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Ten years ago, Jerri Nielsen made headlines when she biopsied a lump in her breast, electronically sent images of the tissue to an oncologist, and, when the lump was diagnosed as cancerous, administered her own chemotherapy while consulting with doctors via video conference and email. The amazing thing was that she did this while stranded at the South Pole. We’ve come a long way since then.

So-called telemedicine is becoming mainstream, thanks to the increasing availability of cheaper video-conferencing technology, high-speed connections, and better Internet security. According to the U.S. Department of Health and Human Services, approximately one-fifth of Americans live in locations with limited access to primary care physicians. Assuming they can obtain video-conference equipment and high-speed Internet, which is a big assumption for now, telemedicine could save lives and ameliorate the suffering of patients who ordinarily might not be able to see a physician. In fact, the industry has been growing almost ten percent per year, amounting to $500 million in revenue this year in North America, and Medicare, Medicaid, and some insurers have begun reimbursing doctors who assist patients in rural regions.

Although increased access to medical care is desirable in underserved locations, we should be wary of the legal implications of the widespread use of telemedicine. It’s hard to imagine that the telemedicine experience is equivalent to an in-person examination, as some claim, regardless how great the technology may be. We all know that medical tests can result in false positives or negatives; touching and seeing a patient in person can make all the difference in the diagnosis. Telemedicine also would seem to invite abuse of the system, enabling patients to potentially fake symptoms they may have found on Web M.D. or other sites, to get medicine they may not need. Doctors already over-prescribe antibiotics at an alarming rate, which contributes to the growing number of antibiotic-resistant bacteria strains.

In addition, we can’t ignore the possible ramifications of telemedicine on malpractice suits. What if a doctor fails to detect a symptom he would have noticed in person? If the patient only has a low-resolution webcam, who is liable when the doctor misdiagnoses the patient? The doctor? The patient? The company who sold the webcam, failing to warn it should not be used for telemedicine? Increased access also may result in more lawsuits just by virtue of the number of telemedicine “appointments.” Going to the doctor can be such a hassle that many people only go when they feel truly awful, but if all you had to do was turn on your webcam and go online to see a doctor, why wouldn’t you? And if you were unhappy with the diagnosis, what would you do? If you’re American, you’d probably sue.

Sarah Duncan

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