Help Is Here

Finding It Is Sometimes A Problem

When a patient presents herself to a healthcare provider with an acute problem and appears very ill, the situation is scary to one of three degrees: 1. Scary as in “Gee, I wish she had gone to somebody else.” 2. Scary as manifested by, “Ohmigosh, this is a really tough problem and I wonder if I can handle it.” Or, 3. Scary like, “She’s gonna die if I don’t do the right thing(s).”

Physician’s professional management of personal fright depends on their training and their location. In a large metropolitan teaching hospital, calls are sent out for all appropriate consultants to gather at the patient’s bedside to render assistance – to both the patient and her doctor. In a small rural facility, the calls go out to any friends who may be available at the time. Some of the friends are not, perhaps, any more knowledgeable than the attending physician, but their presence is comforting as well as reassuring.

Pooling of local ideas and knowledge could result in resolution of a tough problem, or it might lead to frantic probing, imaging, and testing, the outcome of which is further confusion.

Absent the luxury of on-call and physically available consultants, what’s a beleaguered country doc supposed to do? Why not send all of these scare-inducing patients off to the nearest large hospital? Because it may not be easy, because the local guy thinks he can work it out, because the local hospital is cash starved and needs more income, because the patient doesn’t want to go, etc.

One remedy is teleconsultation. This is the 21st century, all of us have access to some sort of Internet hook-up, and somewhere in the world an appropriate consultant is awake and available on that Internet. To keep things simple, as of this moment, there’s only one worldwide web to search.

Actually, there isn’t a consultant available now, not for most isolated or small healthcare activities. (There are exceptions; 24/7/365 consultants are on call now for reading troublesome x-rays, MRIs, or CT Scans, and some pilot programs are providing remote acute-care consultations on a limited basis.)

There are obstacles to teleconsulting, and two of the major ones are the manner of reimbursement for the service and malpractice risk associated with offering advice when not in the presence of a patient. Re the latter, we could say, “What about the radiologist or pathologist who offers very important advice and may not come within a thousand miles of a real live patient?” As for payment problems, teleconsulting specialists are already being paid in some places by some insurance carriers.

Lack of good hardware and reliable communication lines present the other large impediment to telemedicine activities. Perhaps the Gates / Buffet combo could offer some help here. They appear to have enough money to provide broadband service to every hamlet in the world AND pay for the service of the consultants. Absent this kind of funding, progress toward excellent, available, teleconsultations will be a bit slow.

To visit the web site of a successful telemedicine program developed by the University of Arizona College of Medicine and Medical Center, click here.

(Note: One stimulus for this column was my learning of the plight of a person who found herself in the situation described above. Another was reading Thomas Friedman’s “The Earth Is Flat”.)