My last post generated an interesting comment from a reader questioning whether telemedicine can actually be used to do a physical exam. The reader brings up some great questions about how telemedicine can actually work. Such questions and resistance to new technology clearly highlight the struggle for technological progress in medicine.
While I agree that telemedicine is not fully developed and only in its early stages, there are many fields which currently lend themselves to key physical examination points though video conference. One such field is cardiology in which a tele-stethoscope is placed on the patient to allow the remote consulting physician to evaluate heart sounds. In this example the patient does not usually place the tele-stethoscope but a technician or nurse does. Similarly, an echocardiogram machine with teleconferencing capabilities can allow a consulting cardiologist to view the technician doing the echocardiogram and the results live. The examples of telemedicine in the field of cardiology are many. Another example of telemedicine is the use of a tele-otoscope for ENT physicians to examine the ears, nose, and throat remotely. Being able to get this data remotely clearly would be more efficient and save time and money.
While all of these are just theoretical examples, there are plenty of real-life examples of telemedicine being used to examine patients. Any physician or non-physician can search the literature and find great examples.
One example is a recent report coming out of Virginia Commonwealth University and the Virginia Department of Corrections. The surgeons in that group conducted 55 telemedicine sessions over a year-long period. With the assistance of a nurse at the correctional facility and tele-stethoscopes and dermascopes, they were able to recommend surgery for 27 patients with the only face-to-face meeting being the day of surgery! Using telemedicine, they were able to provide care for a needy population and reduce significant pre-operative work-up and patient transfer costs.
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Dr. J.C.,
Thank you for the response.
I think you have missed the point here. Your first article was discussing the possibility of doing a “physical exam” remotely. I am not doubting the potential of telemedicine. Telemedicine is clearly possible for certain aspects of medicine.
1. Teleradiology (e.g. nighthawk) allows hospitals without on site radiologists to have their XR/CT/MRI scans read by having the images sent electronically.
2. Regarding the ECHO, the cardiologist does not have to “view” the technician performing an ECHO. The ECHO results are recorded (like a movie) and can be sent to the off-site cardiologist for interpretation. This applies to any type of doppler study. EKGs can also be sent to offsite cardiologists electronically.
However, my argument is that the “physical exam” cannot be done via telemedicine. Certain aspects of the physical exam CAN be done via telemedicine. But I don’t see how the entire “physical exam” can be performed via telemedicine. And the “physical exam” is an all or nothing procedure. You can’t just perform some parts of it. The utility of the “physical exam” is its use as a screening tool to rule out/in various causes of the symptoms which the patient presents with. Thus, if you do not perform ALL parts of the “physical exam”, it is not very useful. This is also very dangerous.
For example, let’s say a patient comes in with a headache. You perform the entire physical exam except for the fundoscopic exam. You may have missed a patient with elevated ICP (this is a potentially fatal condition).
Again, the utility of the “physical exam” is its comprehensive nature. If you can’t do the entire exam via telemedicine, what’s the point.
I think an easier way to cut costs is to have a nurse or physician’s assistant perform the physical exam and document the findings. The physical exam is not that complicated. Anyone with a high-school education can document the physical findings… although they won’t be able to come up with a differential diagnosis, work-up plan (what tests/imaging should I order), or treatment plan. That’s where the doctor comes in. By the way, this happens every day in teaching hospitals across the country.