During those days, every farm had a well-laid and well-maintained airstrip. Whenever any person on the farm had any health-related problem, they could call up their doctor on the wireless radio that every farm had. The patients would explain their condition and seek advise. The illiterate amongst them had a picture of a man and a woman with numbers referring to the various parts of the body in front of them. They would use these pictures to point out to their doctors as to where exactly their problem lay. The doctor would communicate via the wireless as to how relief may be sought. Each farm had a well-stacked medicine chest with numbers identifying each medicine. A concurrent list was also maintained by the doctor. The doctor could then inform the particular medicine number and advise the patient how and when to take it. If however the situation so warranted, the doctor would physically fly out to the farm and do the needful as warranted. Then there was the sick-at-sea, and I am not hinting at mal de mer. Ships and boats which could not afford to have an on-board medical personnel for paucity of space or otherwise would telegraph or, when it became available, radio to the ports for the land-based doctors to advise them regarding the care to be administered to the ill-person aboard. In both the above cases it was the good old telegraph or the radio that was put to good use in getting medical consultation. Even today, there are numerous instances when the telephone (and fax) is used for the very same purposes. Perhaps without realising it, you might have called your GP or family physician on your phone in the middle of the night to about that high fever your child had or the pain in the tummy that was keeping you awake. Your GP might have asked you to fax some additional information and you might have suggested e-mail instead. Without realising it to be so, you were putting telemedicine to good use!

Telemedicine is nothing but a very serious attempt at extending these very same concepts on a much more wider and deeper scale. One will still be using these machines and then some. Such as the good old PC, cellular phone, computer notebook, the Internet - all backed up with efficient, user-friendly and highly interactive softwares. Some provider of care would still need to be physically present at the side of the patient to actually deliver the care (in the form of nursing, taking samples for investigation, noting the vitals (vitals include pulse rate, respiration rate, temperature, blood pressure, size of pupils, etc.), or do dressings, etc.. The expert or the consultant-in-charge may however be physically present at great distances away. Every doctor treats his (the masculine includes the feminine, the singular the plural - this convention has been used throughout this dissertion) patients by seeing, hearing, talking, touching, reviewing and judging. Telemedicine allows the opportunity to perform all of these things except actually touching - though the technology involved with virtual reality will one day allow the doctor to get a "virtual" feel. [Top]

Scenario 1 [without telemedicine]

It is 1:00 a.m. on a Sunday morning, the on-call physician receives a phone call from a patient hitherto unknown to him. The man says he has a painful blister on his right toe. It has been there for a couple of days but has aggravated since that very afternoon. He cannot move his foot and the toe is throbbing. He mentions that he has had some trouble in the past for which several blood tests have been carried out. These tests are repeated regularly every month and it has been just a few days ago that the last battery of tests was carried out. He cannot specifically say what the tests were for and the blood samples were taken at random without bearing any specific relationship to anything like food, etc. He also is unable to give a definitive 'yes or no' answer to the question as to whether any of his immediate blood relatives ever suffered from diabetes. The physician decides that he must take a look at the toe and investigate before he is able to do anything further about it. The patient is not keen to travel and asks whether or not there was something the doctor could advise for the night and then the patient could attend his clinic or any emergency room in the morning for further management. The doctor firmly dissents and asks the patient to come to surgery immediately. Had there been any way the doctor could have found out about this person's past history which must exist somewhere in some form, there was a definite possibility that he could have decided otherwise. In the emergency room too he would not have had to carry out at least those tests which may have been carried out recently enough not to warrant a repeat at that time.                        [Top]

Scenario 1 [with telemedicine]

It is 1:00 a.m. on a Sunday morning, the on-call physician receives a phone call from a patient hitherto unknown to him. The man says he has a painful blister on his right toe. It has been there for a couple of days but has aggravated since that very afternoon. He cannot move his foot and the toe is throbbing. He mentions that he has had some trouble in the past for which several blood tests have been carried out. These tests are repeated regularly every month and it has been just a few days ago that the last battery of tests was carried out. He cannot specifically say what the tests were for and the blood samples were taken at random without bearing any specific relationship to anything like food, etc. He also is unable to give a definitive 'yes or no' answer to the question as to whether any of his immediate blood relatives ever suffered from diabetes. So he charges up his PC that he always carries around with him. He asks the patient to provide him with some definitive identification details. Luckily, the patient is able to not only provide him with such information but also provide the doctor with the name of his GP. The doctor feeds in the data and executes a search with the help of his PC, and viola! Within seconds all the relevant datas about the patient are displayed in an easy-to-read form on the screen of the doctor's PC. The doctor decides his further course of management with immediate effect.

A slightly different version of the above

...Luckily, the patient is registered with a participating Telemedicine Network facility and has a smartcard enabled access to the same. He has a PC at his end too! Super! The doctor asks the patient to log on to the network and activate patient-doctor access through the smartcard. The patient complies and punches his secret access code (as he would have done at the cash point at the local shopping mall). Viola! All the relevant details of the patient are displayed in an easy-to-read form on the screen of the doctor's screen. The doctor decides he needs to have a look at the toe. No problem, the patient adjusts his position so that the video camera of his PC is able to record the pictures and transmit them through to the PC at the doctor's end. The doctor decides his further course of management with immediate effect and the treatment of the patient is initiated at that hour.                    [Top]

Scenario 2

A 30 year old man has been brought into the Emergency Room at around midnight. He has multiple injuries to the chest and head. His right pupil is dilated and only mildly reacting to light. His pulse rate is around 60 min^-1, Babinski's sign is positive on the right side and he is also semi-conscious. He has just his driving license on him and there is no possibility of finding any of his relatives that night. A baseline array of tests would have to be carried out and the patient immediately shifted to the operation theatre for the management of his chest injuries apart from the cleaning and dressing of his wounds. An emergency CT scan of the head would have to be carried out too and further management depending upon the findings thereof. If the ER doctors had access to a system which would have allowed them to retrieve all the relevant past informations relating to the vital statistics and health of the man, they would have certainly been in a much better position to manage this case.  [Top]

Scenario 2

A 30 year old man has been brought into the Emergency Room at around midnight. He has multiple injuries to the chest and head. His right pupil is dilated and only mildly reacting to light. His pulse rate is around 60 min^-1, Babinski's sign is positive on the right side and he is also semi-conscious. He has just his driving license on him and there is no possibility of finding any of his relatives that night. A baseline array of tests would have to be carried out and the patient is immediately shifted to the operation theatre for the management of his chest injuries apart from the cleaning and dressing of his wounds. An emergency CT scan of the head would have to be carried out too and further management depending upon the findings thereof. The ER doctor powers up the PC in the ER and feeds in the identification details as they appear in the driving license and executes a search on the telemedicine network, and viola! Within seconds all the relevant datas about the patient are displayed in an easy-to-read form on the screen of the doctor's PC. The doctor decides his further course of management with immediate effect.

A slightly different version of the above

...Luckily, the patient is registered with a participating telemedicine network facility and has a smartcard enabled access to the same which he has in his pockets. The doctor activates patient-doctor access to the telemedicine network through the smartcard by punching in a master-all-purpose-emergency activation key number that is only to be used in cases of extreme emergency only. Success! All the relevant details of the patient are displayed within seconds. The doctors decide on the further course of management with immediate effect and the treatment of the patient is initiated at that very moment with the greatest possible accuracy and efficiency.              [Top]

Scenario 3

A patient has been referred for expert consultation. The patient lives at a considerable distance away and has to spend the better part of an hour on the road before he is able to present himself at the physician's office. His general condition is not too good and neither is the road that he has to take. The expert asks him to go over his complaints from the very beginning. Then he asks to see all the past papers related to his condition. The patient has been suffering for quite sometime now and the passage of time has resulted in him misplacing some papers. The consultant asks the patient to undergo a few tests. Only after three further painful and distressing journeys to the doctor's chamber later and undergoing several tests is the doctor able to come to a definitive diagnosis and the actual management begins. Had the physician been able to retrieve and view all the previous records of the patient as well as the test results that were carried out after the first visit, perhaps the diagnosis could have been made on the very first day or at the end of the second visit. Furthermore, had the patient and his consultant been able to somehow communicate face-to-face long-distance, the patient might have been able to eliminate the travel part and save himself from a lot of botheration, frustration, expense, and the inevitable loss of time and the consultant could still have charged him according to the billable hours and received his fee.            [Top]

Scenario 3

A patient has been referred for expert consultation. The patient lives at a considerable distance away and has to spend the better part of an hour on the road before he is able to present himself at the physician's office. His general condition is not too good and neither is the road that he has to take. The expert asks him to go over his complaints from the very beginning. The consultant needs to see all the past papers related to his condition. Unfortunately, the patient has been suffering for quite sometime now and the passage of time has resulted in him misplacing some papers. The consultant also requires that the patient undergo a few more tests. Only after three further painful and distressing journeys to the consultant's chamber later and undergoing several tests would the consultant be able to come to any definitive diagnosis and begin the actual management. The consultant however charges up his PC instead, and asks the patient to provide him with some definitive identification details. The necessary data is punched in and a global information of the patient and his environment is available within minutes. The consultant is then able to decide on the future course of management with the maximum of efficiency and speed.

A slightly different version of the above

...Luckily, the patient is registered with a participating telemedicine network facility and has a smartcard enabled access to the same. He has a PC at his end too! Super! The doctor asks the patient to log on to the network and activate patient-doctor access through the smartcard. The patient complies and punches his secret access code (as he would have done at the cash point at the local shopping mall). Viola! All the relevant details of the patient are displayed in an easy -to-read form on the screen of the consultant's screen. The patient adjusts his position so that the video camera of his PC is able to record his pictures and transmit them through to the PC at the consultant's end. The consultant decides on the further course of management with immediate effect and the treatment of the patient is initiated at that very moment.       [Top]

Scenario 4

"Doctor, I would like to get a second opinion."

"Very well. Whom would you like to consult?"

"Dr. A. B. Cee."

"But he is half-way across the globe and he cannot come and you are in no position to go, financially or physically."

"It's impossible!"

"Then doctor, what am I to do?"

"Well, that all you can do is to pray and then pray harder. You might cry for a week, but a fat help will that do!"

"Dear, oh dear..."

[Top]

Scenario 4

"Doctor, I would like to get a second opinion."

"Very well. Whom would you like to consult?"

"Dr. A. B. Cee."

"Well, he is half-way across the globe and he cannot come and you are in no position to go, financially or physically. But that happily is not a problem at all. If you could care to take a seat and make yourself comfortable, I shall put in touch with him immediately."

The doctor charges up the PC on his desk and instantly connects to the telemedicine network and puts through a request for connection to Dr. A. B. Cee's PC. Since both of their PCs are armed with video cameras, the patient, his doctor, and the consultant can have a live video-conferencing right away then and there.

A slightly different version of the above

...Luckily, the patient is registered with a participating telemedicine network facility and has a smartcard enabled access to the same. The doctor asks the patient to log on to the network and activate patient-doctor access through the smartcard. The patient complies and punches his secret access code. All the relevant details of the patient are displayed in an easy-to-read form on the screen of the doctor's PC which may freely be transferred to and from the consultant's PC who can have an accurate and as complete as possible a picture of the patient and his condition almost instantaneously.                      [Top]

Consultant Gastro-enterologist Dr. X. Y. Zed has been packing his bags with mixed emotions. As he zips his handbag and puts on his overcoat, he gives his front lapels a pat ensuring that his plane tickets and the passport with the other necessary travel documents are in place.

His car is covered with light snow that has been falling for the past three hours. His journey to the airport is a good two hours away in this weather. Possessing a good deal of common sense he decides that he must not start chancing the elements right away. He calls for a taxi.

As he settles down in the back seat of his taxi, he rues his decision to go. He will have to be away from his work for a full four days, two days spent just on travelling. By the time he will be able to get back to town it will already be evening and there would be no point in going in to the clinic after that.

He consoles himself with the thought that that the journey would be worth all that cost especially the loss in earnings. It will help him to undertake a two day intensive workshop on the latest endoscopic procedures for treating gastro-intestinal bleeding with the help of lasers. The training is costing him a pile but the added cutting edge, that it would provide to him will translate into increased expertise and earnings in the long run.

By the time his alights from his taxi at the airport and pays the cabby, it is already snowing quite hard. He wonder whether his plane would take off in time. He reports to the airline check-in counter only to be told "Sorry Sir, but your flight will be at least four hours late. It's the snow Sir." He cannot stop himself from uttering an expletive. The pretty girl at the counter flashes him an understanding smile. She has heard worse over the past half-hour since she has been informing all the other passengers whom she had been forced to repeat the same words. She was sure that she will hear more of the same as she said "May I help you Madam?" to the next lady in line. There were at least fifty more still waiting to be checked in.

As the departure of the flight is announced, Dr. Zed is fed up. It has been six good hours of wait. That meant he would reach his destination that many hours late. He would still be in time to attend the conference but he will not be able to have the rest that he was planning to take in his hotel room. Instead, he would be jet lagged and quite fatigued, unable to fully concentrate on the proceedings of the workshop. All that money paid already seems to be ill-spent.

When he returns on the morning of the fifth day, the snow still quite unabated, he faces the day with a good deal of trepidation. He is tired, his tongue is parched, his eyes weary, his mind meandering in and out of a dreamy state, and to top it all the message from his rather matronly secretary left on his answering machine in her usual stern and formal voice that his first patient is due to come in around an hour's time and is supposed to undergo endoscopy for bleeding in the gastro-intestinal tract. He has four more appointments till lunch time.

"Makes my day, surely!" He hardly remembers what went on for the past few days, let alone all that heady technical stuff and the exhaustion due to mental wrestling with the written material. And he has to use all of his newly acquired skills on his very first patient.

Freshening himself up and getting dressed into a new set of clothes, he goes to his garage and revs up his car. It would not start. Mental cursing he opens the bonnet of his car. His battery needs a jump start. As he manages to get his car started and on the road the snow is thick and heavy.

He is in his foulest mood when at last he parks his car far off his office block, his usual place being occupied by the regular poacher who happens to be that new assistant of his who is yet to be allotted a proper parking place of his own and has to make do with any vacant lot he can get in his clutches, and walks through the light rain that has now replaced the snow which is piled almost ankle-deep on the roads to his offices.

"Good morning doctor." The secretary chillingly greets him, glancing at the wall clock. He is fifteen minutes late for his first appointment. Dr. Zed noticed it and thought momentarily about apologising. He changed his mind. To hell with all, compared to what I really wanted to do everyone must count their blessing and thank their stars or whatever that he has bothered to come at all. He knew he would have acted unprofessionally, totally unbecoming of a medical professional. So he said nothing but without sparing the gristle, he flashed an angry look to his secretary and walked haughtily in to his consultation room.                                         [Top]

Consultant Gastro-enterologist Dr. X. Y. Zed is making himself a cup of coffee with mixed emotions. He is psyching himself up for sitting through the better part of the next three hours to undergo a "live" and online work shop on the latest endoscopic procedures for treating gastro-intestinal bleeding with the help of lasers. He knows he is missing a golden opportunity of going to a exotic foreign locale and not being able t o meet his other professional colleagues face to face but he would rather miss them all rather than having to face the inclement weather conditions that rage outside. He parts the curtains ever so little and glances outside. It is snowing lightly now but the weather forecasts are not too promising with heavy snow predicted later on.

Some poor sod is going to get caught in this weather, but I'm happy it's not going to be me! He permitted himself a smile. The coffee machine emitted a beep indicating that his coffee was done. He walks back and pours himself a cup. Lazily he saunters into his study and powers on his computer. He clicks his mouse in several areas in a particular sequence and viola! He is connected to the workshop in seconds. The "live" demonstration is going to start in around fifteen minutes time. He decides to read through the textual material. He needs clarifications about certain points and types in his questions that are immediately transmitted to the experts who are conducting the workshop.

The "live" event starts. He joins in and poses a few questions online. The experts answer him directly, they can both see and hear him. It proves to be a lively three hour session. The next one is scheduled for the next day.

It is only ten o'clock and the evening is still young. Dr. Zed wishes to go through some selected parts of the various techniques demonstrated. He replays them in slow motion, sometimes slowing down to almost frame by frame and sometimes fast-forwarding t he video pictures, till he is satisfied that he has got the hang of it completely. He decides to call it a day, and potters off to his bedroom to delve deep into the land of sleep.

At around eight he receives a call from his rather matronly secretary who informs him in her usual stern and formal voice that his first patient is due to come in around an hour's time and is supposed to undergo endoscopy for bleeding in the gastro-intestinal tract. He has four more appointments till lunch time. "Sure, no problem."

The drive to his offices proves tricky due to the snow but he manages just in time to beat that blasted regular poacher, that new assistant of his who is yet to be allotted a proper parking place of his own and has to make do with any vacant lot he can get in his clutches, who was about to sneak his spanking new car into his parking area. As he backs up his car into his regular parking slot he could make out from his rear-view mirror the new assistant muttering some chosen expletives as he is forced to search around for some other vacant slot. "Mutter away, you berk!", he sarcastically grinned as he mumbled under his breath, "but try my slot and make my day. I shall have your guts for garter!"

As he walks up to the front door of his offices he is five minutes early. He softly whistles as he goes through the doors and smiles as his secretary greets him good morning. He replies affably and walks into his consulting room to receive his first patient. The procedure goes excellently. Not only did he remember each and every step that he needed to take in performing the procedure he discovers an easier manoeuvre of negotiating that tricky little area that the experts had warned the participants of the work shop about. There was one area though that he needed more clarification. Must remember to tell them about these tonight, he made a mental note, as he bade his patient good day and called his secretary on the intercom to send his next appointment in. He allows himself to recline in his chair in between patients to reflect on the upsides and downsides of the past twenty four hours.

Sure, he had missed a trip and a chance to socialise, may be a round of golf or two, but he is less fatigued, he saved on travelling expenses, had the added luxury of no loss of hours away from his practice and therefore of earnings, and to top it all he is able to immediately use his newly learned techniques on his patients.                      [Top]

A medical doctor is sitting in his home. He wishes to learn a bit more about a certain item of interest. He logs on to the telemedicine network and executes a search for the item. [Already today, excerpts from various major journals are available over the Web].

He may choose visit a virtual conference center and actively participate or interact with other professionals at various levels as if he were physically present there. He may even attend a few telepresence surgeries or perform a " virtual surgery" on a "virtual patient".

Logging on, he may elicit various statistical analyses of the datas, epidemiological or otherwise, that is available at various levels world wide. The software would allow him to design his own statistical analysis should he choose to do so.

Suppose, the doctor is new to the region and is unaware of the trade names of the various drug formulations that are routinely prescribed for certain given conditions. All he needs to do is to log on to the telemedicine network and execute a search for the same. Instantaneously, all the names are displayed and he can prescribe the same. Actually, he may even be able to direct his patient(s) to the nearest location which is capable of dispensing the medication. Even information about the possible price range may be supplied too.                      [Top]

A third-party payer organisation might wish to be informed about certain changes in the epidemiology or demography of the various diseases and malaises that its consumers are currently or are expected to suffer from (by performing a trend analysis of sorts). This would enable such organisations to forecast demands on its funds and allow it to fine tune its own fund management to maximise its profits while minimising its costs as well as risks. Actually, the benefits are quite endless if one really wants to think deeply about them. The payer may choose to log on to the telemedicine network and gain access to the permitted portions of information contained therein. Since it is a global data warehouse for information relating to the health care industry which is being constantly updated, the latest possible datas may be mined.

The employers may search the network to locate the best organisation that would help them in providing the best care to their employees at a value-for-price charged. The employer and the employee may even sit down together and use the same system to come to an agreeable solution for the health care services that one side is willing to pay for and the other side wishes to have. [Top]