OPINION
DOCTORS ' Lounge
The authors estimate that “ based on early experience in primary care , 30-50 percent of visits could be virtually conducted .” By their specialties , they have not logged many hours in a primary care exam room . What percent of patients come in for , say , “ check blood pressure ” ( which should never be done electronically by some inaccurate machine ) but end up having questions or issues in at least three different systems ? Would that be close to 90 percent ? Ask any one of us in primary care and they would say , “ Oh , more !” I do not think the e-doc has a builtin template for the slightly reddened elbow , the rough patch of skin , the grandson who is doing drugs , the cough that is worse in the morning , the relative cost / benefit ratio of five different medicines : all these , and more are fair game , in person , for the two of us to address .
The authors further note : “ The success of technology-based services is not determined by hardware and software alone , but by ease of use , perceived value , and workflow optimization .”
This sounds like business robot-talk . How about , at a minimum , success measured by clinical competence ? How about complications and outcomes data ? Who is following up with whom and when , how soon , and how many follow-ups were due to partial or total failure of the e-visit to help ? It is just so easy to make mistakes in medicine . Cheating the patient of his best chance of having someone get it right – someone who cares about him , not E-Doc Cyborg 45 – does not add up to actual medical care of the sick person . But I am certain he will get billed , nonetheless .
The authors are enthused about how efficient it is to “ manage chronic illness ” using e-connections and not office visits . I can see that this would be useful for managing blood sugar / insulin decisions . I can see that caregivers of the demented and frail elderly would welcome not having to drag the patient out when really , the questions and answers that matter happen between the caregiver and the medical professional . Specialists who live mainly in cities have for years now quickly helped the rural doctor over the internet – but that is entirely different from having the urban doctor try to get answers when only the patient is on screen . I can see that visits for decisions based on imaging ( tumor surveillance visits for instance , when the patient lives far away ) could be easier for the patient . But what if the news is bad ? The doctor cannot reach out and hold your hand over the phone . Nephrology is a truly data-based specialty , but when is the last time you had your blood drawn by your iPad ?
To be fair , I think many times the e-doc will get worried and insist that the patient show up somewhere where actual doctors work . But doctors who are wedded to the e-concept will get their egos involved , and may try to do more than is safe . I worry about the disappearance of the office internist and think one day I will be grateful to talk to any doctor when I am sick , but still – a camera is not a doctor . A microphone is not a stethoscope . A sensor is not a human hand . If I am in the deepest jungle , and my only hope is having the shaman tell me what plant to chew , I will chew it . But if I am ill and my only hope is a camera with some “ medical virtualist ” on the other side of the lens , I will call EMS . They show up .
Dr . Barry practices Internal Medicine with Norton Community Medical Associates-Barret . She is a clinical associate professor at the University of Louisville School of Medicine , Department of Medicine .
MID-20TH CENTURY ANATOMY at the University of Louisville
Gordon R . Tobin , MD
I
wish to correct an error in my March 2018 Louisville Medicine article , The Old Medical School of Louisville III : University of Louisville Years ( 1908-1970 ), and to add some relevant information . The captioned Figures 8 and 9 were switched , with the bacteriological laboratory identified as anatomy , and the anatomy dissection suite identified as bacteriology .
The Kornhauser-Johnson dissection tables , shown in Figure 1 , were designed at the University of Louisville by professors Sidney I . Kornhauser , PhD , and Sydney E . Johnson ,
MD . Dr . Stuart Urbach recognized that he is the student at the farthest left forefront of the anatomy lab photograph , which identifies the photograph as being taken in 1944 . Dr . Urbach recalls that the UofL anatomy course was exceptionally rigorous and much respected by the students , and by national reputation . Dean J . Murray Kinsman , MD , wrote that entering students were “ a bit afraid ” of Dr . Kornhauser , but looked back with great affection after completing his course .
Dr . Kornhauser came to UofL from
Dennison University in 1922 as Professor and Chair of Anatomy . He had nationally recognized expertise in microanatomy ( now called histology ) and microscopic tissue stains . He developed several new microscopic slide stains , most notably the “ Quad Stain ,” which used four different dyes to differentiate cell lines and tissues . In 1923 , Dr . Kornhauser recruited Dr . Johnson from Northwestern University to join his Anatomy faculty . Dr . Johnson was a roentgenologist ( now called diagnostic radiologist ), who also served as roentgenologist at the
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