The ‘Uberisation' of neurosurgery and its fallacies
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.241367
Source of Support: None, Conflict of Interest: None
“Men have become the tools of their tools"
Henry David Thoreau
Professor Ganpathy's treatise on the outreach of telemedicine and its impact on neurosurgical services was an enlightening read. In an era when smartphone applications have revolutionised all services, health care and neurosurgery are not far behind. ‘Uberisation' in the present day parlance, refers to the use of smart phone technology to obtain services on-demand, akin to the taxi service ‘Uber'.,, The global ideal of 1 neurosurgeon for 1 lakh people is far from a reality in resource poor countries., 60% of the world's neurosurgeons serve 14% of the world's population. About 11 countries in the world do not have a neurosurgeon available and hence telemedicine opens up new frontiers for patients in these nations. Having a doctor available on the smartphone app is always an irresistible convenience to the tech savvy layman, but lurking hidden within, are its risks and fallacies [Table 1].,, We decided to give a quick thought to this unexplored dark side of telemedicine.
Abuse of access
“Uber” has become a synonym for ease and convenience. With a third of the world's current population using a smartphone, added with the network connectivity and a high rate of internet penetration, apps for health care like Heal, Pager, etc. have found a market. Patients can access them to view doctors in the area, select a visit from a particular general physician (GP), make an appointment or get a telemedicine consult. If injudiciously used, these telemedicine consultations or app arranged home visits could be abused by the high and mighty. As the “boy who cried wolf” in the Aesop's fable, easy to access telemedicine consults hold the potential to be abused by a hypochondriac society. It would become a challenge to strain the ‘wheat from the chaff'.
Continuum of care
The Uber driver has no liabilities after dropping the customer off at his destination. Medical consultations can rarely be such one-off stand-alone services without a continuum. Periodic reviews and continuity of care form the cornerstones of a doctor-patient relationship. The neurosurgeon's services extend well after the placement of the last surgical stitch, into the post-operative care and rehabilitation period.
All over the world, super-specialisations like neurosurgery have an ‘urban-centric' practice., About 80% of the world's neurosurgeons live in big cities. In India, the North Eastern states have one neurosurgeon for 25 lakh people, while big cities have one neurosurgeon for 2 lakh people. Lack of infrastructure and barriers to socioeconomic progress tend to discourage neurosurgical practice in rural areas. Easy access to telemedicine consultations for chronic illnesses from the famous city based doctors, further supports an urban-centric neurosurgical practice. This could disenchant young neurosurgeons from setting up a rural based practice and further compound the urban-rural divide.
It is not uncommon to see radiologists in developing countries reporting CT and MRI scans of patients from the first world developed countries as a part of telemedicine consults. This is a clear case of cheap outsourcing of expertise, as specialists in these affluent nations would cost much more. Thus, rampant unrestricted use of telemedicine holds an abuse potential almost akin to the outsourcing seen in the information technology and software industry.
Unmanned patient care
As smart phones and smart devices take over our lives, smart cardiac monitors and smart labs are not far away. Pattern recognition using automation and artificial intelligence may completely replace manned patient care and diagnostic services. The i-patient would become as much a part of our lives as the i-phone and the i-pod. Can the doctor's human touch be replaced by the touch screen of a smart phone? Only time will tell.
Ethical and medicolegal concerns
Who is responsible for misdiagnosis and adverse events that result through telemedicine consultations? What happens if the tele-doctor is not available for further consultations after the first advice? What if the local village doctor refuses to attend to complications set about by a rash hasty telemedicine consult ?
In a world of gross disparities, where neurosurgical consultations are still a luxury in some countries, telemedicine has undeniably a special significance. However, with 100 more neurosurgeons added every year to the existing pool in India, it is essential that telemedicine services are judiciously used so that the freshly graduating neurosurgeons do not lose out an opportunity to develop a rural-centric practice. Nevertheless, the role of telemedicine in providing prompt and expert care to the needy in the deepest and darkest corners of the world and Professor Ganapathy's contributions to the same, are undebatable.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.