For patients, negotiating an increasingly complicated and fractured medical system can be overwhelming. Add to the current confusion pre-packaged misinformation touting a variety of technological advances that are not ready for prime time, such as robotic surgery and the electronic medical record. Along those lines, I have read a number of articles lately heralding the dawn of “telemedicine” and I don’t like it.
Telemedicine typically involves a doctor located at one site offering medical services to a patient located at another site. The first example of this that I became aware of involved a radiologist reviewing imaging films at a location remote from the hospital. Shortly afterwards, I became aware of problems associated with this practice. For example, I learned that some radiologists were interpreting films, whether x-rays, MRIs or CT scans, on computer screens that do not have the resolution of devices available at the hospital. Poor quality resolution can lead to poor interpretations of films.
Subsequently, I learned about the use of telemedicine in intensive care settings, wherein a physician will provide evaluation, diagnosis and advice to less qualified physicians at the bedside. The concept behind this practice developed out of necessity in rural areas where critical care physicians were not available to provide direct care. That practice is necessary and laudable. However, the practice is now being extended outside the realm of necessity as a profit-maximizing tool. This puts patients at unnecessary risk. Bedside assessment is critical in the ICU. Further, if too many patients are assigned to one remote physician, the likelihood of fatigue and error rise.
On a purely legal note, one concern about telemedicine is that a physician from another State may be providing care in Ohio. Not only is the physician not subject to Ohio’s licensing requirements (an issue that I personally took to the Ohio State Medical Board but they okayed the practice), but you may not even be able to hold the physician accountable for medical malpractice in an Ohio court.
This blogpost coincides with an announcement by Time Warner Cable that it is working with the Cleveland Clinic on a two-way videoconferencing system to treat patients at home. I can see a number of problems with this idea for patients. First, this is going to encourage some patients to self-triage rather than going to an emergency department for acute care. For example, a patient with chest pain will miss out on the opportunity to be assessed by a skilled triage nurse in the ER. The patient may also delay emergent treatment while waiting on a “tele-doctor” to direct them to the nearest ER for actual treatment.