If you could iChat or have a Skype visit with your doctor, how would you feel about that?

How do you think your doctor would feel about that?

That is a simple way to understand telemedicine but it is far more than face-to-face communication.

Telemedicine enables physicians to monitor, remotely, Intensive Care Units, for example, for hospitals which need the back-up. They use  monitors and other equipment which is simple compared to much of what is used daily in hospitals.

Telemedicine, used for that purpose, is there to offer a comprehensive approach to patient care—- monitoring the patient, enabling early rescue (responding to subtle but important changes), helping with the care plan, if asked. The goal is to help enhance the quality of care, with specific measurements used to determine if it working or how well.

Telemedicine also is the term used for working with physicians in underserved areas using the technology.  When a doctor in a rural area sees what may or may not be a skin cancer and can get a consultation on the spot. When a sick baby comes in and the nearest big hospital is hours away, telemedicine could be the country doctor’s new best friend.

Telemedicine is not a new idea. You would think it is brand new  based on a new study published in the January 23-30, 2009, issue of the  Journal of the American Medical Association.

That study set out to measure one thing—telemedicine’s impact on the quality of care using mortality and length of stay statistics—and ended up finding another impact unexpectedly.

The researchers stumbled into how high care-givers’ resistance to telemedicine use is. Doctors and nurses in a leading Texas hospital did not want to hear what may be happening with their patient or how receive suggestions about how the care-giver might consider treating the patient from another care-giver in a remote location.

Patients and families were happy to have “another set of eyes.”

Not surprisingly, the study conclusion could not show any benefit from the use of telemedicine. The researchers found that “remote monitoring of ICU patients was not associated with an overall improvement in mortality (More patients lived than expected.) or LOS.” (Length of stay)

The care-givers did not want the system. There is no way to know if the monitoring could have improved care or not. Still, it is a valuable piece of research because it shows how doctors really feel about its use.

The Other Side to This Story…Telemedicine Could Change Things Which Should Not Be Changed

To be fair to the telemedicine-resisters, every change is the patient-doctor encounter needs to be carefully, carefully considered.

There is enough going on in a visit in an office or at bedside without introducing strangers or allowing any form of intrusion into that time.

The idea of a stranger looking in could have, at the very least, an inhibiting effect on patients who may already have problems telling the doctor what they really need to disclose.

Many wise physicians have said, in different ways and in different decades,  it is the patient who tells them what the diagnosis is—-by answering their doctors’ questions.

Any change which risks jeopardizing patients’ sense of comfort with their own physicians or their confidence in the privacy protections which should be in place needs a lot of scrutiny.

However, when doctors balk as the doctors in this study balked, it is about more than stubbornness or doctors being slower to accept change.

Telemedicine and its use will force everyone to re-examine the doctor and patient relationship.

Is anyone really ready for that?

Citation: JAMA. 2009;302(24):2671-2678.