Time Capsule: Lay Your Hands on the TV to Be Healed: The Emergence of the Superstar Remote Physician

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in September 2007.

Lay Your Hands on the TV to Be Healed: The Emergence of the Superstar Remote Physician
By Mr. HIStalk

What do these micro-trends have in common?

• Big-name US hospitals open branches overseas
• Recognized organizations and practitioners offer remote second opinions
• Centralized intensivists monitor ICU patients
• The military uses telemedicine to improve battlefield care and services to remote locations

It’s a two-part answer: (a) all were made possible by technology, and (b) all point to a growing de- emphasis on the traditional patient-physician relationships. (There’s actually a third part: providers following an evidence-based practice framework can deliver better outcomes than free spirits making it up as they go, valuing conformity as much as brilliance).

Blame HMOs and hospitals if you don’t like this inevitable future of care delivery. Both organizations deal swiftly and decisively with episodic symptoms, but aren’t so hot when it comes to mind-body-spirit care or, in fact, anything that requires more than a set of labs, rads, and physical measurements to conclude that a surgery, treatment, or prescription is in order. It’s like Whack-A-Mole-Medicine — diagnosis and treatment for a generation raised on video games.

We patients have been dutifully conditioned to expect nothing more from our sometimes faceless providers or interchangeable institutions. No one cares that you’d rather see a doctor instead of a physician assistant. You can do well in a hospital stay attended to by non-physicians 23.75 hours a day. Doctors cover for each other without advance notice. Apparently it doesn’t matter who’s manning the stethoscope.

Patients are accustomed to being told which movie, car, or college is "best". It’s not much of a leap, then, to expect them to flock to notable experts for serious diagnoses, even if that person won’t every lay eyes or hands on them. Can the local, faceless doctor with a state school education and an unimpressive residency do as well as an Ivy League super- specialist working remotely, just because you’re sitting naked in front of them? There’s an obvious precedent: pathologists and radiologists who rarely leave their darkened basements to render professional services.

This will happen: very good doctors, singled out as such by any of dozens of score card and pay-for- performance plans, will be busy offering remote services to those who grew up believing that medicine is about objective processing of health data, not being a family friend who’s know everything about you and your family. They’ll make a mint, of course.

Remote medical practice will drive – and be driven by – the interoperability of electronic medical records. Accurate decision-making and efficiency will demand extensive data review: notes, diagnostic images, prescription records, digital pictures, video, and sound files.

Remote, faceless medicine is inevitable except for those with the financial means to seek alternatives. It will require extensive electronic, portable records with a wide variety of sources and formats. Good doctors will have their reach extended by the reduced need to be tied to a physical location, broadening their customer base like a TV preacher or Suzanne Somers hawking jewelry on the Home Shopping Network.

Doctors will be a brand name. Information demands will be extensive. Interoperability will be a given. And if you want a (figurative) shoulder to cry on, you’ll have to join an online support group.