Telemedicine – beyond the confinement of the pandemic

In our current world of instant and endless access to multiple sources of medical information, it is easy to think that we can all self-diagnose our ailments through a simple ‘Dr Google’ search.

But can we really? Can we really replace the clinical experience of a physician with a simple algorithm? Can we afford to forgo the traditional “see, feel, listen” (and more often than not a prod and poke as well) element of a normal consultation over a quick video call?

Our technology has progressed at a phenomenal rate and so have our medical diagnostic and treatment capacities, but what has not changed is the fact that we STILL need that one person to make that final call and make it all happen … that one person to care about our health and general wellbeing. That is the role of the true Family Doctor. But is that starring role about to be eclipsed by technology?
Even before the Covid pandemic, studies were being carried out about the pros and cons of telemedicine, which included video and telephone-only consultations. The more correct term is defined as ‘telehealth’, which can encompass many forms of technology, including but not limited to: remote health monitoring; education and training; and telephone and video consultations.
With the Covid pandemic, this form of remote medicine became an “easy and safe” alternative to the traditional face-to-face consultation. However, the massive fear of virus transmission and the sheer lack of access to normal GP and other medical services during the lockdown periods may well have skewed the results of the research done during the pandemic, giving more credence to the virtual than it actually deserves – especially as research outcomes focused on patient satisfaction with the service during the pandemic, giving a potential bias of “something is better than nothing”. Interestingly, there appear to be very few studies asking that same question of the doctors.
One of the most difficult diagnostic tasks in medicine is to timeously identify and separate the serious and life-threatening diseases from the less consequential ones.
At Medical School, we are taught to assess the patient by taking a detailed history of their symptoms, and then examine them for any physical signs, which together pointed the way to the diagnosis … a task potentially less achievable through telemedicine. In fact, a 2022 study of medical students in the UK showed that only 50% valued their learning from a telephone consultation.
Patients may not perceive the significant disadvantage of no visual interaction or tactile examination, but any physician knows that without all the possible clues, a misdiagnosis could be made far more easily … a fact corroborated by regular tabloid headlines.
In this spirit, the WHO recommends “… clear clinical protocols to explain what can and cannot be done in the remote consultation …”. Protocols which many health authorities are still “clarifying”.
Undisputedly, telemedicine can be very effective in delivering health services, however, the question remains whether it is appropriate in all settings of healthcare, as it undoubtedly has its limitations and should probably be reserved for the follow-up of well-known and established patients in a non-acute medical situation.
It is easy to simply tick boxes on call-center checklists, follow protocols and dish out generic advice and treatments. It is far more difficult to integrate all that information with the individual needs and characteristics of each patient, creating a custom healthcare plan for them in keeping with the right diagnosis.

It is even more difficult to create a strong doctor-patient relationship, where communication, trust and mutual respect are key, through simply a telephone or video call … just ask any online dating aficionado! For millennia, traditional spiritual leaders and healers have relied on the healing touch of the hand, and even modern science agrees on the proven benefits of touch in patient recovery and medical care in general, conveying not only reassurance, empathy and comfort. According to a Mount Sinai study, therapeutic touch can even promote cellular stimulation.
So, as much as literally cloning myself would be an absolute godsend sometimes, it is going to be a very long time before this doctor will be regularly seeing patients in a virtual consultation.

Best health wishes,
By Dr Jo
7th March 2023