Telemedicine

Telemedicine is a relatively new field that utilizes technology for doctors to take care of patients remotely. Recent advances in video and internet communications have allowed this field to blossom. Now, radiology studies are read by physicians in India, teledermatologists consult on patients based on computerized images, Kaiser physicians have secure email with their patients, and doctors can monitor arrhythmias with the patient's cell phone. But even more, traditional patient encounters are being transformed into telemedicine; some doctors do "home visits" by webcam.

This has lead to a novel and perhaps dangerous proposition of ICU telemedicine. A good portion of intensive care involves sophisticated monitors, frequent laboratory tests, and daily radiology studies. Some of the clinical decision making each day depends on the blood pressures, ventilator settings, electrolytes, and chest X-ray. All this data can be easily computerized and transmitted to physicians remotely. Conversely, the history and physical exam are given lower priority in the ICU setting - whether this is right or not is a different question. But this has allowed ICU telemedicine to gain traction; a physician remotely monitors many ICU beds, possibly at several different hospitals. This is usually done at night when each hospital may not have the resources to have overnight physician staffing.

To me, the advantages and disadvantages of ICU telemedicine need to be considered carefully. There is one compelling reason to do it: it brings care to places that don't have it. Whether rural community hospitals or the third world, technology can bridge some of the health care disparities we see. However, I don't think telemedicine is a solution to geographical physician maldistribution, and we need to continue trying different approaches to bringing care to those who don't have it. On the other hand, I don't think telemedicine is ideal medicine. How can you take care of a patient without ever meeting him or the family? How can you reduce a person to a series of numbers, and how can the practice of medicine simply be a routine of correcting abnormal laboratory values? I know there's some burgeoning evidence that telemedicine produces comparable results (in mortality and length of stay) as having full-time on-site physicians. I also understand the economic pressures to move toward this model and I am aware of the shortage of intensivists, but I'm resistant to it. I think there is a real and tangible role to the face-to-face patient-doctor interaction that computers and phones simply cannot provide. While technology evolves quickly and things may change, I think ICU telemedicine's role at this stage should remain minimal.