Although telemedicine already appeared as an option in pre-pandemic times, the spread of Sars CoV-2 and the conditions it imposed accelerated its acceptance by the medical community and society as a whole. In the present, the number of patients who prefer online consultation grows: computers, tablets and cell phones are put at the service of people who use ICTs to alleviate an ailment and, in exchange, receive a remote diagnosis, without leaving the comfort of their homes. If in 2020, 4,788 health workers carried out teleconsultations with their patients through the platform of the portfolio headed by Carla Vizzotti, a year later that figure had doubled. In 2021, according to the survey carried out by the Ministry, 1,404,504 were carried out throughout the national territory. Globally, it is estimated that 50 percent of insurers already offer this service. Little by little, citizens get used to attention mediated by screens.
“Telemedicine started regarding four years ago, but the pandemic sped everything up. It pushed for greater acceptance by the population and health teams, who saw it as a phenomenon of the new reality. Today we can say that it is here to stay”, says Thomas Orduna, head of the Tropical Medicine and Travel Medicine Service at Muñiz Hospital in Buenos Aires. The very dynamics of an infectious disease that is transmitted by the respiratory route and that has the distance as one of the main requirements to protect itself from contracting it, led to the virtual gaining ground once morest the face-to-face much faster than expected.
Medicine, from Orduna’s approach, follows the path towards hybridity between the face-to-face and the virtual in a similar way to that of other professions and part of the educational sector. Nevertheless, there are actions that are irreplaceable: “The handshake, the fact of seeing the patient, the greeting upon admission and discharge, eye contact are key and seem to be lost”. From the World Health Organizationin this line, warn that telemedicine is a tool that can be useful in many cases, although it complements and does not replace the traditional consultation of the body present.
At the domestic level, within the Ministry of Health, there is the Telehealth Coordination, whose mission is to develop and apply policies related to the area, with the aim of democratizing the access of all the nation’s inhabitants to the health system and thus contributing to decongesting it. They informed this newspaper that, to date, there are 1,122 nodes (health effectors) and 9,523 workers carry out teleconsultations through its platform. The number of users grew significantly during the pandemic, if one takes into account that by October 2020 that number was stationary at 4,788. At present, we are working on the concept of digital hospitalwith the purpose of making the platform friendlier for doctors and patients.
More accessible and agile
One of the main advantages offered by telemedicine is that it has improved access for people who otherwise would not connect with the health system. “I think that it brought many people closer to the care of professionals who were not cared for before, due to geographical distance. In recent times, I have gone from serving people from other provinces and that is a huge advantage”, he observes Leda Guzzi, infectologist and referent of the Argentine Society of Infectious Diseases. She then continues with her reasoning and highlights other points in favor. “A significant percentage of medical consultations might be resolved by telemedicine. Perhaps a first contact with the professional requires attendance, but the following ones, in which the patient usually presents their studies, do not require it. Often, making the consultation virtually relieves and speeds up”, he maintains.
In this way, by avoiding going to health centers, people save money and time, and can receive a diagnosis from the comfort of their homes. As Guzzi related, simultaneously, it enables citizens who live far from urban centers where complex care medical institutions are usually located to also have access to a dialogue with professionals from various specialties. On the other hand, the benefits of ICTs are also at stake when sending reminders to patients so that they take their medicines, to pregnant women to attend their controls, and to the relatives of boys and girls so that they do not forget to comply with the immunization calendar.
always start over
According to the specialist Caroline Moreno in an interview with the newspaper El País (Spain): “When they went to see you at home, you were already better before the doctor walked out the door, because he touched you, he asked how you felt. People say that the doctor doesn’t even look you in the eye anymore.” What the specialist in public communication of science refers to with respect to the Spanish case is further enhanced by telemedicine in domestic territory. “Among the main disadvantages of telemedicine, it is located loss of face-to-face contact with the patient. Being able to contain relieves and contributes a lot to start reversing diseases”, he comments from his Guzzi experience. About, Georgina Di Genaroa doctor who works in private clinics in Olivos and Lomas de Zamora, points out: “I think that avoiding direct contact, in fact, goes once morest good medical practice.”
In this new context, for Orduna, the health professional must be very aware and know how far to go with virtual consultations and when it becomes imperative to go face-to-face. “Through the screens we only see heads, necks, some gestures and a bit of the upper body, but not all the rest.”, he highlights. The complexity becomes even more difficult to overcome when the heterogeneity that characterizes remote medical practice is described. For example, it is not the same to virtually diagnose a known patient than an unknown one. Nor is an individual with a chronic illness who requests a prescription the same as one who has symptoms such as fever, vomiting or sore throat for a week.
Patients, according to Di Genaro, always consult with different professionals who never get to know them completely, who know nothing regarding their medical history. In this way, “every encounter with a patient is a fresh start”. From here, he concludes: “The division of medicine into specialties contributes to dehumanizing the patient, not seeing him as a whole. Virtuality, far from improving this situation, makes it worse”.
Precariousness and cyber(in)security
There are two drawbacks of telemedicine that deserve a separate paragraph: precariousness and vulnerability to computer attacks. Regarding the first, Guzzi states: “Virtual care is not regulated and it is not very clear how to charge. With the consultations that went from face-to-face to virtual during the pandemic, there were not so many problems, but then everything that has to do with WhatsApp and messages with orders of any kind constitute medical acts that deserve their remuneration, ”he comments. The lack of regulation, ultimately, leads to precariousness: his cell phone, as he relates, is full of phone numbers of patients who write to him at any time to send images of injuries or request prescriptions.
On the other hand, as virtual health care grows, the emergence of more cyber attacks. Carrying out confidential and secure video consultations is projected as one of the great challenges. Health information is especially susceptible to being stolen: the illegal sale of medical records is already beginning to be in the folder and appears as one of the main obstacles that the sector will face.
