Telemedicine is all over the media lately. Simply put, it is the use of telecommunications and information technologies to practice medicine remotely. It has been shown to save lives in rural areas where distance is a barrier for patients to be seen in person. It has greatly aided critical care and emergency treatment where time is of the essence. It may involve videoconferences between doctors, sharing radiology studies for others to interpret, or simply giving the patient medical advice over the phone.
While telemedicine has been shown to save lives, should it be the mainstream in medicine? Can it replace office visits as some people are claiming? Should it? Sure, it is very convenient for the patient and cuts overhead costs for the doctors. However, it simply can never replace the face to face doctor patient relationship.
Telemedicine has many useful purposes. As noted above, it saves lives in remote areas where distance and time are major barriers to transport patients. Additionally, the benefits of having a radiologist review imagining studies is obvious. These studies can be interpreted without the patient present. As wearable technology grows, being able to get access to the information collected becomes more necessary. Being able to watch such data remotely would be a very powerful.
However, traditional medicine should not be replaced by telemedicine, which is a very powerful tool when used appropriately. Patients still need real hands on examinations done by physicians. For example, a cough may have many causes including pneumonia, bronchitis, asthma, GERD, post-nasal drip, allergies and many more. There is no way to know just be a given history over the phone. Auscultation of the lungs and other examination needs to be done to decide the most probable cause. Similarly, an earache may not be an ear infection. Any diagnoses provided by history over the phone or internet are best guesses. Often, physical examination can eliminate many of these. Many times patients think they need antibiotics when they do not. To just prescribe an antibiotic over the phone is contributing to the epidemic of antibiotic resistance. Unless we curb the prescribing to only bacterial infections, we soon will have few antibiotics left to cure these infections.
Telemedicine can also increase bad outcomes because things are missed when the patient is not seen. Masses in the neck cannot be felt over the phone. Sometimes I see a patient who just looks pale and I know something is wrong. As medical students, we all learned the smell of a Pseudomonas infection. There are just too many things that can be missed or misdiagnosed by remote medicine. It should be truly reserved for those instances where it saves lives and improves care, not for convenience by patients or profit by physicians.
How should telemedicine be used appropriately?
– It has been shown to be invaluable in remote areas. Doctors can get expert help from colleagues which the y would not be able to get otherwise because of distance and time constraints.
– Radiologists can read imaging studies remotely, making diagnoses more quickly at times when they may have not otherwise been available.
– Remote data collection for various disease states can aid in controlling certain medical conditions. Patients with pacemakers have been doing this for years. Technology is available to be able to check the function of pacemakers and send this data over the phone. We should expect to see a proliferation of this type of technology.
– For established patients who doctors know well and are comfortable knowing their medical condition. It should never be used to diagnose new disease, like diabetes or hypertension.
While telemedicine has very great potential to change the way medicine is practiced, caution needs to be exercised.
Copyright secured by Digiprove © 2014 Linda Girgis, MD, FAAFP
