Ihave to chastise CMAJ gently about the statement in a news piece that Canada's telehealth services “trace back ... 10 years.”1 Equally erroneous was the assertion that “the telehealth model was originally imported from the US.”
In 1973/74 we received an Opportunities for Youth grant through the Queen's University Alma Mater Society (AMS) to create a “Teleclinic.” Our preliminary research at Kingston-area emergency departments had pointed to large numbers of nonurgent visits that might have been discouraged by better patient education.
The Teleclinic was staffed by medical and other health sciences students, and our mission was to provide advice by phone to people concerned about a health problem and wondering whether they should visit the emergency department. We trained the students and developed a series of “protocols” or “pathways” based on common complaints such as headache, GI bleeding and dyspnea or cough. Initially a couple of students worked at it for the summer. When the grant ran out, the project was funded by the AMS and staffed by student volunteers; it became a year-round service. It was popular and well used.
After I became an emergency physician, I decided that the project was in fact a medicolegal quagmire and I argued for its closure. Similar projects were briefly popular in the US with the advent of managed care in the early to mid-1990s. More recently, however, the American College of Emergency Physicians and most other responsible professional bodies have opposed any requirement that patients seek approval before visiting an emergency department.
Providing medical advice over the phone to unknown patients is potentially dangerous. In the US, it clearly discouraged some essential visits. Unless a physician is providing advice based on knowledge of that particular patient, a predictable number of wrong decisions will be made and the wrong advice provided.
Yes, the advice is usually correct and the visit is unnecessary. But what price a human life?
Peter L. Lane Director of Clinical Research Department of Emergency Medicine Albert Einstein Medical Center Philadelphia, Pa.
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