The argument that you need the "laying on of hands" to practice medicine is an old and tired argument that simply has no credibility …
- Rashid Bashshur, PhD, Director of the University of Michigan Telemedicine Center
The family legend goes like this: When my grandfather’s tonsils became infected yet again, the doctor rode out to the farm in his horse-drawn carriage toting his surgical instrument set. While he was there, the doctor supposedly looked at my dad, who was about 7 years old.
"Does Ray complain of sore throats, too?" the doctor wanted to know.
"Sometimes."
"Well, put him up here on the dining room table. Let’s take his tonsils out right now, too!" And so they did.
In the days of my dad’s childhood, medical care was routinely delivered in the home.
For better or worse, the focus of medicine may well return to the home. Consider this scenario: Bob has a headache, sore throat, and a runny nose. He walks into his kitchen and sits down at his computer.
Type, type, type, type. Click. Enter. [wait] Fill in name and personal information. [wait] Enter credit card information. Enter. [wait] Screen pops up. Smiling doctor appears.
"This is Dr. Johnson! Are you Bob? How can I help you?"
Bob pulls his bathrobe tighter around his shoulders and concentrates on his keyboard. The blue light next to the camera on his laptop blinks on.
"I’m sick, Dr. Johnson. I hope you can give me something to make me feel better."
Dr. Johnson peers at the image of Bob on his monitor and sets to work trying to figure out if the symptoms represent a cold or something more ominous. Over the next few minutes, Dr. Johnson makes a diagnosis, comes up with a treatment plan, and generates a bill. They both sign off. A few minutes later, Dr. Johnson opens a video chat with a different patient. The two of them could be in the same town or separated by a thousand miles.
Quick and efficient! Germ-free! No parking hassles!
A recent article describes the future of telemedicine and how, in Texas, it is already a reality. For $40, an internet company offers Texans 10-minute live video medical evaluations. The company’s Web site notes that "while sometimes there is no substitute for an in-person visit, [the clinic] offers you a convenient complement to a traditional practice." I suspect that, for a lot of ailments, a quick discussion with a prescription might be perfectly suited to a live video chat.
Where could this all lead? Perhaps, new iPhone applications will take vital signs, peer into eyes, check blood sugars, and buzz disapprovingly when we walk into fast food restaurants. Guitar Hero will spin off Surgery Hero. Digital cameras will tour our intestines in the privacy of our own homes. On-screen instructions will tell us where to place the Wii controller while we bend over and cough. Web-based interface systems will control common kitchen appliances and power tools that allow surgeons to remotely perform delicate operations.
Traditional face-to-face office visits — flesh-on-flesh — are challenging enough. They are fraught with the nightmare of overlooked signs of disease, delayed diagnoses, incomplete evaluations, and misunderstood instructions. Sometimes, words spoken in the hallway after the visit are as important to making a diagnosis as what transpires in the room. To my old-school thinking, I have enough trouble coming up with treatment plans when I have the opportunity to sit side-by-side with my patients and touch them physically. It would seem that the benefits and risks of the office visit would only be magnified in a virtual clinic.
Medical care during my dad’s childhood days was not perfect. Did he need his tonsils out? Probably not! However, there was inherent value in receiving all of his health care on the farm from the family doctor.
Perhaps the day of that "in home" approach is returning. It seems so odd to me, though, that in an era when we value both "high tech" and "high touch" medical care, that our physician-patient interactions might actually be receding to a place where we see each other only behind a computer screen and feel each other only through a keyboard. Somehow, I think, Bob and all of our future patients deserve better.
The following is feedback received for this blog:
I agree patients deserve better! And you deliver!
- Marilyn Hagerman
right on, scribbler b! nicely written argument for the importance of in-person healing. my psychological training supervisor, back in the day, told the story of a home visit by his g.p. (in ireland!) who walked into the ill child's bedroom and announced "it smells of rheumatic fever here!" i don't think you can do that via telemedicine.
- RICHARD HOLLOWAY
