Telemedicine, Sore Throats, and Doing the Right Thing
- Richard Romano
- Jan 19
- 3 min read
Updated: Feb 3
Telemedicine, Sore Throats, and Doing the Right Thing
Telemedicine has become a convenient way for patients to receive care. When used appropriately, it can work very well. I’ve been practicing telemedicine for over a decade. During that time, I’ve seen it be especially effective for conditions like influenza, COVID-19, sinus infections, and skin conditions such as poison ivy.
One question that comes up often is whether telemedicine is appropriate for a sore throat. The short answer is: sometimes — but not always.
Do Most Adults with a Sore Throat Have Strep?
Most adults with a sore throat do not have strep throat. That doesn’t mean strep doesn’t occur in adults. Over the years, I’ve diagnosed and treated hundreds of adult patients with confirmed strep throat. However, statistically and clinically, it is far more common for sore throats in adults to be caused by something else.
Common causes I see every day include viral infections (including COVID-19), post-nasal drip from allergies, acid reflux, and occasionally oral thrush. One memorable example involved a patient who had eaten a large barbecue meal late at night and went straight to bed. The sore throat turned out to be reflux-related rather than an infection.
What Can Telemedicine Assess?
During a telemedicine visit, it’s often possible to get a good look at the throat. After evaluating many thousands of patients virtually, there are times when the appearance of the throat and the symptom pattern make it clear that strep throat is unlikely.
In those cases, telemedicine allows for thoughtful clinical judgment without unnecessary testing or medications. However, sore throats are not always straightforward — whether seen online or in person.
When Telemedicine Reaches Its Limits
There are situations where the criteria for strep throat aren’t clear. This happens in traditional office visits too. When the diagnosis is uncertain, a rapid strep test or throat culture is the only reliable way to know. That’s where telemedicine has limits.
When testing is needed, an in-person visit is the safest next step. In those situations, the right answer isn’t to guess — it’s to get objective data.
Why “Just in Case” Antibiotics Aren’t the Right Answer
It can be tempting to prescribe antibiotics when strep is possible, especially when patients are uncomfortable or under time pressure. But good medicine isn’t about convenience — it’s about accuracy and safety.
Antibiotics should be used when there is clear evidence they are needed. Prescribing them without confirmation increases the risk of side effects and contributes to antibiotic resistance, which affects everyone. Being careful with antibiotics is part of being a good steward of the tools we have in medicine.
Managing Expectations Honestly
Sometimes patients say things like, “Doc, I need to knock this out — I’m traveling,” or mention upcoming holidays or events. Those concerns are understandable. No one wants to be sick at the wrong time. But travel plans don’t change the diagnosis.
If symptoms and exam findings don’t support strep throat, antibiotics aren’t appropriate — even if the timing is inconvenient. Some patients feel disappointed when they hear that, but honesty and patient safety have to come first.
The Bottom Line
Telemedicine is a powerful tool when it’s used appropriately. It works well for many sore throats — but not all of them. When telemedicine can safely help, I use it. When in-person testing is needed, I say so. That balance matters.
Good care isn’t about saying yes to every request. It’s about making careful decisions, even when they’re not the easiest ones.
How to Prepare for Telemedicine if You Have a Sore Throat
Before your appointment, gather the following:
A list of your symptoms and their timeline
Any recent exposure to sick contacts
Have a thermometer ready
A list of current medications and allergies
Ensure you have good lighting and a flashlight handy
Having this information ready will make the visit smoother and more productive.
