Telemedicine: Entering the Workforce as a 21st Century Doc

by Natalie Ernecoff

Today’s medical practice provides many enticements for the budding medical student, from intricate surgeries to fine-grained imaging. Medicine provides access to the sleekest technologies that would not be encountered in most any other setting. There is no doubt that the attractiveness of new and different technologies will continue driving medicine into the future. Therefore, it is wise for those entering the field to stay up-to-date on the technological progress that will affect them in years to come, its impressive implications, and the risks it may pose.

Telemedicine is one of the technologies that are now being integrated into modern medical practice. Telemedicine is defined as the use of audio-visual technology to provide medical services from a distance. It offers individuals in remote communities access to healthcare that they might not otherwise receive. With the assistance of a local nurse or primary care physician, remote specialists can observe and interact with their patients via a video monitor in addition to more discrete monitoring of real-time vitals statistics of in-patients. For example, a neurologist can observe a patient with potential motor damage moving through a battery of diagnostic tests from afar.

These remote exams take minutes to an hour to complete, and may save patients hours to a day of traveling. Research on the practice of telemedicine is expanding, and a portion of it is being conducted at the University of Pittsburgh’s School of Medicine and Graduate School of Public Health.

Dr. Jeremy Kahn, a professor of Critical Care, Medicine and Health Policy at the University of Pittsburgh’s School of Medicine and Graduate School of Public Health, studies health care delivery where efficiency and quality intersect – including the field of telemedicine. He explained that there are different types of telemedicine used to care for remotely-located patients. One type is called “store-and-forward,”  which involves some clinical data  to be  stored and sent over some distance, and causes a separation in time as well. “So the classic example would be an x-ray or a pathology slide that’s read from a distance,” Kahn said. “The kind of telemedicine I’m more interested in is the remote consultation type where there’s actually a live patient encounter.”

The real-time encounters Kahn speaks of aid individuals in out-patient and in-patient settings. For the out-patient seeking a specialist, telemedicine can save a long-distance trip, a day taken away from work and the costs associated with these ventures. Patients simply travel to their local practitioner, where they are presented to a specialist via an audio-visual encounter and can be examined in a matter of an hour.

However. convenient out-patient telemedicine services may be, the capabilities this technology holds for inpatients are even more beneficial. Intensive care unit (ICU) patients, who may be hospitalized for days or weeks on end, can stay in local hospitals; this allows their families to stay in their own beds and saves them the costs and stresses of traveling to a specialized care center. Intensive care physicians at a remote specialty center can still monitor these patients’ diagnostic and treatment information, while the physical care is provided locally by general practitioners or another care provider.

The advantages offered by telemedicine are appealing, and students entering medicine in the coming decade will want to be educated on the implications this technology has for their careers and practices. According to Kahn, since many facets of telemedicine are relatively new to the market, Medicare, Medicaid and other private insurers are reluctant to cover such services. They may hesitate due to a lack of evidence on efficacy, or the fear of overutilization of expensive specialist resources if they become too easily accessible. Another possible implication is that telemedicine will require more time from specialists, who are already spread too thin among face-to-face patient encounters. After all, the complexity that technology and distance adds tends to make telemedicine appointments longer.

Perhaps most important for new and future physicians to consider with respect to telemedicine is the availability of training during medical school. As Kahn notes, “Only in the last 10 to 15 years has medical education said, ‘Look, we need to teach people how to communicate with patients.’ And we’ve spent a lot of time incorporating it into medical school curricula, for teaching the physician-patient encounter.”

Kahn also suggests that “Now we’re going to have to build on that [physician-patient encounter] even more. Not only do we have to make you a good listener and a good communicator in person, but we have to make you a good listener and communicator remotely. And it’s wrong to think those skills are going to translate right away.”

There are also some distinct barriers to implementing telemedicine. Not only must physicians be trained to communicate well, but patients must become comfortable sharing their sensitive medical information across technology, distance and multiple providers. Instead of sharing with one doctor behind a closed door, Kahn explains that now “you’re introducing more people into it because it has to be facilitated on the local end and the [specialist] end.”

He then puts it in perspective: Would you be as open about your health issues to someone who’s on the other side of a screen – a sort of disembodied face – as you are a person?

Overall, telemedicine is glamorous at face value; it offers varied benefits to patients, like saving a person time and money. But it also faces a set of barriers, including the need for social acceptance and comfort, the cost of implementation, and added patient load to already fully-booked specialists. The complexity of these variables requires serious evaluation as to how this technology should be implemented and how to maximize efficiency as it evolves.

The expansion of telemedicine is likely inevitable, given the infiltration of progressive technology into modern medicine. As Kahn puts it, “We need to not necessarily put the brakes on this, but [to] think through the issues.”