Committed connection: one-year telemedicine lessons


Let’s be honest: telemedicine is not there yet. I have been treating patients through remote care for almost a year now and so far I am disappointed. And my patients have voted with their feet; most still want to see me in person. I suspect they are not satisfied with the compromised connection that telemedicine offers.

So I want to decompress some of my ideas about telemedicine. Specifically, how can marginal initial experiences give way to something better?

Let’s start with something I really believe in: the human connection is from person to person. Whenever the human connection is mediated by technology, it interferes with the way we have evolved to be together. From the subtleties of body language to the way the mother and baby interact, so much is lost on the fuzzy screen. So between a face-to-face visit and a video meeting, the IRL connection always gives me more as a doctor. It just does.

But, as we shall see, in many cases there is nothing wrong with a compromised connection.

Exhaustion as proof of a compromised connection

Telemedicine fell from the maximum inflated expectations until the drinker of disillusionment in June 2020. But why? For one thing, we’re just discovering what we do as advanced doctors and professionals when it comes to caring for a virtual connection.

I wrote about it exhaustion of the telemedicine meeting which I experienced shortly after developing my own telemedicine clinic in the spring of 2020. I couldn’t understand why but I thought it was because of all the real time adjusting I had to. Fallen words and phrases, technical tweaks and the emotional stress of trying to read physical cues, a key part of my job.

But that’s the important thing: while giving me an IRL visit month that a telemedicine visit, I don’t always need month.

But improved access can make up for the compromised connection

Let me clarify something before technologists cancel me on Twitter: compromised human connection doesn’t mean there aren’t significant benefits in the growth of telehealth. Like my ability to care for more children, for example. Even if we miss some of the nuanced things that humans share when in the same room telemedicine has the potential to offer access where it didn’t exist. This is huge.

A good example of a useful remote transaction that has no nuances is the drug reload request on a text-based application; i just need the message to take action. On the other hand, an established West Texas teen with ulcerative colitis who has a rash needs more than a text exchange with me (trying to assess the problem this way is torture because I have a lot of questions). Video is a great solution here, as you don’t have to make the 7-hour trip to Southeast Texas, I know, and the acute care meeting is really transactional – I just need the facts to get us to the next point of attention. On the other hand, critical conversations, such as end-of-life discussions, outreach, and planning around life-changing diagnoses, or exploration of certain physical problems, can be better managed with a face-to-face encounter. face or belly.

Like me he said here in 2015, the commitment to disease is complex, so we need to understand what they can do and what our tools can do when to use them. This is a new skill of the 21st century health professional.

Therefore, while remote care may compromise the raw human connection, its ability to scale the connection with more patients compensates for the commitment. It is a reasonable commitment in many cases and defines the disruptive nature of telemedicine in medical practice.

Beware of the paradox of the present

But here it is important to keep my blind vision of telemedicine in 2021.

There is a so-called effect the paradox of the present. While the term has been popularized by futurists Amy Webb and used in various ways, for our purposes we can say that it is when we believe that things could be based on how they are now. Or, to put it more clearly, it is hard for us to see beyond what we know to be true at the moment. Kevin Kelly a The inevitable Understand the 12 technological forces that will shape our future talks about how what we know blinds our view of how things could be:

… we tend to see new things from the frame of the old. We extend our current perspective to the future, which in fact distorts the new to fit into what we already know. That is why the first films were filmed as plays and the first VR made as films. These shoes are not always bad. Narrators exploit this human reflex to relate the new to the old, but when we try to discern what will happen in front of us, this habit can deceive us.

Proof of this is the fact that we have built telemedicine platforms with all the comforts of the clinic, such as “waiting rooms” and even doctors with stethoscopes around their necks (“What will you do with a stethoscope during a telemedicine visit?”)

Therefore, we must understand that as technology evolves it will not always be so. The new tools will allow for new types of connections that will change the telemedicine experience for both physician and patient. Next-generation platforms will offer a less compromised connection (or one in different ways). It won’t be as good as being there yet, but it will be closer.

Eating dog food: a pessimistic twist on face-to-face medicine

I started here with the assumption that direct human exchange is the ultimate interface. But it is possible that we are witnessing a kind of evolution in which humans may be more comfortable participate asynchronously or through some kind of tool; a good example is my teenager who doesn’t want to talk but will allow a text exchange. Or we may be better in person, but we are afraid of the intimate reality of face-to-face engagement. This idea of ​​hiding behind a screen corrupts my fundamental idea. While we may believe we feel better from person to person, we may be losing our ability to have the kind of connection IRL offers. Or in the words of Sherry Turkle, with remote connection we are attracted by the comfort of the connection without privacy requirements. If you want to explore this issue, you might read Turkle’s brilliant book, Alone Together | Why do we expect more from technology and less from each other.

The success of telemedicine depends on criticism

Blindly accepting telemedicine in its current form is one of the worst things we can do. As end users, we need to talk about where this technology is strong and where it is not. Unlike press releases and “made for Twitter” appointments from telemedicine CEOs, this technology needs a lot of work. And understanding this is important because it recognizes that telemedicine has limitations. And it’s okay. It gives us all a place to start.

The industry sees it too. An interesting StatNews First opinion essay last week from the CEO of Doctor on Demand.

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Personally modified photo original of Creedi Zhong turned on Unsplash

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