Telemedicine is taking off. The ability to provide specialist consultations in remote areas via videoconference, access nurse or physician phone lines 24/7, and even have medical device data automatically pushes alerts to a physician’s iPhone about potentially dangerous cardiac rhythms – these capabilities showcase some of the best of what telemedicine has to offer. Recently, Maria Cheng of the Associated Press described how this technology may be pushing the boundaries though, entering territory that I consider morally ambiguous at best.
She describes an emerging industry in the United Kingdom in which websites are essentially automating the practice of medicine. Have a medical problem? Fill out the most pertinent questionnaire and if you answer correctly, you’ll get a supply of whatever relevant medicine you wanted. Granted, these websites primarily seem to address erectile dysfunction, hair loss, and STI’s while avoiding narcotics. Still, they bypass what has traditionally been the fundamental tenet of medicine, the patient-physician relationship.
One of the first lessons imparted to me as I began my residency training was the danger of “telemedicine” in the hospital – prescribing painkillers, antihypertensives, and even IV fluids without assessing the patient. And assessing the patient meant more than just looking at the vital signs – it meant talking to, examining, and treating the patient rather than the numbers.
Granted, their are some validated algorithms that have proven to be better than just physician judgment. I suspect however that ED and hair loss screens are not among them. Even worse, if a patient wants Viagra, they need only Google the “correct” answers to the questionnaire to allow them to get what they want, even if they take nitroglycerin for chest pain as well.
Overall, this trend concerns me. I do expect that technology and statistics will come to supplant some more traditional forms of decision-making. However, I don’t think it can ever replace the trust between a physician and a patient that allows for informed decision making and avoidance of medical harm.