Telemedicine: myth or reality?
John Wootton, MD, CM, CCFP, FCFP
Shawville, Que.
Can J Rural Med vol 3 (1):5
© 1998 Society of Rural Physicians of Canada
A group of recent graduates gather around a table in Sioux Lookout while a technician readies the equipment to send an x-ray of a child to a distant hospital. A group of keen but inexperienced GPs have scratched their heads for several days over the child's diagnosis. The heart seems big. There are several unidentifiable prominences, which look nothing like anything found in the medical texts.
More than 1600 km away, as the x-ray's image forms on the monitor, Dr. Barney Reilly, at Toronto's Hospital for Sick Children chats to the docs in that distant room about the weather, about pickerel, about the quality of the phone line. Ah, the wonders of telemedicine in 1997!
Wrong! Switch those digits around! The year is actually 1979, and telemedicine conferences similar to the one described have already been happening in Sioux Lookout for several years.
Fast forward to 1997. This time to a room in Rouyn-Noranda, where this rural doc has come from afar to observe a telemedicine conference on breast cancer. The base hospital is Montreal's Hôtel-Dieu, and the equipment at each site cost more than $100 000. The cameras beam real-time images to their respective monitors. The problem is that the presenter has forgotten to show up, no local docs are in the room to participate, and none of the other remote sites that usually hook up even bother to connect.
Judging by these 2 vignettes we may not have come as far as we think in almost 30 years.
Make no mistake, I am a fan of telemedicine. It causes me no end of misery to see it continually fail to live up to its promise. This is particularly tragic for rural medicine where the prima facie case would seem to have been made for its usefulness. How often have you agonized over a "c-spine" that seemed all right, but you weren't sure? How often did you forgo a fetal assessment because your radiologist didn't see fit to visit your community that week? Information is good. It won't keep you awake at night nearly as effectively as the lack of it will. So where's the roadblock?
As is pointed out by Manson, reflecting on the Australian experience in this issue's "literature of rural medicine" (see page 39), the adoption of telemedicine may outstrip the ability of the legislative and administrative frameworks to keep pace.1
Using a Canadian example: Is a radiologist in Montreal who interprets an x-ray sent from rural Newfoundland practising medicine in Quebec or Newfoundland? Is a licence needed? In which province? Who pays him?
Rural doctors must become involved in this debate and not leave it in the hands of the "regulators." We must define the questions that we want telemedicine to answer and describe the structures required to make it happen. Perhaps if the process is driven by real rural needs rather than theoretical benefits we will advance more quickly. The alternative is endless cycles of pilot projects and promises, and precious little to show for it.
Reference
- Manson N. Telemedicine and the New Children's Hospital (Royal Alexandra Hospital for Children). J Telemed Telecare 1997;3 Suppl 1:46-8.
