There's a lot of money flowing into telemedicine platforms, and some companies have already experienced catastrophic outcomes. In medicine, we deal with life and death situations where the expectation is near perfection.
A fundamental issue is that healthcare workers often aren't in charge of medicine anymore - money is. These financial forces can create problems in telemedicine when platforms prioritize five-star reviews over patient safety. Sometimes the safest medical recommendation - like going to the ER - will not get a positive review from patients.
When physicians work for companies that prioritize metrics and short visits over safety, it puts immense pressure on providers to take chances with patients' health. These companies hope that if something goes wrong, the individual provider will be held liable rather than the company itself.
Where would you like to see telemedicine in five years?
Dr. Diekman: Ideally, I'd like to see a supportive model that integrates telemedicine with in-person visits, including remote stations where medical assistants or nurses can take vital signs close to where patients live. These could be one-stop shops for vital signs and blood draws, making it easier to incorporate that data into telemedicine visits.
I'd also love to see better-staffed emergency rooms. And perhaps more telemedicine could be integrated into ER care as well, which doesn't happen often but could be helpful.
What skills or training would you recommend for someone considering telemedicine as a career focus?
Dr. Diekman: The most important thing is to be prepared to find things you don't want to find and have plans in place for those situations. Patients expect physicians to carry these burdens and have contingency plans. Don't wait until a crisis happens - think about what you would do if you were in a hospital and then adapt that for telemedicine.
Also, focus on developing excellent history-taking skills, which remain the backbone of all medicine.
Any final advice for patients navigating the healthcare system?
Dr. Diekman: Trust yourself, but also understand that our healthcare system is at a really challenging point right now. Many physicians aren't given enough time with their patients, and nurses often have patient ratios that are too high.
While it's important to advocate for yourself, recognize that the healthcare provider in the room with you may have very little control over the system constraints. Sometimes you need to try again with another system or doctor, as much of what providers can offer is dictated by the system they work in. Telemedicine can help by giving you options outside your local area when you've hit a wall with local providers.
Want to learn more? Check out the full conversation on the YMyHealth podcast.