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Dr. Joseph Sirven: The Doctor Is In — Online

Dr. Joseph Sirven
Dr. Joseph Sirven
Dr. Joseph Sirven

My on-call shift starts like any other, with a phone call from the emergency room waking me up at 2 a.m asking for help. A patient thought he had a stroke and his ER doctors wanted to do everything they can to preserve the brain.

I examine him and give advice to the ER physician. The patient thanks me profusely, the ER doctor is grateful, and I go back to my uneasy slumber. 

So you’re probably thinking, OK, what’s so special about this hospital encounter versus any other? Well, when I got the call, I didn’t get into the car and drive to the hospital. I simply opened my laptop, clicked a link, and the patient appeared from an ER in Kingman. The entire visit was conducted from my kitchen table with my dogs lying at my feet.

Tonight, I see patients in Queen Creek, Las Vegas, Yuma, and Flagstaff without ever leaving Scottsdale.

Welcome to the new reality of healthcare — telemedicine.

Telehealth services are expected to grow 32 percent by 2018. Virtually any aspect of medicine that can be transmitted electronically or by video or phone is game. This service is a lifeline for people living in rural communities without access to doctors. 

The only reason it hasn’t grown faster is because the old rules of medical practice still prevail. You still need a state medical license at the hospital or clinic that the patient is going to be linking up to you. And, then that facility has to credential the physician as one worthy to be working on their behalf. 

As you can imagine, this is a bureaucratic process and there is not a one-stop shop. In fact, Congress is considering a bipartisan Telemed Actwhich would eliminate these licensing barriers.   

For all of the "gee-whiz" moments of my telemedicine call night, the experience is oddly antiseptic. I am missing the barrage of other senses that I typically rely on for medical diagnosis like touch or smell. The extent of the information sent over the airwaves is all I get to see, nothing more nothing less. And if a medical clue is out of camera range, it’s lost to me which in some complex cases makes me nervous about what details I may not be hearing or seeing.

The other odd thing is how easy it is to disconnect from the situation. If the patient was finished with me or vice versa, I just pressed a button and they were gone. That never happens in real life.

It’s ironic that the Internet, one of world’s most modern tools, would bring us back to a version of the old-fashioned house call with a twist. 

Listen, I gotta get back to work; I have a few more patients to click to before the end of the night.

Dr. Joseph Sirven is the chairman of neurology at the Mayo Clinic.

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