How healthcare in rural areas can change for the better with tele-medicine

If you wanted to be a serious network in the early days of television, you had to have an orchestra. Classical music and opera were staples of the small screen in the late 1940s and early 1950s, from the NBC Symphony Orchestra to the Opera Theater. Why? Certainly not because it made for riveting television.

The ability to see a violinist doesn’t add much to a concerto. In part, it was a way to give the new medium some high-culture credibility. But mostly, it was way to keep doing things the way they’d always been done. Opera worked wonderfully on radio, so it was easy enough to set up a few cameras, do a bit of panning, and package Carmen as a one-hour prime-time special. Television: Almost as easy to make as it is to watch.

{mosads}As we all now know, this attitude didn’t last. Television was not just radio with pictures; it was an entirely new medium that could do entirely new things. And yet, our first impulse when confronted with new technology is to use it exactly as we did the old thing. Which leads me to telemedicine: The technology that lets a doctor treat a patient from afar can — and should — do so much more.

To say there aren’t enough doctors in the United States isn’t quite accurate: If you’re a patient at Mount Sinai Health System in New York City, there are plenty of brilliant specialists. It’s when you’re a patient at Haywood Park Community Hospital in Brownsville, Tenn., that there aren’t enough — that hospital closed its doors in 2014. Haywood County is what The Washington Post recently called a “dead-hospital zone,” a part of the country where the local ER is the back of an ambulance and the old operating room is used for movie shoots.

It is areas like this, in rural America and around the world, that telemedicine can most immediately help save lives. That melanoma can be caught earlier when diagnosing it is as easy as taking a photo. Chronic cough can be assessed without missing a day of work to make a pilgrimage to the clinic. And the availability of those remote services frees up healthcare professionals on the ground to devote themselves to the most urgent cases.

But as helpful as that will be to the citizens of Haywood County, it’s a solution that aspires only to bring us back to where we were. Telemedicine is a symphony on television. For a few, it’s exactly what they want. But the model can’t scale because it doesn’t let doctors see that many more patients. Yes, there is an immediate time savings in skipping the trip to the hospital and the time spent in the waiting room. And yes, a doctor might be able to squeeze a few more patients into each workday. But that’s not fixing healthcare. That’s trimming around the edges.  

That’s why the next era of telemedicine is distributed medicine. Your rash can be instantly seen by thousands of healthcare professionals, all of whom can offer their feedback in real time. The specialized knowledge of a dermatologist in a clinic on the other side of the country can be unlocked and put to immediate use. This model taps into the power of the crowd, only everyone in this particular crowd has a medical degree. Rather than getting 20 minutes of one-on-one time with a single doctor, you can get 10,000 healthcare professionals to consider your symptoms for two minutes apiece — more medical attention than most healthy people have ever had in their lives.

Of course, this model challenges some traditional expectations of healthcare. The doctor-patient relationship would change, and that will take some getting used to. But when you have citizens with no primary care access at all, it’s an obvious improvement. And as a first step, we can dramatically amplify the knowledge base in a way that is invisible to patients. By connecting healthcare professionals, we can give the one doctor in Brownsville the knowledge of all Mount Sinai’s specialists.

The solutions of the future are often too big for the problems they’re supposed to solve. Yes, television was a way to get opera to more people — but it was even better at bringing them live news, educational programming, and The West Wing. Similarly, the true power of telemedicine lies in distributed medicine, because dense networks of healthcare professionals are much more valuable than a series of one-to-one connections. Technology won’t reopen the Haywood Park Community Hospital, and it shouldn’t even try. But it can help us build a new healthcare system, one in which standards of care are raised across the board, no matter where you live.

The writer William Gibson famously observed that the future is already here, though it’s not evenly distributed yet. It’s time to deliver that future to the patients of Haywood County.

Dr. Joshua Landy is a practicing critical care physician and the co-founder of Figure 1, a free knowledge-sharing app for healthcare professionals. You can find him on Twitter: @joshualandy.

The views of contributors are their own and are not the views of The Hill.