Thoughts on telemedicine

Telemedicine existed before the Covid era, primarily in other countries. For instance, a Greek friend and colleague who is a Psychiatrist with US experience conducted tele-assessments of psychiatric patients at a major US hospital for a fee, achieving great success over a long period. If a tele-assessment can be conducted for a psychiatric patient, such as determining admission or treatment, it stands to reason that it can be done for any patient. Or not? Telemedicine began in the early internet era (late 90s-early 00s) out of necessity. For example, there was a need for basic medical assessments in remote areas of Greece from urban centers due to the lack of doctors. With the advancement of the internet and teleconference platforms like Skype and Zoom, the percentage of patients preferring telemedical (or telepsychological) assessments increased. The significant and sudden change occurred during the Covid years. Since 2020, more patients started "visiting" doctors telemedically, initially because scheduled appointments (at public and private providers) were halted by authorities, and later because some patients were afraid. For others, it was simply more convenient to have a remote medical assessment. Concurrently, the measure of immaterial prescription ("άυλη συνταγογράφηση") was introduced. This pioneering measure (for any country) highlighted fundamental issues in Greek society, similar to other electronic reforms that were correctly implemented in principle. Some issues highlighted by intangible prescribing include a lack of education in managing medical matters, a lack of trust and respect for healthcare providers, and the carelessness characterizing a significant portion of Greek society, including in relationships between service providers and recipients. The result was a substantial increase in remote requests for referrals and prescriptions to doctors, often without any intention of visiting the doctor's office.

Conditions were not significantly different overseas. The concept of "working from home" became ingrained in the mindset of various professionals, including doctors. We must all acknowledge that it catered to the work fatigue prevalent at the time, particularly in the medical field. Is it acceptable for a Nephrologist to assess kidney patients remotely, in any country? Yet, this practice became widespread in many countries, notably in the United Kingdom, which serves as an example to avoid. In the UK, while doctors were not attending their workplaces as a precautionary measure—and in some cases, still are not—the measures to control Covid were minimal, lacking any governmental oversight and personal accountability.

During our foundational medical education, both in Greece and globally, we learned the sequence "history-clinical examination-laboratory tests". History. Clinical Examination. Laboratory.

And reevaluation. This crucial trio, which has followed this order only since the rise of Medical Science, has been disturbed in recent years and, unfortunately, largely supplanted by the belief that remote monitoring, simply by documenting tests and medications, is somehow sufficiently effective.

However, it's insufficient.

At our Clinic, we provide telemedicine services for patients seeking an Endocrinology assessment because of distance. This service has been extremely beneficial for patients both within Greece and internationally. Indeed, most of our tele-appointments involve patients outside Greece who, for various reasons (such as challenges with local health systems due to inadequate primary care, or the need for a second opinion from a specialist), seek an assessment from a Greek specialist. The remaining tele-patients are typically residents of remote Greek areas lacking Endocrinology services, and for others, we offer telemedicine for the evaluation of results when visiting the clinic is not feasible.

However, for us, telemedicine is limited to its current scope. It does not involve substituting a medical visit with phone calls, emails, or other forms of communication. It does not involve requesting tests and prescriptions without a prior consultation with the doctor. It does not imply practicing telemedicine without the involvement of medicine.

Medicine continues to be practiced in doctors' offices and hospitals, and it remains a discipline that should always retain its focus on human-centered care, regardless of any advancements in technology.