The limitations of telemedicine

Infectious agents do not travel on the internet, which makes telemedicine attractive as a device for physicians and patients to interact during a pandemic. As a televised interview, we need not be in the same space, thus eliminating commuting time for both parties.

But telemedicine has its limitations.

Within the confines of a televised contact, physicians can review a chart, access laboratory data and medication lists, and obtain a history of the patient’s life and illness.

But four tools characterize the classical physical examination: inspection, palpation (feeling), percussion and auscultation.

Inspection can be done remotely if the patient is cooperative, and the room well lit. Auscultation, using a stethoscope, can be done remotely if the patient is willing and trained and suitable electronic equipment is available.

But percussion, tapping to identify solid or hollow areas of the chest and abdomen, cannot.

Palpation, also, cannot be done remotely. And palpation includes feeling for softness of the normal abdomen or detecting the rigidity of an inflamed abdomen. It includes touching skin, feeling for healthy warmth or sickly clamminess. Palpation represents the classic “laying on of hands.”

It also communicates caring, and fellow feeling. And it contributes to the development of trust. It can say “I understand” and “I care.”

There is an immediacy to being present. It is akin to the difference between a movie and a play.

I suppose that there are other ways of doing this. Both doctor and patient can learn to do without touch, without being in the same space. But something important is lost in the process, and with it much of the satisfaction of the doctor-patient relationship.

Dr. Steven Wolfson Guilford