Telehealth and Telemedicine: A Doctor's Perspective
Updated: May 18, 2020
Telehealth and telemedicine are almost the same. Perhaps telehealth is directed more at maintaining good health, and pursuing a healthy lifestyle and telemedicine is more about dealing with a medical problem. Both words imply that the person requesting the information and the one giving the information is at a distance or “tele” from each other.
The interaction could refer to a telephone conversation, but increasingly these terms refer to some form of “videoconferencing” between the two parties. The COVID-19 Pandemic has rapidly accelerated the move toward telemedicine. In this article, we will look at my view, as a physician, of how telemedicine might change healthcare and medical care in ways that no one could have imagined just a few years ago.
As a neurosurgeon, my first contact with telemedicine was when a neurologist colleague began to use it to evaluate possible stroke victims and decide if urgent treatment at a stroke center was necessary.
Subsequently, I found that I could use telemedicine to communicate with some of my own potential and actual patients. I found it to be an excellent way to, for instance, evaluate someone’s tremor.
One of my particular areas of interest is a condition called Essential Tremor that affects up to 5% of people over the age of 65 and can be inherited. I found that I could ask prospective patients to perform various writing tasks and drink from a glass to test the severity of their tremors. I could then decide if treatment such as medications or, in some instances, a variety of surgical treatments should be recommended. I was able to provide this service to patients throughout the United States and even sometimes to patients abroad, something that would be impossible without telemedicine.
Another neurological condition that I treat Parkinson’s Disease is ideal for telemedicine monitoring. In addition to episodic observations, patients can be fitted with a variety of monitors so that things like falls are monitored continuously.
ADVANTAGES OF TELEMEDICINE
The advantage of, or in some cases, the disadvantage of telemedicine is that the patient and healthcare provider is not in physical contact, as is the case with an in-person medical visit. During the current Pandemic, telemedicine removes the risk that the COVID-19 virus will be passed from one party to the other.
Under normal circumstances, telemedicine has other significant benefits. It can be a great help for people who live in rural areas where a physician may be many miles and many minutes or hours away. Telemedicine can be an excellent substitute for a long ride, waiting in a crowded office and seeing a physician for 10 or 15 minutes and then an equally long trip back home. Not only is telemedicine convenient in rural areas or where a physician is not readily available, but it is also significantly more efficient for the patient and the physician.
During the current COVID-19 Pandemic, telemedicine provides a way for patients to obtain an evaluation of their symptoms from home if they are concerned about a possible coronavirus infection. Telemedicine advice can avoid a trip to the doctor’s office or hospital that may not be necessary, and that might even be dangerous. As symptoms progress, they can be monitored as often as needed by way of telemedicine, and recommendations can be modified as symptoms change.
Surveys show that patients are generally very satisfied with healthcare delivered remotely.
DISADVANTAGES OF TELEMEDICINE
The major disadvantage of telemedicine is that it is not possible to conduct the routine physical examination during such patient/physician encounters. On the other hand, many aspects of a physical exam are possible via a telemedicine encounter.
In my field of neurology and neurosurgery, some parts of a neurological exam can be carried out during a telemedicine contact. A recent article in the JAMA Neurology states that “the pandemic is transforming neurological care more than any other crisis in modern history.”
Things like walking, balance, coordination, tremor, and speech, for instance, can be observed easily. Other things like an examination of sensation and reflexes can’t be done during a telemedicine evaluation.
The technology necessary for telemedicine contacts is problematic for some people, particularly those of lower socioeconomic status. Internet connections are not available for some people in rural areas, and many older people are not sufficiently tech-savvy or do not possess the necessary equipment for telemedicine contacts.
The technology of telemedicine can also present problems even when it works smoothly. Those effects can leave one feeling awkward and disappointed, and they can lead to stress and anxiety for both the patient and physician/therapist.
Telehealth and telemedicine are the waves of the future. Even after the COVID-19 Pandemic is over, these new ways to practice medicine will be embraced by both patients and physicians. From my perspective as a physician, telemedicine is and will be a great asset in the way that I interact with patients.
Robert Young M.D.