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The Pitfalls of Telemedicines and Robots

Bragg, Fort CA

doi: 10.1097/01.NT.0000388429.24345.6e
Letters to the Editor

Peter Glusker, MD, PhD

Dr. Orly Avitzur's articles, “Is Teleneurology Replacing the Neurologist” (Aug. 5) and “Sending a Robot to Do A Neurologist's Job” (Aug. 19) on the potential perils of telemedicine, but especially those of robotics, is particularly well timed, given that this technology is exploding into medical care. This tool, however, is inextricably intertwined with the major complex issue affecting “modern” medicine, which entails the virtual control of medical care by insurance and other commercial interests.

The philosophical roots underlying the historical medical ethos have been drowned in a sea of commercial interests. This bodes very poorly for both patients and doctors. Patients have to use a modicum of marketplace ”buyer beware” tactics, with additional accounting and legal help to sort out their drug and insurance options. Doctors have to battle insurance companies about coverage and strategize how to outwit them in order to get the care their patients need. That's a long way from Osler, let alone Hippocrates. And, it is also not science, the informational tap root of medical care. Medical care, by virtue of its intrinsic nature – human suffering – does not fit the shoe of a commercial ‘product’ or ‘service,’ although that is how the insurance companies try to define it.

We should have had a wake, perhaps, had we but recognized the point along the slippery slope at which the classic medical ethos became as extinct as the dodo. It cannot be resuscitated in the present world of commercialized medicine. The best we can do now, in training new residents, is try to inculcate at least a prioritization of values: patient care first and everything else after. Even that sounds much easier than it actually is, because the younger generation's concept of ”practicing medicine: is quite different today. Medicine has become a 9-5 job, with benefits and schedules.” It is not as it used to be, an historic profession or a way of life. This change in medicine opens a very sobering ethical black hole for our society. This dark place needs to be exposited, discussed, and alternative options raised.

Most societies find ways to care for their wounded and elderly. Lyndon Johnson borrowed from the British when he started Medicare. Are we so wedded to the economic benefits of capitalism that we really need to use human suffering to make money? Are we not creative enough to find alternative ways? The sooner we start, the easier it will be to transition our economy, since such a significant portion of it is now dependent on profits from health care.

Peter Glusker, MD, PhD

Fort Bragg, CA

©2010 American Academy of Neurology