New technology always goes through a period of interrogation. A period in which there are people flocking to either pole (‘this new tech is really bad’, and, ‘this new tech is great’.) The Luddites and the industrial revolutionaries, if you will. Over a period of time the interrogation moves, sometimes painfully, to a sort of nuanced, often unforeseeable at the outset, middle ground. A consensus emerges through practice and behaviour rather than the entrenched dogmatic positions.
Well, with that sweeping preamble out of the way, let me get to the point. So one of the ironies in the wicked world of healthcare continues to be the fact that many more people, in the developing world, have access to reasonably good internet through a reasonably priced smartphone than have access to proper healthcare. That has been the core promise of telemedicine. Early telemedicine players, in India, tried to solve for the connectivity problem (buses with VSAT, file sharing at very low bandwidth etc) and implicit in those attempts was the idea that connectivity will take care of everything. Well, it did not. Also most of those efforts became redundant very quickly once the towers started sprouting all overt this land of ours.
If one discusses this problem with experienced doctors then often the following themes emerge:
A. Healthcare is intrinsically tactile, and so cannot work remotely
B. A doctor gleans a lot of information from just looking at a patient
C. “Real” doctors don’t do online consultations
On the other hand, there the proverbial upstarts who look at remote consultations as a viable solution to all problems:
A. Look at the sheer convenience of it
B. If only doctors were not so protective of their craft...
C. It is only a ‘when’ (it takes off) rather than an ‘if’ question
That’s been the debate. I think we are getting to the middle ground emerging. Healthcare is not as homogenous as it comes across in this debate.
Examination of a subcutaneous lump is of course tactile and asking the user questions about its attributes to take a decision is futile and potentially dangerous. However asking the user if he has been waking up with a morning erection works across formats. In fact, it can be argued that it works even better as part of a self-administered questionnaire than across the table from a doctor. The consulting room, at least in India, does not afford the time to a person to consider a question such as this one accurately. Throw into the mix the possibly intimidating figure of the male doctor across the table, and the pressure to lie increases dramatically. And the doctor being a woman is no solution either. The issue is that one’s sense of self is intricately tied in to the answer of the question. The primal instinct would tell me to answer, ‘yes. Of course I wake up with a throbbing erection every morning’, even though I know that that’s not true and that an honest answer to the question is of course a necessary (but not sufficient) condition for good resolution. You can of course sample the quiz at www.misters.in to see the pieces of information essential to get to the right resolution. Consider each question—each question that is essential—and consider the propensity to misrepresent even for generally truthful people.