February 05, 2009

Does telemedicine work? Is this telemedicine?

BY Dr. Keith J. Kaplan

'GMA' Tries Out Three Web Sites to See How They Would Advise Patients

Came across a story on ABC News looking at use of web-based physician consulting services by providing a list of symptoms to three sites and their responses.  As you might predict, based on the premise of the story, none of the 3 sampled did particularly well helping the "patient".

The reality of this experiment I think amounts to nothing more than calling a physician whom you have never met, equally important, has not met you and providing some symptoms for immediate diagnosis, treatment and follow up plan based on some symptoms at that particular time.  The fact that the encounter is web-based does not eliminate the need for a relationship to be established with appropriate medical history, problem list to date and taking the symptoms into account in terms of generating a differential diagnosis to lead to the appropriate diagnostic evaluation, additional tests as needed and/or follow-up in terms of office visit, referral or as needed. 

I think the story does cover the instances where a patient-physician relationship is established and the practicality of using technology as granular as e-mail (perhaps in place of telephone) for dealing with sub-acute problems that can be addressed when e-mail can be read and responded to appropriately. 

I would consider this "telemedicine" or "telehealth", that is the practice of medicine at a distance and applicable to certain problems in the appropriate context of patient and health care provider. 

Try calling a few physicians at random with some symptoms; I guarantee none will speak to you if you are not an "established patient" and perhaps the same limits should be used for these web-based consultations. 

"Of course, the sites themselves claim no responsibility for their physicians' practices and services and I presume the physicians themselves are somewhat protected in the absence of a "patient-physician" relationship which these sites clearly do not offer.  This will be tested as I have mentioned previously (See: Telemedicine and the Law). 

"With the days of routine doctors' house calls long gone, many patients have turned to telemedicine to get quick, convenient diagnoses.

While 30 million American said they have consulted their doctor via e-mail and another 70 million said they wish they could, only a third of doctors actually offer e-mail or telephone appointments, according to Manhattan Research, a market research and advisory firm for pharmaceutical and health care companies.

So many patients have turned to online resources to help pinpoint their problems.

Several online sites offer symptom checkers and access to medical experts — allowing patients to ask doctors for advice without ever meeting them face to face. But some critics question just how reliable such resources can be."

 

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