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CORRESPONDENCE
Year : 2018  |  Volume : 66  |  Issue : 5  |  Page : 1528-1530

The ‘Uberisation' of neurosurgery and its fallacies


Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India

Date of Web Publication17-Sep-2018

Correspondence Address:
Dr. George C Vilanilam
Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.241367

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How to cite this article:
Shivhare P, Vilanilam GC. The ‘Uberisation' of neurosurgery and its fallacies. Neurol India 2018;66:1528-30

How to cite this URL:
Shivhare P, Vilanilam GC. The ‘Uberisation' of neurosurgery and its fallacies. Neurol India [serial online] 2018 [cited 2018 Oct 23];66:1528-30. Available from: http://www.neurologyindia.com/text.asp?2018/66/5/1528/241367




“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.[1] 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'.[2],[3],[4] The global ideal of 1 neurosurgeon for 1 lakh people is far from a reality in resource poor countries.[5],[6] 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].[2],[3],[4] We decided to give a quick thought to this unexplored dark side of telemedicine.
Table 1: Uberization of Neurosurgery-Pros and Cons

Click here to view


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.

Urbanised neurosurgery

All over the world, super-specialisations like neurosurgery have an ‘urban-centric' practice.[6],[7] 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.

Cheap outsourcing

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.[5] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

1.
Ganapathy K. Telemedicine and neurosciences. Neurol India 2018;66:642-51.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Available from: https://www.techcrunch.com/2016/06/11/why-there-will-never-be-an-uber-for-healthcare. [Last accessed on 2018 Jul 22].  Back to cited text no. 2
    
3.
4.
5.
Iype B, Vilanilam GC. Patellar jerks in the 3-Tesla era: No knee-jerk excitement anymore! Neurol India 2017;65:1445-7.  Back to cited text no. 5
    
6.
Dewan MC, Rattani A, Fieggen G, Arraez MA, Servadei F, Boop FA, et al. Global neurosurgery: The current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. J Neurosurg 2018;27:1-10.  Back to cited text no. 6
    
7.
Vilanilam GC, Easwer HV, Menon GR, Karmarkar V. “Magister neurochirurgiae": A 3-year'crash course'or a 5-year'punctilious pedagogy'? Neurol India 2017;65:434-7.  Back to cited text no. 7
    



 
 
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