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.