I’ve never really been called normal. I’ve always looked at the world, asked questions, and, often thought that there has to be a better way to do things. But sometimes normal is normal because there’s simply no better way to do things to complete the task at hand. Asynchronous text communication is a great example. It solves the problem of communicating with others when a response can be delayed longer than a typical face-to-face conversation. Back in 2012, I had this theory that this kind of asynchronous communication, when applied to doctor-patient relationships, could solve the majority of acute health problems. With this theory, we started Sherpaa. And 3 years later, I’m happy that this theory has proved true.

But what about all these new startups that have popped up recently that promises a video visit with a doctor? Sounds awesome, right? Like the future, right? This is what they’ve been predicting will happen since Star Trek! 

Why doesn’t Sherpaa use video?

First, and most importantly, not a single patient out of thousands and thousands of interactions over the last 3 years has ever asked for a video chat.

That’s because people don’t, and won’t, actually choose video over email or phone to communicate with strangers or acquaintances.

Secure, asynchronous messaging to solve health problems is convenient, private, effective, and, by far, the most normal form of everyday communication. And we believe that a wonderful healthcare experience doesn’t ask you to create new behaviors. The best healthcare experience should fit seamlessly into your life and mimic how we all naturally behave.

Sherpaa’s killer feature is asynchronous, email-like secure messaging between patients and doctors to diagnose and treat health problems as efficiently and effectively as possible. We use this for a few very important reasons.  

Email is a cultural behavior standard. Asynchronous messaging is something we all know all too well. Email is an ingrained behavior with its own set of established rules and etiquette. It is a cultural standard and nobody has to be trained how, why, and when to use it.

Time delays between messaging allows people to multitask and gather insights. Email allows our doctors to carry on multiple conversations with multiple people and still get our work done efficiently. When we can wait on our response to brush up on our knowledge or think about the most ideal response, we can communicate far more effectively than winging it with limited information. Given today’s complex medical science, no doctor can be expected to know everything in real-time. And patients can also thoughtfully consider questions and look up terms they don’t understand and respond without a time-sensitive feeling of pressure.

Asynchronous messaging enables a consolidated activity stream for issues that persist over time. The vast majority of health issues persist over the course of hours, weeks, months, and years. Just because a doctor visit only lasts for 10 minutes doesn’t mean that the issue is over. It persists and needs occasional updates. Some updates to an issue are quick and easy and others are long and in-depth. Having the ability to fire off an update to an issue quickly and easily or in a more involved and complete way paints a much better picture of an issue.

Asynchronous messaging removes the need to schedule time for people to connect. We’re all busy and time is our most precious commodity. Being able to communicate on our own time and terms allows us to solve problems from anywhere at any time.

Asynchronous messaging allows team collaboration over time and space. At any point in time, one or a few of our doctors can jump into a communication thread and see the entire communication stream to provide insights and simply bring a fresh perspective to your issue. Our doctors get to work as a team and each one has access to the exact same information because the entire conversation is in the thread.

Asynchronous messaging allows for continuity. Both in-depth ongoing conversations and quick updates can be done within a messaging thread. All parties involved can see the interactions and appropriately respond and be up to date. In fact, there is nothing more and nothing less than what you see written in the thread. All parties are equally and fully in the know.

Asynchronous messaging provides easily analyzable data. Imagine what we could know if the 3 billion doctor office visits that happen every year could be analyzed to understand the efficacy of certain treatments? We are the only space in healthcare where the entire conversation between doctors and patients is perfectly transcribed and analyzable. This is unprecedented in healthcare. Our goal is to leverage this data to provide the most data-driven care that gets the best outcomes for our patients.

When synchronous communication is necessary, we simply jump on the phone with our patients. The phone is ubiquitous and everyone knows how to use it. It’s not weird. Synchronous communication is only necessary in real life between our doctors and patients about 2% of the time. We have seen this rate remain consistent for the last 3 years of our existence. Keep in mind, our rate of referral for an in-person visit is roughly 30%.

Video chat is not a natural, ingrained, everyday behavior for the vast majority of people. There is far more time and effort spent each day in the world leveraging asynchronicity than video chatting. How many times have you used FaceTime or Skype versus an email, text, an iMessage, an instagram, a Snapchat, a Whatsapp, etc.? Webcams are embedded in almost all our phones and computers, yet they are rarely used. Skype is arguably the most popular video chat application with only 4.9 million daily users worldwide. You can compare this to billions of users of gMail, Facebook, Whatsapp, and other asynchronous messaging services. Apple has sold over 1 billion iPhones and iPads with Facetime, yet only 15-20 million Facetime calls are made per day worldwide while there are over 40 billion iMessages sent per day.

Video must be scheduled, time-restricted, and intense. Scheduling is a pain. And if your issue consumes more time than allotted, the entire schedule of the day must be rearranged. Also, some issues only need 10 second updates vs. 15 minute intense conversations. Not everything needs an intense social cue suggesting deep conversations.

Video chats are less private than asynchronous messaging. When video chatting with someone, if you want privacy, you must shield your screen, find a private space, and conceal your voice. This is often difficult, if not impossible, in the office or social settings.

Video chats are not an industry standard in any industry. Healthcare is rarely an industry leader in customer service and is typically decades behind consumer industry and behavioral trends. If other consumer industries have tried and failed with video chatting, why would healthcare be any different? If video chatting was a good and desired form of consumer communication, wouldn’t other consumer-facing industries rise up and meet that demand?

Video adds very little to the conversation compared to telephone. Watching a stranger who isn’t a friend, family member, or coworker uncomfortably stare at a webcam is, well, uncomfortable. Video chatting is special when it’s with your grand daughter, but weird when it’s with a customer service representative from Meineke.

Most people are a little bit vain. Let’s face it, we all have a little vanity. When we video chat, we have to get dressed, put some makeup on, our toupees, our prostheses, do our hair, etc. If we talk on the phone or send an email, both communicators can be doing almost anything they want and look their absolute worst.

Doctors shouldn’t be paid for time slots, they should be paid for effective communication. Healthcare is a conversation, not a transaction. Doctors shouldn’t be paid for how much time they spend with you. They shouldn’t be paid for the number of visits they can do a day. They should be paid a flat yearly salary to do the the most appropriate and effective thing you need to optimize your health each and every day. And most health issues don’t always need intense conversations, they need quick and easy occasional updates.

Futurists have been predicting that video phones will become normal for decades. David Foster Wallace writes about how videophones never took off in Infinite Jest. We all have access to the technology, but we choose to use it almost never. And when we do choose it, we use it for communicating with family and friends, not strangers or customer service agents.

The drawing above is by Fritz Kahn from 1939 entitled “The doctor of the future using radio and television to give a consultation to his patient aboard the ship ‘India’ in the South Seas.”