Are doctors ready to accept remote medicine?

The robots are coming.  Or that’s what those who advocate for so-called “telemedicine” predict.

In a recent New York Times column, Pauline Chen discusses the phenomenon of telemedicine, looking at a study of remote monitoring of intensive care patients in addition to usual care. Despite most families feeling that these “extra set of eyes” may improve patient safety, doctors and nurses physically in the ICU were apprehensive.

There was so much resistance, in fact, that the study investigators were not able to draw any general conclusions, as “this lack of acceptance made it difficult for the study investigators to assess the impact of telemedicine on patients who were less sick but who had much to gain.” Findings did show improvement in survival among the sickest patients, but medical staff reluctance made widespread implementation of remote patient monitoring unlikely.

Like everything else in medicine, old habits die hard. Good ideas that break the mold, even in the name of patient safety, take time to become accepted. And that includes remote monitoring of patients.  But Dr. Chen notes that rural parts of the country have trouble finding enough doctors to staff their hospitals. Practicing medicine remotely, or a “virtual visit,” so to speak, may be the only option in these cases.

It would be nice to have more data to assess its feasibility, but for that to happen, more doctors and nurses need to be open to an unconventional idea like this.

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  • Prashanth

    Hmm…..are patients ready to accept telemedicine? I think there are still a lot of cultural issues to telemedicine acceptance by communities. Most patients in rural India do not want to get advice from a computer. Tele-education, tele-farming or a telecentre for anything else has much more acceptance than telemedicine as of now, in my experience.

  • Dr. Kona

    I partially agree with Prashanth’s comment about patients not being ready to accept telemedicine, but I also argue that in a lot of centers this is done similarly already. The attending physician intensivist rounds with physician assistants on the ICU patients, but is not present in the unit for most of the day, and certainly not at night. Many times the attending physician will do chart rounds, where they look at vital signs, lab data, radiology reports, etc. to make decisions and write treatment orders without seeing the patient. The physician assistants are working directly with the patients and help to carry out the orders. They report back to the attending with data and questions regarding patient care. This happens all the time. I think remotely-situated physician oversight is not that radical an idea, and telemedicine does not refer to computer-generated advice.

  • Anonymous

    For providing TPA in rural hospitals, there is tele-medicine and this is JACHO and AHA approved. why can’t other things be approved as well?

  • alex

    It sounds like it failed because the idea is absurd. They act like it’s shocking that the majority of doctors didn’t want a remote critical care attending writing orders on their patient without ever seeing them. Which isn’t even touching the complexities of now having two totally different doctors responsible for primary management of an ICU patient at the same time. If the patient’s BP drops who writes the order? Who needs to physically evaluate the patient? There’s a reason the concept of “primary team” exists.

  • Dr. Kona

    Yes, alex, it can get very confusing if there is more than one doctor responsible for the patient in the ICU; however, this is almost always the case already. There exist both “open” and “closed” units in most American hospitals. In an open unit, the ICU team manages the patient but the patient’s individual primary physician determines the general treatment plan and writes orders as well. In a closed unit, the ICU physicians are the only ones making the decision; however, there can be a lot of confusion when the primary physician and other consultants have treatment ideas for the patient as well. Most ICU level patient have several doctors participating in their care, so it makes no difference the type of unit, there is always confusion about who is calling the shots.

  • ArkyDoc

    I am a hospitalist (general internist) in a critical access hospital without any other specialty help available. I absolutely LOVE our eICU – started a couple of years ago. My partner and I work a 7-on, 7-off schedule, with home call when we are not on-site. We have come to know and have a great collaborative relationship with the eICU critical care specialists at our parent facility.

    The technology is wonderful! The camera can zoom in close enough to check pupil size, read all the infusion pump and ventilator settings, etc. I had a chance to visit the control/monitoring center at the central facility, and it was truly impressive.

    It is great not to be awakened every two hours with the latest electrolytes on one of our DKA patients. It is really fun for me and our respiratory therapists to estimate what ventilator changes will be recommended based on the latest blood gas before we fax it for evaluation – and we have really learned from it. We are most often in agreement with what the critical care specialist recommends these days. I think it has really helped me grow professionally, and the patients love it too. They feel much more confident staying in our hospital when they are really sick.

    We have a variety of “sign-out” options available. We can ask to be called with every order, to discuss and concur or disagree. Or, we can totally sign-out and countersign the electronic orders in the morning. At first, I was uneasy, but the relationship has grown so that now I routinely sign out when I go home at night. The critical care specialists still call me to alert me if my patients need on-site care (i.e. wearing out on Bi-Pap, need to be intubated soon) so that I can go back in.

    I think once the original wariness has worn off, most people who try it will really like it. It is really a win-win for physicians and for patients.

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