A few days ago, a message on Twitter from a patient in the Emergency Department of the Villalba Hospital in Madrid caused a stir. In it, she explained that she had gone to the hospital service due to the worsening of the sciatic pain that she suffered. Her surprise came when the doctor who treated her did not visit her in person but through a screen: “A doctor through the webcam. No exploration, no tests. Puncture and home”. The text was accompanied by an image of said visit that recalled the famous plasma of the appearances of the former Prime Minister, Mariano Rajoy.
As much as it may seem like a simple anecdote viralized by social networks, the truth is that it is a new medicine alert that awaits us just around the corner. It is worth reviewing the sequence of events. The patient went to the emergency room and there, most likely, a nursing professional did the proper triage. Later, and when she believed that she would be seen by the medical specialist, she found herself in a room with a television screen, on the other side of which a doctor appeared prescribing a treatment and referring the patient to her home.
From what has transpired in the case, it seems that this care system is already implemented in several hospitals in the Community of Madrid and the Minister of Health of said community, Enrique Ruiz Escudero, values this methodology very positively and is committed to its generalization , as explained after the complaint by the patient at the Villalba Hospital.
It is not about reviling telemedicine, a resource that, when properly applied, brings undeniable benefits, such as streamlining processes and optimizing care time. On the other hand, from the business point of view, there is no doubt that this model is advantageous: a single doctor on call (possibly localized, whose price is lower) offers care to several hospitals simultaneously and treats patients as if he were in front of a assembly line. But we must ask ourselves if remote care is desirable in a case like the one described above. And it is also worth questioning whether doctors should lend themselves to it.
In the first place, because we are faced with a highly heterogeneous demand for urgent care, which may require multiple services and medical specialties at the same time. Banal pathologies go to the Emergency Room, but also collapses, heart attacks, accidents with complex fractures and a long etcetera. In some cases, the telematic visit may seem sufficient (although most doctors would disagree), but in many others a professional will not be able to do anything electronically. Thus, a doctor who is remote and far from the hospital is not going to be able to provide correct health care for all the emergencies in his specialty.
As we can see, clinical variability discourages this type of practice, but health managers insist on its positive value. His proposal involves denaturing the medical act by excluding the physical examination from the diagnostic-therapeutic process. Do you really believe that in urgent hospital care the examination of the patient is not relevant?
It is clear that certain actions can be supported by telematic means, taking all precautions and means to ensure data protection, but telecare cannot be generalized to all fields of health care, disguising as modernity and technological progress an evident desire to continue to cut costs in public health.
Unfortunately we are not always aware, but it is in our hands, those of the doctors who work in public health, to consent to procedures that often cause embarrassment. We must refuse to perform certain medical acts that jeopardize our clinical judgment and, consequently, the safety of our patients. And to give us protection are the collegiate organizations and professional unions whose mission is to always defend good medical practice.
Because telemedicine cannot replace the exploration of a joint, cardiac auscultation or palpation of an abdomen, nor can it shake hands with a patient who needs it to transmit certain news. We must directly oppose the generalization of practices that only pursue the “rationalization” of health resources. If there is a shortage of staff, the thing to do is hire more and treat them better, not replace them with holograms.