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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