09
Jan
10

Waiting on the doctors…again

A couple of days ago the NYTimes’ Health section Dr. Pauline Chen did a piece about a recent study by U Texas of the adoption of telemedicine for the ICUs of five  hospitals. The conclusion in the JAMA abstract is nothing if not concise:

Conclusion Remote monitoring of ICU patients was not associated with an overall improvement in mortality or LOS.

But Dr. Chen’s article has some more information which is suspect is not in the journal article (I’m not forking over $15 to JAMA to find out). Essentially doctors and nurses were reluctant to let their patients fully participate in the protocols and so evaluating the impact on telemedicine tools and on patients was difficult. The article elaborates:

“Families seemed to be very accepting of the technology because they felt that someone was always looking in on the patient,” said Dr. Bela Patel, the senior author of the study and executive medical director of critical care at the Memorial Hermann Hospital-Texas Medical Center.

Despite the seemingly obvious advantages and patient willingness, however, the majority of doctors in the study chose to have as little remote involvement for their patients as possible. Many were worried about telemedicine’s effect on their relationships with patients and that it might adversely affect care.

Further:

This lack of acceptance made it difficult for the study investigators to assess the impact of telemedicine on patients who were less sick but who had much to gain. “Early recognition of changes in a patient’s status is what really helps in critical care,” Dr. Patel said. “When a patient’s heart stops or a patient is clinically crashing, everyone knows about it. But when a patient’s heart rate goes up slightly, not everyone catches that. If you notice and act upon these kinds of changes early, you can rescue the patient early.”

While the researchers ultimately found that telemedicine could significantly improve survival among the sickest of I.C.U. patients, the resistance of on-site clinicians made it nearly impossible to assess the broad impact of such technology on quality of care.

Does this seem as annoyingly familiar to you as it does to me? In my more than three decades around the health field it seems to me that again and again new ideas and tools for extending health resources have been greeted with less than open-armed acceptance. Medicine is said to be a “conservative” profession, and perhaps that’s warranted to some degree because, after all, lives are at stake. But I’ve become more cynical about the motivations for this conservatism as years have  passed. During the years I’ve worked in public health my observation is that the medical profession has steadily become more ensconced in what has to be called a medical/industrial complex. All too often what the profession appears to be conserving is its own interests — authority, control, money —  and its justification is frequently cloaked in claims physicians are only concerned about the doctor-patient relationship.

Be that as it may, forces for change from outside the medical establishment continue to mount. The Health 2.0, participatory medicine, and patient-generated content movements are attracting a constituency among people who want an alternative to the passivity and powerlessness that have characterized personal health care for the past century. For its part, telemedicine might be said to be underway already in the flocking of people to the internet for health information, in the flourishing patient sharing sites around specific diseases, and in the rapid uptake of monitoring devices and health-oriented tools for smartphones.

I will be saying a lot more on this blog about a paradigm shift for human health that, to my mind, is inevitable. Along the way we’re going to have to cobble together the best electronic support systems we can from consumer products, pull together open sources of quality information from science and patient experiences, and demand access to all forms of our health data while accumulating our own viable data from self-monitoring.  Only when we have our own ante can we play in the game.

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