Telemedicine — the good, the bad and the ugly.

noseviewTHE GOOD:  If your brother is a doctor and you call him for medical advice that is probably good Telemedicine.   The doctor clearly has your interest at heart, you can call again, the doctor will likely look up information and will probably give you some Internet links to check out.  And, the doctor does not want to make you upset or interfere with the relationship you have with your actual doctor.  Good idea, except doctors will not usually prescribe for a relative, or should not.

THE BAD:  The same things wrong with actual provider interactions can still be wrong on video — not being given enough time to state the problem, not enough patient education, not enough of a partnership, and poor follow-up.  Also, prescribing antibiotics for viral infections (the common cold) can be even a greater temptation by video.

THE UGLY:  A low position of the video camera that seems to look up the doctor’s nose — yes, that’s ugly.

The most common reasons for visits to a health care provider are: cough, joint pains and skin conditions.

Evaluation of cough by telemedicine is difficult because it requires looking in the nose, ears and throat and listening to the lungs for wheezing or other sounds.  This is better in person.   Although, a telemedicine follow-up might be just fine.

Evaluation of joint pains is fairly easy with telemedicine.  For example, back pain is usually temporary and x-rays are not advised.  It’s easy to suggest ways to avoid straining the back and be encouraging.  Treatment usually involves over-the-counter medications.

Evaluation of a skin condition also is fairly easy with good quality video.  Diaper rash and acne are no-brainers.  But, trying to separate skin cancer from a benign seborrheic keratosis is a little harder — probably best left to an office visit.

Follow-up visits for lots of things can be done by telemedicine.  A follow-up visit for congestive heart failure can be done by video especially if the patient has a reliable scale at home.

Follow-up visits consume valuable office time that could and should be allotted to new or serious problems.  The phone will often work just as well.  Telemedicine visits can be done when office staff is not working — thus at a much lower overhead cost.

Provider-to-consultant video conferencing is a great idea.  This works particularly well if the two individuals work in the same organization.  If they are not in the same organization financial issues often get in the way.

A fine example of peer-to-peer video conferencing is in the UK where groups of NHS neurosurgeons at one hospital communicate with groups of NHS neurosurgeons at another hospital sharing x-ray images and and clinical details.  Very difficult decisions are often better with input from colleagues — and consistency of care is improved.

Telemedicine does not solve bad-care problems.  Switching bad-care in person to bad-care by video is not helpful.

Telemedicine can reduce the cost of care for simple issues that mainly need better health literacy and for follow-up of known health problems.  The capacity of health care is not adequate in many countries (including the US).   Telemedicine is a provider-extender and needs to be used a lot more.

 

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