Photo Credit: Arbron
Marc Goldyne is a California dermatologist who uses his computer to work with patients who live hundreds of miles away. He practices what’s called telemedicine.
Marc Goldyne: My waiting room is essentially my email box.
If a rural patient needs to see a specialist – for a skin problem, for example – she may have to travel for hours to get a 15-minute consultation. Dr. Goldyne said this is not uncommon in his field.
Marc Goldyne: Forty-two percent of Americans are considered to be living in areas underserved by dermatology.
Using telemedicine, a local doctor collects relevant medical information and images from the patient. It’s sent through a secure email system to Dr. Goldyne’s computer. He makes a diagnosis, and then follows up with the doctor and patient to recommend treatment.
Marc Goldyne: The goal is to really move data, and not move people, whenever it’s possible.
He believes this adds efficiency to the healthcare system.
Marc Goldyne: You’re allowing more timely access. You can prevent delayed diagnosis. You can prevent multiple office visits. You can prevent wrong medicines being prescribed. All of these factors can lead to millions to billions of wasted dollars.
According to the National Center for Policy Analysis, many patients find it hard to see their doctors, overuse emergency rooms when they can’t get timely access to care, and do not think that they are receiving adequate information from their doctors. Dr. Goldyne believes that increasing the use and frequency of information technology in healthcare might improve access to timely care, while reducing costs and improving the quality of care.
Marc Goldyne: In my field of dermatology, if you want to see a dermatologist, it’s an 8 week wait. If you have an acute problem, 8 weeks is just inappropriate. Whereas, if the doctor can send a consult to a specialist, the turn around time can be 24 – 72 hours.
Dr. Goldyne said that the lack of overhead – offices and support staff are not necessary to practice telemedicine – allows him to operate at 50% of the traditional cost. Plus, he is able to help more patients.
Dr. Goldyne: If I’m seeing people in person, I have only a limited number of office hours. When I’m doing telemedicine, I can come home in the evening and take care of consults. I can purely look at the data that’s been sent to me, and the pictures, and then let the primary care provider know what I think of the diagnosis, what therapy should be instituted, and how to follow the patient up. It requires no sacrifice of time on the patient, other than visiting the primary care doctor.
Dr. Goldyne said that he has seen 2,500 patients via telemedicine in the past six years. He described one patient’s treatment.
Dr. Goldyne: I looked at images on the electronic medical record, and it looked like malignant melanoma. I said she needed to see someone to have this taken care of. I got a call from the patient the next day, and she said she had a two month wait in the rural area where she lived. I called the University of California San Francisco Melanoma Center, and I was able to get her in not in eight weeks, but in two days to have it removed. That’s an example of where we saw a patient and it was determined we really needed to bring her from her hometown, to the city for more timely care.
Areas applicable to medicine include dermatology, ophthalmology, cardiology, psychiatry, and neurology. Dr. Goldyne added that telemedicine is intended as a support, not an alternative, for regular doctor visits.
This seems now more important than ever!
Hank: There are actually hundreds of papers hidden in professional literature that tell the story of what telemedicine can provide. Unfortunately, there are hundreds of thousands of people whose livelihood depends on the old system. So there are the “not on my watch” people (including medical academics, politicians, and workers) who would rather fight than switch. They constitute a very strong force against change. Innovation, even if providing many answers to problems, often has to wait for the right environment to blossom. There’s no better example than the stethoscope which is now the icon synonomous with doctors or other health care providers. No one would argue today that it not a valid medical instrument, but it took 100 years (1819-1920) before it gained world wide acceptance. In fact here is a statement regarding the stethoscope that was published in the London Times in 1834, 15 years after the stethoscope made its debut: “That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; because its hue and character are foreign and opposed to all our habits and associations”. That says it all. You could say the same about Telemedicine today.
All I can say is that I have practiced traditional in person medical dermatology at universities, two county hospitals, a VA Medical Center, and a private practice office over the past 30 years and I can say unequivocally that if appropriately practiced, telemedicine works! Marc
“Dr. Goldyne: … I called the University of California San Francisco Melanoma Center, and I was able to get her in not in eight weeks, but in two days to have it removed. That’s an example of where we saw a patient and it was determined we really needed to bring her from her hometown, to the city for more timely care.”
The testament of a Doctor who really cares for his patients! Any thoughts on publishing an abstract quantifying how telemedicine can improve patient care? It seems to me your work in telemedicine is a model that can improve other areas of health care.
Dr. Goldyne,
Thank you for your thoughtful and informative reply. The medical center I work with is actively implementing web based technologies to enhance not only the interface between our doctors and referring physicians but also to allow patients to interact with the center from home as many of our patients must travel from surrounding states. Being much involved in the center’s implementation of said technologies, I was much interested in hearing your experience.
I forwarded a link to your podcast interview to my center’s president, who, besides being one of the world leading perinatologists, is also a confessed techo-geek and main driver of the center’s investigation into web technologies.
I am convinced that tele/web medicine will do much to bring a host of specialized medical services to not only remote communities in our country but also to 2nd and 3rd world countries where medical care is even more inaccessible or non-existent. Thank you for sharing your experience and successes through E&S.
Dr. Goldyne,
I am an orthopaedic shoulder specialist in SF. Recently, I\’ve had several workers comp patients sent to me for very routine problems from distances as far as Eureka. One of which I conducted his post operative evals via a PT and the phone, to save him 11hours on the road. It is pretty clear that many patients both rural and urban would benefit for access via telemedicine to specialty care. It has become a project to help the frontlines sort out common problems early. Any further information you can share would be very useful.
Glad you have taken up the topic which will help us all. Thx PBR