At the dawn of medicine, when a physician wanted to assess a patient’s heart, he would put his ear directly on the patient’s chest to listen. Then came stethoscopes. At first people didn’t trust they would be as accurate as the human ear alone and deemed the scopes to be simply gadgets.
In the development of modern medicine, when a physician wanted to assess a patient’s heart rhythm, he would use an electrocardiogram. At first, people didn’t trust all of those wires and electrodes and deemed them to be just gadgets. The stethoscope, of course, was the standard.
During the growth of technology based healthcare, when a physician wanted to assess a patient’s cardiac function, he might order an echocardiogram. At first, people didn’t trust their accuracy and deemed them to be just new gadgets. What could deduced from an image that could not be detected from EKG tracings?
Well into the stride of evidence-based, data-driven, patient-centered healthcare, the emergence of telehealth devices allow physicians to assess their patients from a distance of another building, state or even a different country. Whether in real-time (synchronous) or using a store and forward method (asynchronous), remote visits bring a level of care to people who otherwise might not receive it. Specialized telehealth-enabled instruments, like video otoscopes or dermatologic cameras are operated by a nurse, technician or sometimes by the patient. Such procedures increase access, convenience, lower costs and can improve quality of care when a physician or specialist could not otherwise be consulted locally.
Just as prior breakthroughs permitted hearing and seeing what we could not previously perceive, this technology breaks the barriers of geography and access to healthcare and education. Unfortunately, there are people who do not view telehealth this way.
There is a debate occurring in some states whether or not to permit physicians to rely on telehealth when they have not seen the patient face-to-face. In some areas, like Texas, technology is losing the battle. At a time when people need better access to quality care at lower costs, you may think this is a surprising and alarming trend. You will recall that people often fear and dismiss technology they don’t yet understand.
We trust our physicians to prescribe medications, perform surgeries and myriad other procedures that hold a life in the balance of their judgement. If a physician deems a remote visit sufficient to make a diagnosis, and the research supports that decision, shouldn’t he or she be permitted to treat the patient as they see fit? But a great barrier is erected when telemedicine is restrained: research populations remain low and quality measures are often called into question when any measurements have been taken by patients themselves.
Better standards need to be in place for certain, but this can only be accomplished through an increase in telehealth initiatives, third-party reimbursement parity and industry advocacy to standardize telemonitoring data collection. And, as we’ve proven with so many other new technologies in healthcare, it should not be dismissed out of hand but vigerously studied, tested and validated.
To paraphrase The Independent journalist John Diamond, “perhaps there is no such thing as [telemedicine]…just medicine that works and medicine that doesn’t.”
There is no need to apologize for disrupting our beliefs about the traditional doctor-patient relationship; that’s par for the course in technology. Rather, when we find something that is safe and effective, especially when it is an improvement or provides an option where none existed previously, it should be fully enveloped into the scope of modern healthcare.
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