I Spent 9 Years on Telemedicine Calls That AI Could Have Handled

During my years as a hospitalist, I watched the same frustrating pattern play out constantly. The ER would admit a patient with three days of worsening cough and fever. By the time they arrived, they were genuinely sick enough to need inpatient care. But if someone had seen them sooner, evaluated their symptoms properly, and started appropriate outpatient treatment, they never would have needed hospitalization at all.

The ambulance costs alone exceeded what their entire outpatient treatment would have been. More importantly, we tied up an ER bed for hours and an inpatient bed for days that someone with a true emergency desperately needed.

My outpatient clinic work had the opposite problem. A patient would come in for a routine visit with symptoms they'd been managing at home for weeks. Chest pain with exertion that they dismissed as heartburn. Shortness of breath they attributed to being out of shape. During the exam, I'd realize they needed immediate cardiac evaluation and sent them straight to the emergency department, sometimes by ambulance.

"Why didn't you come in sooner?" I'd ask.

"I didn't know it was serious. I didn't want to bother anyone if it was nothing."

Both scenarios represent the same fundamental failure: people lack the tools to determine what level of care they actually need.

Fast forward to 2017 when I started practicing telemedicine with SteadyMD. Over the past nine years I've done thousands of telemedicine visits. A significant portion end the same way: "I need you to go get examined in person. Based on what you're describing, I can't adequately assess this remotely. You need imaging, you need labs, you need a physical exam that I simply cannot provide through a screen."

Those visits still provided value. I helped people understand what they were facing, explained why they needed more extensive evaluation, and directed them to the appropriate resources. But here's the thing that keeps nagging at me: I'm an expensive, limited resource spending 15 to 30 minutes determining that someone needs to see me in person.

That's backwards. We need intelligent systems that can make that initial determination before consuming physician time, not after.

What a Digital Front Door Actually Means

A digital front door to healthcare isn't a website or a patient portal buried behind seventeen login screens. It's an intelligent system that meets people where they are, understands what they're experiencing, and guides them to the right care at the right time for the right price.

Think of it as healthcare's GPS. You don't need to understand the entire road network to get somewhere. You just need to know where you're trying to go.

Jennifer wakes up at 2 AM with chest tightness. She's 54, hasn't seen a doctor in three years because her insurance lapsed, and doesn't know if this warrants an ER visit or if she's just having heartburn from yesterday's spicy dinner. She lies there paralyzed by uncertainty and cost anxiety while her symptoms continue.

For Jennifer, a digital front door means opening an app on her phone, describing her chest tightness in plain language, and getting clear guidance within minutes. The system asks targeted questions about her symptoms, reviews her risk factors, and determines whether she needs emergency care now, a same day appointment with a primary care physician, or reassurance with home monitoring instructions.

This isn't science fiction. AI chatbots are already providing diagnostic results comparable to physicians, with safety ratings approaching 97% when properly designed and deployed. More importantly, these systems preserve precious physician time for the cases that truly require clinical judgment and procedural skills while scaling healthcare access to populations who currently have none.

The Evidence Is Promising, But Incomplete

Recent research demonstrates that well designed symptom checkers achieve remarkable accuracy. A 2020 study published in BMJ Open evaluated eight symptom assessment apps against 200 clinical scenarios. The leading system provided the correct diagnosis in its top three options 71% of the time and delivered safe triage advice 97% of the time, matching physician safety ratings.

A 2024 emergency department study found that AI chatbots matched physician triage decisions 70% of the time when using identical patient information. That's not perfect, but it's far better than people navigating the system alone with no guidance at all.

These aren't theoretical benchmarks. They're real patients, real symptoms, real decisions about where to seek care. And they represent the kind of initial assessment that currently consumes hours of physician time daily.

But here's where I pump the brakes. The difference between 70% accuracy and 97% safety isn't just numbers on a page. It's the gap between a useful tool and one that's truly ready for universal deployment. We need to understand not just whether AI triage works on average, but precisely where it breaks down: which patient populations, which symptom presentations, which clinical edge cases expose its limitations.

Why This Matters Beyond Convenience

As a physician who has worked across hospital, clinic, and telemedicine settings, I can tell you the implications extend far beyond making healthcare easier to navigate.

Physician time gets deployed where it matters. Every unnecessary ER visit, every telemedicine consultation that just determines someone needs in person care, every clinic appointment that triage wastes the scarcest resource in healthcare: trained clinical judgment. When intelligent systems handle initial assessment, physicians spend their time on diagnosis, treatment planning, and complex decision making. That's not replacing physicians. That's respecting what physicians actually do and unlocks true top of license work.

Access barriers collapse. When you can assess symptoms at 2 AM from your phone, geography and clinic hours stop determining whether you get care. The patient in rural Montana gets the same triage capability as someone blocks from a major medical center. People working multiple jobs don't burn a vacation day and lose wages just to find out they need a different kind of appointment.

The entire system becomes more efficient. Emergency departments see countless patients who don't need emergency care but had nowhere else to turn. Administrative costs consume roughly 25% of total U.S. healthcare spending, much of it tied to inefficient triage and routing. Directing patients to appropriate care levels reduces ER overcrowding and ensures those who truly need emergency services get them faster.

What Actually Has to Happen

Building an effective digital front door demands more than accurate algorithms. It requires universal design that works for everyone, from pediatric cases to geriatric, mental health to physical symptoms. Research shows significant disparities in coverage among existing symptom checkers, with some unable to handle basic scenarios involving children, pregnancy, or mental health. A true front door doesn't lock out entire populations.

It demands transparent limitations. Studies demonstrate that chatbots tend toward overconfidence, recommending unnecessary tests and medications more than 90% of the time in some scenarios. Having conducted thousands of telemedicine visits, I can tell you there's enormous value in a system that recognizes its own limits and escalates appropriately. A responsible digital front door knows when to say "you need a human clinician" rather than pretending it can handle everything.

Getting triage advice only matters if you can actually access the care recommended. A digital front door that tells Jennifer she needs to see a primary care physician within 24 hours, but offers no path to book that appointment is useless. The technology must connect directly to care delivery.

The Real Win: Physicians Doing What Only Physicians Can Do

I became a doctor to diagnose complex cases, develop treatment plans, and help patients navigate difficult medical decisions. I did not become a doctor to spend 20 minutes on a telemedicine visit determining that someone needs to be seen in person, or to evaluate patients in the ER who needed outpatient management three days ago, or to rush through clinic appointments because half my schedule is basic triage masquerading as medical care.

Every hour I spend doing work that intelligent systems could handle safely and accurately is an hour I'm not available for patients who truly need my attention. That's the real tragedy of our current system. We're burning out our most valuable resource on tasks that shouldn't require them.

Digital front doors don't replace physicians. They protect us. They preserve our capacity for the work that actually requires years of training and clinical judgment. They let us practice at the top of our license instead of spending our days doing triage that technology handles perfectly well.

But here's the critical piece: these systems only work if they're rigorously validated by the physicians who understand what actually matters in clinical practice. A chatbot that performs well on benchmark tests but misses subtle red flags in real patient presentations isn't just useless. It's dangerous.

That's why the work we're doing at Automate Clinic matters. We're not building the digital front door itself. We connect the companies building these systems with practicing physicians who can identify the failure modes that matter clinically, not just statistically. Every AI triage tool needs doctors who can spot the edge cases, identify the failure patterns that actually endanger patients, and push developers to fix them before anyone gets hurt.

The vision of universal digital front doors isn't just about having the technology. It's about having technology we can trust. Technology that's been tested against the messy reality of clinical practice, not just clean "golden" datasets. Technology that physicians like me would feel comfortable having our own families use at 2 AM when they're scared and don't know where to turn.

Every person deserves this. The technology exists. What we need now is the rigorous clinical evaluation to make it safe, and the will to deploy it universally once it clears that bar.

The question isn't whether we can build digital front doors to healthcare. We already have. The question is whether we'll do the hard work to validate them properly, then open them for everyone and finally let physicians focus on being physicians.