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Table of Contents    
CORRESPONDENCE
Year : 2018  |  Volume : 66  |  Issue : 6  |  Page : 1852-1853

Deployment of Telemedicine in Neurosciences: The good and the evil—A balanced approach


Apollo Telemedicine Networking Foundation, Apollo Hospitals, Chennai, Tamil Nadu, India

Date of Web Publication28-Nov-2018

Correspondence Address:
Dr. Krishnan Ganapathy
Apollo Telemedicine Networking Foundation, Department of Neurosurgery, Greams Lane, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.246295

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How to cite this article:
Ganapathy K. Deployment of Telemedicine in Neurosciences: The good and the evil—A balanced approach. Neurol India 2018;66:1852-3

How to cite this URL:
Ganapathy K. Deployment of Telemedicine in Neurosciences: The good and the evil—A balanced approach. Neurol India [serial online] 2018 [cited 2018 Dec 14];66:1852-3. Available from: http://www.neurologyindia.com/text.asp?2018/66/6/1852/246295




There is so much good in the worst of us, and so much bad in the best of us, that it ill behoves any of us, to find fault with the rest of us”.

Shivhare and Vilanilam (Ref. Shivhare P, Vilanilam GC. The ‘uberisation’ of neurosurgery and its fallacies. Neurol India 2018;66:1528-30) have rightly pointed out, what would at first glance appear legitimate concerns about the deployment of telemedicine in neurosciences.[1] That ‘Good’ and ‘Evil’ are two sides of the same coin have clearly been enunciated in our Upanishads several eons ago. As one who has spent the last two decades evangelizing the concept of “remote health care,” I may be permitted to humbly suggest that here the ‘Good ‘outweighs the ‘Evil’ although the latter, of course, exists. I would like to address each point raised so that the reader gets a truly balanced view.

  1. The authors have equated telemedicine in neurosurgery to “uberisation,” which in their understanding is synonymous with “irresistible convenience to obtain services on demand”. This is a comparison of apples with oranges though both are fruits. Where Uber is available, almost always there will be Ola, autos, shared autos, call taxis, metros, two wheelers, etc., to take you to your destination. This is not at all true for obtaining neurosurgical services. In a previous publication the author[2] had pointed out that in September 2014, 935 million Indians lived in areas where there was not a single member of the Neurological Society of India or the Indian Academy of Neurology. Obtaining a neurological teleconsultation in this milieu is not equivalent to the utilization of ‘Uber’ serivces, which is no longer a monopoly wherever it is available
  2. Abuse of access: So long as humankind exists, there will be an abuse of access. Even in stark hard core communism, it is well known that all men are equal but some are more equal than others. Raising this concern, to use a hyperbole, is akin to shooting the messenger!
  3. Continuum of care: One of the greatest advantages of telemedicine is in the establishment of the continuum of care. It is location independent. The author continues to follow up patients he had treated with radiosurgery in 1995 even after 23 years. This is a boon particularly for follow up of patients who initially came from thousands of miles away and even from overseas. One would/should not have become a specialist clinician if one's relationship with one's patient is “dropping the customer off at his destination
  4. The authors are concerned that easy access to urban neurosurgeons would dissuade youngsters from setting up rural based practice. On the contrary, a major disincentive in setting up rural practice - namely the difficulty in being mentored and getting a second opinion – is not there now. The “famous” city based doctor is now virtually available to the “rural” specialist in real time. In the real world, the most “famous” city based doctors do not embrace telemedicine. At a personal level, I have tele-mentored younger neurosurgeons on many occasions – one neurosurgeon was in an operation theatre in a Middle-East country asking how to stop the bleeding during surgery, with the camera focused appropriately.
  5. Cheap outsourcing: Nobody would “outsource” health care because services could be disseminated “cheaply”. Teleradiology centres in India do global reporting not because they are less expensive but because they are available 24/7 and the quality of their reporting is better than the best. “Cheap outsourcing” cannot be sustained without world class quality. Interestingly, the “average” patient will never ever want to save money and get into complications
  6. Unmanned patient care: There is an erroneous perception that the doctors’ human touch will be endangered with an increasing deployment of artificial intelligence-aided telemedicine. The author[3] in an exhaustive review of artificial intelligence (AI) in neurosciences, has clearly pointed out that use of AI will make a good doctor better. The contrary is likely to be true. Telemedicine is a means to an end not an end by itself. As Lars Leksell famously remarked several decades ago, “A fool with a tool is still a fool”. Incidentally, AI scientists are also working on creating artificial empathy!!
  7. Ethical and medicolegal concerns: These are being addressed and hopefully specific regulations will be notified soon. Compliance and adherence to general teleconsultation norms by all the stakeholders is necessary. Unfortunately, the media thrives on sensationalism. Misreporting leads to concerns where none exist. Again on a lighter note, with repeated adjournments, it will take decades before a court decides on where the case is to be filed – in the city from where the teleconsultant gave the advice or in the town where the beneficiary resides!


I congratulate the authors for raising these valid points. Awareness is the first step to avoid and circumvent a problem. I recollect with nostalgia how the promoters of telemedicine were looked at two decades ago. It is reassuring that telemedicine is slowly but surely being accepted into the core of the health care delivery system. It is sincerely hoped that such discussions will further increase awareness, leading to adoption. As neurologists and neurosurgeons, we should ensure that we extend our reach to the maximum and overcome any impediments along the way.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shivhare P, Vilanilam GC. The ‘Uberisation’ of neurosurgery and its fallacies. Neurol India 2018;66:1528-30.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Ganapathy K. Distribution of neurologists and neurosurgeons in India and its relevance to the adoption of telemedicine. Neurol India 2015:63;142-54.  Back to cited text no. 2
    
3.
Ganapathy K, Abdul SS, Nursetyo AA. Artificial intelligence in neurosciences: A clinician's perspective. Neurol India 2018;66:934-9.  Back to cited text no. 3
[PUBMED]  [Full text]  




 

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