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The doctor will Skype you now

New technologies can improve how you communicate with your doctor

Last updated: July 2011

In this month's 5-minute Consult column, Consumer Reports' chief medical adviser Marvin M. Lipman, M.D., explains how to use new technologies to communicate with your doctor. 

Several years ago I received an e-mail from a patient on vacation in Mexico. He had developed a stinging rash on his left forearm and shoulder. He was convinced that some "south of the border" bug had bitten him and wanted to know what medicine to take. He had taken a color photograph of the rash with his cell-phone camera, which he uploaded to his laptop and included as an attachment to his e-mail message. Upon opening the photo, I knew the diagnosis immediately. He had shingles. I prescribed antiviral medication, and in a few weeks he was fine. Little did I know that I was in the vanguard of a relatively new entity called telemedicine, the practice of medicine remotely using electronic communications.

An app for that

Illustration: Michael Sloan

The notion of diagnosing or treating a problem without a face-to-face encounter is nothing new. Since the advent of the telephone, doctors have had, and used, the option to treat patients remotely, especially when symptoms are obvious and a visit to the office would be overkill.

But the past 20 years have brought an unprecedented sea change as the Internet, social media, and other advances have made possible face-to-face interaction, in real time, with no regard to physical location. Medical students can "attend" lectures and "examine" patients online. Skype and other computerized audiovisual technology have become tools for practicing medicine, particularly in specialties that don't require the laying on of hands. For example, the company Virtual Radiologic employs board-certified radiologists, some overseas, who interpret middle-of-the-night CT scans, saving hospitals the cost of having radiologists on call.

Cardiologists can now read electrocardiograms from the comfort of their living rooms, and neurologists at large medical centers can offer potentially lifesaving care for stroke patients by reading brain scans and MRIs transmitted from rural hospital emergency rooms that lack such specialists.

Wanted: More evidence

Like most technological advances, the explosion in remote doctoring raises a lot of questions, many of which we simply lack the evidence right now to answer. Has the technology outstripped the science? Which patients or diseases can benefit from advice given by a remote health-care provider? To what extent can telemedicine save lives, decrease pain, or increase longevity?

The existing evidence is limited and mixed. For instance, a systematic review published last year looked at 85 studies that analyzed the accuracy of diagnosing skin diseases on a computer screen compared with in-patient office visits. Twice as many papers favored the office-based diagnoses over those gleaned from computer images. At the same time, research suggests that the potential of telemedicine to provide medical care to underserved areas is huge—as is its potential to reduce health-care costs.

Bottom line. Until there's clearer evidence to support telemedicine, proceed with some wariness—taking into account, too, your relationship with your provider. Do you feel comfortable e-mailing color photos of your rash to your doctor? (And are you confident that he or she will respond?) If so, then go for it. Otherwise, if you're far away and feeling ill, a face-to-face consultation at an ER or urgent-care facility might still be your best option.

Marvin Lipman, M.D.

Chief Medical Adviser and Medical Editor
   

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