Telemedicine

E

El and Bill

New member
Had an interesting discussion this am with a neurologist about telemedicine, and thought it might be worthwhile to share.

For some time now, a doctor we know in Las Vegas NV has been able to operate on soldiers in Iraq via telemedicine -- the doc in US manipulates the scalpel (with a device that looks like a video game, and with a clear tele-picture) -- the attending doc in Iraq does routine procedures (suturing, etc) and acts as a standby to the 'distant' doc who actually performs the 'tricky' part of the surgery. These links to the military are now operational in many hospitals in the US.

This morning's discussion centered around telemedicine for stroke patients in the US -- some hospitals in rural Colorado now have a telelink to the Stroke Center in Swedish Hospital, outside Denver -- the Denver doc can 'see' (via a very good t.v. monitor) the patient in the rural hospital, be told all the vitals, and decide whether to recommend the administration of the medication required within three hours of a stroke to help stabilize (and perhaps save the life) of the distant patient. This medicine carries a significant risk of bleeding in the brain, so shouldn't be given to every person who has had a stroke, and the Denver doc is more experienced in making this decision than most rural docs.

The discussion was predicated because I had a stroke two months ago. I did not require the special medication, and have since had a stent emplaced in a vertebral artery at the base of my brain -- and, because of our desire to continue our nomadic lifestyle (often to remote areas distant from Stroke Centers) we were considering setting up a telelink between our laptop (with a mounted t.v. type camera) and the Denver Center. However, he suggested, since he knows me and my condition so well we would (until the telelink improves to the point that it can be used by a linked individual, rather than a hospital as it is now), use telephone in an emergency from a distant medical location to him at the Stroke Center.

Maybe, we were speculating, there is a significant trend in medical practice that might someday bring the 'family doctor' back to house calls. Telemedicine, scanning your sniffling kid in his bedroom, might give the 'distant doc' all the info needed (like in a house call) to care for the kid. Thus perhaps reducing costs, giving personal attention via the link, relieving congestion (and potential infection) in waiting rooms -- and changing some of the medical world we know today.
 
All I can think of is that surgery taking place over a cel phone link that drops in the middle - like on those TV commercials... :wink:
 
Probably more realistically for the US, will be the federal health care who has a PA doing the scanning. Yes there are lots of break thrus in Medicine, but there are only a hand full more physicians graduating from Medical School now than 50 years ago. We make up the quota from foreign medical grads--and even those are in short supply because of the current imigration policies for professionals. Another problem is that physicians make less in todays dollars than they did 20 years ago. There are higher demands in paper work--and less time to see patients. There is a requirement for typed electronic medical records--Alok can fill you in on how he handles this. I know of a peditrician who spends hours at home each evening because she is not a good typist and has to transcribe the records from that day.

Even the "in the room" video surgery is limited to very specific cases for many conditions (like cardiac, vascular and neuro surgery). If things go bad all of a sudden, there has to be a back up plan.

I agree that you will find the best medicine practiced in the major medical centers.
 
I was going to say something (tongue in cheek-ish) about "keeping it simple", but then hit on another way to utilize this equipment onboard Halcyon...

"It's time for the El & Bill Show, coming to you live from the world's waterways, onboard Halcyon the Wonderboat. This week's guests include Pat, the guy who won't retire; Dave the magician, the guy who chops his boat in two; a special man-on-the-water report from Chris, live from Lake Powell, and our musical segment: Jack from Alaska, playing his Ford radio!"

"And now... heeeeeeeeeeeeeeeeeeere's El and Bill!"

Director: "Cue music (I Got You Babe), go to camera 4, cut to the cockpit cam, go to the crowd shot, back to El and Bill. Good, now drop the music, widen out, and... Oh my God, who dressed Bill tonight? That sequin jacket is glaring back at the camera! Camera 3, signal him to turn to the side more. That's enough! Damn, this was easier when they were keeping it simple!"

:mrgreen:

But, I guess that medical stuff would work with this equipment, too. :wink:

Best wishes,
Jim B.
 
Telemedicine from home (or a boat) isn't really very practical. First, you need a really high resolution camera (and lots of bandwidth) to get a usable visual feed. More importantly, you need a clinics worth of medical equipment such as otoscopes (with special camera), ophthalmoscope (with camera), electronic stethoscopes and the like to do a physical exam (and someone to operate them).

In the example of treating strokes with tPA in a community hospital, the community hospital will need to have cat scan machine, as that is a necessary test to determine whether you are a candidate for tPA - not something you can get done in your boat (or in a lot of community hospitals, for that matter since the CT needs to be done within something like 30 minutes of arrival).

One of the reasons that American doctors don't do house calls anymore (aside from the fact that it isn't an efficient utilization of their time), is that they are too dependent on technology, and really can't accomplish anything in the absence of their clinic full of equipment. To open a telemedicine satellite would need an investment of several thousand dollars at a minimum. It's expensive on the satellite side, and it's even more expensive at the medical center side, as they need to have suitable specialists available all the time to provide the telemedicine service. One reason that the military is pioneering this technology is that they are the only ones who can afford it.

Anyway, in my opinion, this technology isn't practical for general use at the moment.

Jim

By the way, I'm a nurse practitioner for the State Department, and have worked in Africa for the past 16 years. I'd really love it if I had telemedicine available. The State Department explored it a little bit, but abandoned the idea for a lot of reasons, one of the biggest being lack of adequate bandwidth in the third world countries where you need it the most, and also due to the expense.
 
thataway":7x8zuly7 said:
, but there are only a hand full more physicians graduating from Medical School now than 50 years ago. We make up the quota from foreign medical grads--and even those are in short supply because of the current imigration policies for professionals. Another problem is that physicians make less in todays dollars than they did 20 years ago.
Click to expand...

Then there's the other problem. Holding down health care expense. A recent article in our local newspaper reported the annual salary pulled in by the CEO of AMN health care and I was shocked. :shock: :shock: Who in the health care provider world makes anywhere near 53 million?

The middle man. Few responsibilities, major profits. ARGH

Don
 
El and Bill, with their usual perception, have hit all the important points about telemedicine in the initial post. I am a children's kidney specialist and have been involved in pediatric kidney dialysis and transplantation for almost three decades. I have been following the thread with interest.

Remote medicine is currently being used in two broad areas. The first is "consultation", where a physician can see the patient on a TV monitor. The patient is usually accompanied by a nurse, physician, or some other trained medical professional. The remote physician can evaluate the symptoms (provided by the patient) and clinical findings, laboratory test results, and radiographic images (provided by the accompanying medical professional) and give advice. This is now fairly common.

The second is remote surgery. The surgeon is at a remote console in a room next to the patient- or far away. The the main advantage of remote surgery is that the surgeon's hands do not have to enter the incision. Instead, miniature surgical instruments, including video cameras, are introduced into the patient through small incisions. The surgeon can see a high resolution 3-D image of the surgical field and can manipulate the cutting and suturing tools that are inside the patient from the remote console. The surgeon's hand movements are both stabilized and miniaturized, producing very "clean" and fine incisions and delicate suturing that minimizes tissue damage. Not only is the incision smaller, but the recovery time for patients is less.

The surgeon can be in the next room or half-way across the world, but the data link has to be high-speed broadband, both to convey rapid and accurate 3-D images from the surgical field and to convey the surgeon's hand responses.

Even though "what is the best for the patient" should always be the first question, like so many other things the future of different kinds of remote medicine/surgery will be governed in large part by cost-effectiveness. Anything that reduces costs- by allowing a physician to provide distant consultations or by reducing the length of hospital stay after surgery- will be targeted for further development. I will not say anything about CEO salaries!

C-Brats: what a great site!
 
Thanks, guys -- for the chuckles (we're still trying to find that sequin jacket for our next cruise) -- and for the knowledge from those of you practicing in the field --
 
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