There was an interesting article in the New York Times this weekend regarding telemedicine titled “The doctor will see you now. Please log on.”
According to the article, the telemedicine business has been growing by almost 10% annually, and is now a half-billion dollar industry.
One of the issues brought up by the article is a question regarding high end video systems (which are typically proprietary and so expensive that the patient needs to leave home to get to them) and the lower end webcams represented by those that are typically used by people using Skype.
Apparently, members of the Texas Medical Board have raised concerns that “doctors might miss an opportunity to pick up subtle medical indicators when they cannot touch a patient.”
I looked on the Texas Medical Board’s website, but couldn’t find anything there to follow up on the Times article.
I can see plenty of places where the concerns raised by the Texas Medical Board might be valid.
One example would be dermatology. A lot of dermatology is visual pattern recognition, and every couple of months of so when I have a patient with a drug rash, I usually start by looking at the rash under sunlight, rather than under the muted lighting that I usually have on in my office. My eyes are not as good as they used to be, and I think it would be really hard for me to even describe a rash from a webcam image.
Another example would be more prosaic, for example, someone on venlafaxine who needs a BP check. These days, about half my patients have access to a BP machine at home or with a relative, and I have told people to go check their blood pressure and tell it to me. I’m very aware that these drugstore machines aren’t that accurate, but, so far as I’ve been able to see, they tend to be within 10 points or so of what I measure in the office.
The question I would like to ask of the Texas Medical Board would be how many of their concerns would relate to telepsychiatry versus telemedicine.
First, most of the outpatient psychiatrists I know don’t touch the patient often other than to take vital signs, put him or her on a scale, help him or her out of a chair, check for EPS or look at a rash or a wound (with a chaperone in the room if needed).
Second, I know at least three mental health workers with fairly profound visual problems and I’ve never thought for a second about whether their visual problems would affect their care of patients.
It would be hard for me to argue that these mental health workers shouldn’t be working with patients, but that would seem to be a logical extension of some of the Texas Medical Board’s concerns.