How Telemedicine Will Replace the Once-Sacred Doctor’s Exam

Despite the advances of “Going Live” that I wrote about previously, there are some areas of the health system where a computer cannot replace the presence of a human doctor. In medicine the sacred territory of the doctor is the “physical exam” – the physical examination of a patient. This is the Holy Grail of medicine – the most powerful thing that allows doctors to be doctors – the diagnostic intuition that impresses upon them after they examine a patient. From this exam, the physician with his wealth of knowledge and years of experience can get a sense of exactly what is going on with a patient. Nothing can substitute for a good physical exam.

Despite the “physical exam” being the secret magic that allows doctors to be doctors, it is also the main hindrance to the one advance that would truly make the healthcare system more efficient. If you don’t know what I am talking about, I am referring to medicine in which the doctor does not actually have to be in the room. Telemedicine is where the doctor is actually not physically in the room but is seeing the patient through a video screen. Another variation of this is robotic medicine in which a robot with a live video camera cruises around the hospital floor going from room to room visiting patients. On the other end is a physician seeing the patient through his video monitor.

Why is this so important? If you think about all of the possible areas to improve efficiency in medicine, the actual practice of medicine – the seeing of patients to diagnose and treat them – is the most time consuming and thus the most costly for the healthcare system. Have you ever wondered what doctors do all day? Well, they go around and visit their patients in the hospital – they “round on their patients.” They also see patients in clinic. The remainder of time is usually spent discussing patient care issues or continuing their education through lectures or talks. Thus making this more efficient of a practice would save enormous amounts of time and money.

Imagine being able to see patients and diagnose their diseases from a different place. Expert physicians could do consultations from across the globe. Physicians could efficiently see more patients. Video files would document all examinations. The physician would not actually need to go to each and every hospital location. How great this would be!

There are many layers of resistance to this movement. Patients, in their state of need, actually want to see a doctor face to face if they have the means to do so and if there is someone available not too far way. Physicians, with their intuitive minds, have gotten the sense that if they could be replaced by computers then they would not be in high demand. If any patient could see another doctor by logging on a computer with video camera and clicking on a button then many doctors would go out of business. Perhaps most importantly, healthcare systems and their prudent risk managers worry about liability issues with telemedicine.

As information technology continues to transform the healthcare system, it will undoubtedly continue to transform the way we practice medicine. Someday probably not too far off, we will be able to do a physical exam via telemedicine. Some of us can’t wait to be accessible to the vast worldwide patient population that awaits.

2 comments to How Telemedicine Will Replace the Once-Sacred Doctor’s Exam

  • J.L.

    Dr. J.C.,

    How will doctors be able to do a physical exam remotely? How will they auscultate the heart to listen for murmurs/gallops/rubs? Will the doctor tell the patient to place a remotely connected stethoscope to different areas on his chest (aortic/pulmonic/tricuspid/mitral)? But then, how about the PMI? And that’s just the cardiac exam.

    Abdomen. How will you percuss for tympany? Will the pt percuss him/her-self? How about fluid waves for ascites? And when palpating the abdomen for tenderness, will the pt press down on his/her own abdomen with both light pressure and strong pressure? How about CVA tenderness?

    How about the rectal exam/stool guaiac? How about the prostate exam to look for prostatic masses? How about lymph node enlargement? How about inguinal hernias?

    There are many more examples….

    I was wondering if you could clarify how the physical exam can be performed via telemedicine for even the above mentioned items.

    Based on your comments, you have never performed a physical exam before… and therefore, have never attended medical school.

    You are not an M.D. Don’t be dishonest about your credentials. You are a wanna-be.

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