A friend sent me a link to an article in the New York times titled “Are doctors ready for virtual visits?”
The article talks about the results of a study done at the University of Texas Medical School looking at the impact of telemedicine on patients in intensive care units.
There were two really interesting findings in the study, the first relating to patient outcomes, and the other to doctor’s attitudes.
Although there wasn’t a significant difference in patient outcomes when super sick and just sick patients were grouped together, it turns out that the super sick patients actually did a little better when managed by telemedicine, while the less sick patients did no better, or maybe a little worse. That’s a interesting finding, particularly if you are one of the super sick patients.
The real finding of the study though was that many of the doctors and nurses in the ICU really didn’t like the idea of telemedicine.
On the surface, the rationale the people who were opposed to telemedicine gave was the they were worried it would jeopardize the “doctor-patient” or “nurse-patient” relationship.
I wonder if that’s really the whole story. Invoking the “doctor-patient relationship” is one of those motherhood and apple pie kinds of arguments. The motherhood and apple pie argument for anything goes like this:
Premise: Motherhood and apple pie are a good thing
Premise: X is a not a good thing for motherhood and apple pie
Premise: Things that are not good for motherhood and apple pie are not good things
Conclusion: X is not a good thing
The problem with the telemedicine argument used by the participants of the study is that there isn’t any evidence that telemedicine hurts the quality of the doctor-patient or nurse-patient relationship. In fact, the article also points out that the patients and their relatives really like the idea of an extra pair of eyes on the patient.
The default argument in medicine against anything that health professionals don’t want to do is that it “hurts the doctor-patient relationship.” It’s true that some things do hurt the doctor-relationship, and that’s a bad thing. The problem is not to acknowledge that it’s incumbent on someone who makes the argument to prove it.
It’s no wonder that bloggers like David Collin say things like:
Does this seem as annoyingly familiar to you as it does to me? In my more than three decades around the health field it seems to me that again and again new ideas and tools for extending health resources have been greeted with less than open-armed acceptance. Medicine is said to be a “conservative¡ profession,” and perhaps that’s warranted to some degree because, after all, lives are at stake. But I’ve become more cynical about the motivations for this conservatism as years have passed. During the years I’ve worked in public health my observation is that the medical profession has steadily become more ensconced in what has to be called a medical/industrial complex. All too often what the profession appears to be conserving is its own interests — authority, control, money – and its justification is frequently cloaked in claims physicians are only concerned about the doctor-patient relationship.
Be that as it may, forces for change from outside the medical establishment continue to mount. The Health 2.0, participatory medicine, and patient-generated content movements are attracting a constituency among people who want an alternative to the passivity and powerlessness that have characterized personal health care for the past century. For its part, telemedicine might be said to be underway already in the flocking of people to the internet for health information, in the flourishing patient sharing sites around specific diseases, and in the rapid uptake of monitoring devices and health-oriented tools for smartphones.
Actually, I think he’s got a point.
Who’s being served by being against telemedicine? I don’t think it’s the patient. Time for medicine to get a little more 2.0….
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