(The following article was published in Manila Standard Today, November 7, 2011, on their section Diaspora)
A few months ago I saw and examined a patient while she was sitting 50 miles away from me. Yes, you read it right, 50 miles away! All through the wonders of technology. Welcome to the age of telemedicine.
I was in my clinic in greater Des Moines, in front of a TV screen, and my patient was in a hospital’s outpatient clinic somewhere in rural Iowa, also in front of another TV screen. While I can speak directly to the patient via videoconferencing to get her history, the physical examination was skillfully performed with the aid of a nurse who was in the patient’s room.
The nurse, under my direction, placed the otoscope into the patient’s ears, and I could see her ear canal so clearly in my monitor. Then the nurse placed a scope in the patients mouth and I could visualize her throat – without smelling what she ate for lunch! Then the nurse placed the special stethoscope to the patient’s chest and back and I could hear her heart sounds and lung sounds crisply through my headphones.
Our clinic is not a pioneer of this telemedicine. In fact, this technology has been operational in some places for about a decade now. It is not limited to outpatient clinics where the patients are quite stable. It is also used in a hospital setting. There are electronic Intensive Care Units (e-ICU), where a critical care specialist sits in a command center-like room miles away from the hospital, while he monitors and examines patients, and instructs the nurses or doctors inside the ICU room, and co-manage the severely ill patients. There are surgeries done nowadays where the head surgeon is not even in the operating room, but in some other room far away (even continents away), controlling a robotic equipment in the operating room that performs the intricate surgery (telesurgery). It is just like playing a video game.
I cannot even claim that I am the first one in my own household to use the teleconference technology. My daughter who is now in middle school has been doing her piano lessons for more than two years, via videoconferencing with her music teacher in New York.
Technology has bridged the distance between us. It has made our world much smaller. However, advancing technology does not mean we become more closer and personal. In fact, it may be the opposite.
I would say that the practice of medicine has been much different since the time Laennec invented the first stethoscope in the 1800s. Before that, physicians would place their head in the patient’s chest (and breast!) to listen to their heart sounds, not to mention smell their body odor and all. How close and intimate can you get?
Laennec serendipitously developed the stethoscope when he was called to see a young lady with heart problems. Because of the age, sex and plumpness of the patient, he was reluctant to put his ear on the patient’s chest. He remembered his observation few days earlier, of two children playing with a long piece of solid wood, with one listening at one end while the other scratching a pin at the other end. He then rolled a piece of paper and directed one end to the lady’s chest and placed his ear on the other end, and to his amazement he heard the heart sounds with much clarity.
Since the advent of the stethoscope, which has become the iconic symbol of doctors, physician have kept their “distance” from their patients. This may be good in a sense, especially if the patient did not take a bath before the exam. Aside from our bedside instruments that were developed over the years, the doctor’s of today also have become more reliant to auxiliary testing and imaging studies like x-rays, CT scan, MRI, ultrasound and the like.
Perhaps with advancing of technology, there is less actual laying of physician’s hands on the patient. Are we using our hands less and less in performing our physical examination, which has been the foundation of the practice and art of medicine for ages? Are we slowly losing our healer’s touch? And are we becoming more detached and less personal?
Back to telemedicine, obviously I cannot use my hands to examine the patient. I cannot palpate (touch) her for any swelling or bumps, nor could I do percussion (tapping) on patient’s chest while listening for the evoked sounds. You could detect fluid in the chest if the percussed sound is dull, or air if it is resonant. This is akin to thumping a watermelon to determine if it is juicy or not. For cynics, they would say: what do you need that for, when you have the x-ray and the ultrasound to determine that?
Still on telemedicine technology, being developed currently is a kind of examining gloves with sensors wherein an examiner can put on and palpate the patient, while the doctor who is on teleconference puts on a different gloves and feels the sensation as if he is actually touching the patient. But I don’t think that will ever be the same as actually laying your hands on the patient. Can you imagine a “hilot” doing his manipulations on a patient with this “specialized gloves” while he directs an assistant through videoconferencing?
Despite losing the “personal” healer’s touch with the materialization of telemedicine, I find it very interesting and hopefully would provide some personal conveniences to me in the near future. With this technology, I can just be at my home and can see patients anywhere in the US, or in the world for that matter, including our “kababayan” in the Philippines. Or the other way around: I can be back in my native land, under a swaying coconut tree, in front of the lapping ocean waves, and with blowing tropical breeze, and see my patients who can be somewhere in the world out there.
I think I like that better.
My E.D. doctor was sharing this similar practice one day. He works part time to an oil company in the middle east. He would diagnosed and treat uncomplicated cases. But you are right, the healer’s touch is gone. It may be practical at certain times but I remember how my family doctor’s, even until now creates a meaningful relationship with their patients. Makes you feel like a human that matters and not just another number or another dollar points to a now more material world. Medicine may it be on the physician side or the nursing side has changed so much particularly in first world countries. Everything is defensive practice to avoid law suit. Never also have I seen patient’s telling physicians basically the treatment they want and not necessarily whats is best for them. It has become a business. The heart and compassion , even the basic common sense is slipping away. It can be so frustrating sometimes. Miss those good all days. Great post my friend. An eye opener to all…
You are right, the practice of medicine has really changed so much so that “everything is defensive practice to avoid law suit.” Sooner or later “Defensive Medicine” just like “Preventive Medicine” would be a new subspecialty.
Medyo okay pa sa akin ang telemedicine bilang isang pasyente lalo na kung nasa Pilipinas. Kasi dati naman ay nakakausap ang doktor lalo na sa atin(minsan kasi ay mahirap mahagilap ang doktor sa atin) sa telepono lang at sa pag-uusap pa lang ay pwede nang sabihin ng doktor kung gamot lang muna o compine na sa hospital. Mas siguradong effective/accurate ang may video at yung mga robotic or remote sensors sa pag-examine sa pasyente lalo na nga kung magkalayo ang pasyente at doktor.