The Promise And The Peril Of Virtual Health Care
Amid the coronavirus pandemic, telemedicine has become a standard in health care. But do we want the future of health care to look like this?
For years, telemedicine was pushed to the margins of health care. The crisis caused by the COVID-19 pandemic has forced many patients and doctors to switch to virtual medical consultations. And it turned out that it actually works. Rather than go to the doctor with a severe sore throat, which is not always possible anyway, the patient can simply get medical advice over the phone or a video call. Patients with chronic conditions, such as diabetes or hypertension, no longer need to visit an outpatient clinic regularly to have routine tests. All they need is a computer or a smartphone. It is estimated that about 50–70% of all appointments could be replaced with teleconsultations. However, even the COVID-19 pandemic will not remove well-known obstacles for the adaptation of telemedicine, e.g. those related to funding and technical infrastructure.
Some outpatient clinics and hospitals in small towns are concerned that their small medical staff and income from procedures performed on site will be even more limited by telemedicine. We should also remember that the patients who need care the most, i.e. elderly people and those with a low social status, do not have smartphones and broadband Internet, or are not that familiar with handling new technologies.
There is also the question of responsibility. A teledoctor who misdiagnoses a stomach ache, which then turns out to be stomach cancer, has the same liability as a traditional doctor. This is why doctors who offer remote consultations have to deal with uncertainty and rely on the patient's declared health condition. It is not surprising that they prefer an appointment at the doctor's office, where they can order laboratory tests and perform a physical examination.
Despite all of this, telecare has many advantages to offer to patients. They do not have to wait in a line, or take time off work or travel to a medical facility, sometimes just to collect their prescriptions. And visits to the doctor's office leave much to be desired anyway. Doctors spend long minutes studying or filling in documents on a computer screen. In the case of a virtual appointment, the doctor takes care of this when the call ends.
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London hospital starts virtual ward rounds for medical students
Students running after doctors and observing their everyday work is a common sight in hospitals. However, it is not always the best way to learn: the doctor finds it difficult to focus on the patients, and the patients are deprived of intimacy. But this may soon change. A few weeks ago, Imperial College London conducted the world's first virtual ward round for medical students. An entire class of 350 students could observe a consultant examining patients at the same time, which would be impossible in the case of a traditional round.
The doctor conducting the virtual round is wearing Microsoft's HoloLens glasses. The image is transmitted directly to the students' computers. They not only see what is going on but can also hear the doctor talk to the patient. Teachers can also display the patient's documentation on screen, including X-rays, test results and lists of drugs. They are also free to highlight any elements they wish to emphasize.
Dr Amir Sam, head of the school of medicine at Imperial College London, said that the innovation became a necessity in the face of the COVID-19 pandemic. Hospitals are trying to minimize the risk of infection, which means that any person who does not have to stay in them is prevented from entering, which includes students.
Virtual ward rounds can be recorded. In this way, universities are creating their own libraries of cases. It means that more students will have an opportunity to meet patients with rare diseases and have a better understanding of their symptoms and how the hospital works.
Oliver Salazar, a fifth year medical student who participated in the virtual round, said that it was an invaluable clinical experience: "Despite the ward round being virtual, it felt far from it – we were expected to ask questions and think about clinical problems in real-time. It was really helpful to be able to access investigations like X-rays and blood tests in an instant, and the way the information was projected felt natural."
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After the pandemic, doctors want their new robot helpers to stay
With the outbreak of the COVID-19 pandemic, hospitals had to face a real challenge: insufficient staff, strict disinfection requirements, and procedures which limit the contact between medical personnel and patients to the bare minimum. What came to the rescue were autonomous robots. The first to arrive were UV cleaning machines. It is one of the most effective ways of removing bacteria and viruses. Ultraviolet light reaches every surface and the disinfection process is really fast. But most importantly, UV is dangerous to humans, so the task has to be performed by a machine. For example, thorough disinfection of a CT scanner takes a human cleaner an hour. The Violet robot needs just 15 minutes. Another advantage is that machines do not get sick, so they cannot actively transmit the coronavirus all over the hospital.
Ever since the outbreak of the pandemic, robots have delivered food and drugs to isolated patients, transported laboratory samples which required testing and served as receptionists. For example, in Antwerp University Hospital (Belgium), robots welcome patients who arrive at the hospital and suspect that they have COVID-19. A special camera is used to measure every patient's body temperature and check whether they are wearing a mask. If not, the robot instructs them to put one on. Then, the robot scans a QR code generated on the basis of a questionnaire which patients are required to fill in before they enter the hospital. The robot assesses every case and directs the patient to an appropriate hospital ward.
Moreover, the Phoenix Children's Hospital in Arizona uses telepresence robots. They have helped child patients confined to their rooms by giving them some semblance of contact with the outside world and their loved ones. Children could take virtual trips outside the hospital, for example to a fire station, watch shows prepared for them, play games, take quizzes and host special guests, such as local sports stars. The development of robotics shows that innovations are often born in a time of crisis.
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