Want to ‘Tweet’ or ‘Poke’ or ‘Friend’ your doctor? How about skip the drive to his or her office and have a scheduled visit in the comfort of your own living room?
The internet is making technological communication possible and more commonplace than seemed imaginable not so long ago. When medicine is practiced via electronic media it’s called “Telemedicine.”
Telemedicine has the potential to serve at least 5 functions:
1) Increases access to care
2) Offers efficiency
3) Improves overall health status
4) Decreases cost
5) Brings care to the patient (patient-centric medicine)
Telemedicine programs in the United States increased by 1,500% from 1993 to 1998. (1) That’s huge! Telemedicine use has grown 10% annually in recent years and has become a $4 billion per year industry in the United States. (2) It’s now an option for doctors to care for patients via Skype.
Although the benefits listed above favor video-chat doctor visits, telemedicine has downsides. Patients lose out on the complex multidimensional aspect of a face-to-face encounter. There is also inherent awkwardness in remote communication. Do you really want to divulge personal information via the internet? Or show your rash/unidentified skin lesions via the Web?
Privacy cannot be guaranteed and this brings into question the ethics of diagnosis and treatment via Skype. There is a potential for inadvertent HIPAA violations. Not to mention that it is impossible to perform a physical exam through a Web exchange.
Can providers really uphold the standards of care that their profession demands via a technological exchange? Even psychiatrists, psychologists, and therapists could miss key findings. There are subtle nuances in every mental status exam, every patient encounter, that could be easily evade the narrow range of the camera’s eye.
Notwithstanding, Skype interviews are sometimes necessary and better than nothing. It could even be optimal when weather is dangerous, when an elderly or impaired patient can’t get to the office, or when somebody lives in a rural location.
It’s definitely a topic worth exploring. I worked with a colleague years ago to offer a more comprehensive medico-legal review of the merge between medicine and Skype, which can be found at http://www.currentpsychiatry.com/pdf/1012/1012CP_Malpractice.pdf
Currently, there is no official recommendation about the benefit to risk ratio of doctoring via Skype. The American Telemedicine Association has issued some practice standards and guidelines that could be very helpful for practitioners. (3)
Technology is exponentially taking over our world. Let’s continue this discussion! Has anyone here had any experiences either giving or receiving care via Skype? What were your experiences?
References
(1) Hilty DM, Yellowlees PM, Cobb HC, et al. Models of telepsychiatric consultation—liaison service to rural primary care. Psychosomatics. 2006;47(2):152-157.
(2) Freudenheim M. The doctor will see you now. Please logon. New York Times. May 29, 2010:BU1.
(3) American Telemedicine Association. Telemental standards and guidelines. http://www.americantelemed.org/i4a/ pages/index.cfm?pageID=3311.
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