Telemedicine Works—But What
Happens When Patients Don’t Think So?
B y N a n cy Ro w e o n
July 2, 2015
“
Telemedicine doesn’t work!” That’s
what I heard a few years ago from two
angry friends who knew I worked in
the field of telebehavioral health.
few-minutes-long, telemedicine meeting
with a neurologist (especially when
neurology turned out to have nothing to do
with the cause of his symptoms).
It turned out that the husband had had
symptoms that led the ED staff at their
local hospital to think he might be having
a stroke. That hospital had a telestroke
service, which was used to determine
whether he had had an ischemic stroke
and needed the clot-busting drug tPA to
save his life.
It’s also of concern to me that a
telemedicine service that worked exactly
as it was supposed to was perceived as a
failure—especially by two highly educated
professionals, one of whom is a clinician.
The stroke doctor at the remote site found
that my friend had not had a stroke and
should not be given tPA. That diagnosis
turned out to be correct.
This instance of telemedicine, in fact,
worked perfectly. My friend was diagnosed
correctly as not having had a stroke. To me,
it was a shining example of a successful
telestroke program.
So why did my friends feel that
telemedicine didn’t work?
It turns out that they didn’t understand
that the telemedicine session had one goal:
to determine whether he had had a stroke,
and if so, was it an ischemic stroke caused
by a blood clot—one that could be treated
with tPA. My friends thought the goal of
the emergency telestroke session was to
diagnose whatever was causing the strokelike symptoms.
To me, this signifies that the ED staff likely
was not completely clear about what
could and could not be expected from the
telestroke session in terms of a diagnosis.
It’s possible that my friends, in their fear
and panic, just didn’t hear whatever they
were told. In either case, the message
didn’t get through that a telestroke session
is an urgent, life-or-death meeting to
answer a single question—not an allencompassing, full-body diagnostic series.
After several specialist visits and multiple
diagnostic tests spanning more than a
month, the cause of my friend’s symptoms
was finally discovered. It is of concern to
me that my friends thought this discovery
should have occurred in an emergency,
20
How can we fix this?
Many states, including Arizona, require
“informed consent” by the patient before
the patient is treated via telemedicine. But
obtaining informed consent, apparently,
doesn’t always mean the patient
understands the goals and limits of a
telemedicine session. Obtaining informed
consent can be a good opportunity to
provide patient education on what to
expect and exactly what the session is
for. Patients know that, for instance, a
It’s of concern to me that
a telemedicine service that
worked exactly as it was
supposed to was perceived
as a failure.
dermatologist is not likely to be able to
diagnose high cholesterol—so why would
they expect a neurologist to diagnose
anything other than a neurological event?
But regardless of whether informed
consent is required, basic patient
orientation seems to be called for.
In my friends’ situation, perhaps a clear and
basic script to help the ED clinicians explain
to patients what to expect (and what not
to) from the telemedicine session would
have helped. And, in an ED setting where
the patient is terrified for his life, perhaps
some kind of interactivity needs to be built
in to ensure the patient and/or his loved
one understand the service.
A lot of attention has been given to how
successful telemedicine