Some Pros and Cons of Telemedicine

By Lucy Gleysteen

From PHN Issue 40, Summer/Fall 2019

What Is Telemedicine?

Telemedicine is the exchange of health information through the use of
electronic communication. Telemedicine often involves the use of either phone or video consultation. It is used for diagnosis, treatment, maintenance, and prevention of diseases and illness. In order for medical providers to use telemedicine, they must make the audio and video encrypted, meaning no one except the medical team will be able to see what is on the screen or hear the audio. Telemedicine visits are not audio or video recorded, but your medical provider will still document the visit in a medical record.

In addition to using telemedicine to talk to a medical provider, it can sometimes include a physical exam through the use of high-definition cameras, monitors, electronic stethoscopes, and other computerized health tracking equipment.

Why Is Telemedicine Used?

Telemedicine allows for the patient and healthcare provider to interact in real time, often from a distance. There is a reduced cost burden for the prison system, because they do not need to coordinate transport and pay for the security and other logistics involved. Medical specialists who might not live close to the prison are able to see patients who they would not ordinarily be able to see. Prisons usually are not equipped to provide specialty care for all the health concerns that people in prison experience. For example, telemedicine has been used to connect people in prison who are living with HIV to doctors who are specialists in treating HIV. Some medical providers might not want to drive far to a rural area to see people in prison, but they are willing to see them through the use of telemedicine. There is a shortage of mental health providers in the United States, particularly a shortage of psychiatrists. Using telemedicine might reduce the amount of time you would normally have to wait to talk to a provider about your psychiatric meds.

What Are Some Challenges with Using Telemedicine?

Video visits might feel impersonal because you are talking to someone through a screen without physical contact. The medical provider will not be able to physically touch you, and it will be harder to understand each other’s non-verbal communication cues, such as body language or facial expression. In using technology, there is the possibility that it won’t function how it’s supposed to. Often the biggest issue is network connection. This means that if the internet is being slow, it might impact your visit. It’s also less likely that you’ll have continuity of care. This means that it is possible that every telemedicine visit involves meeting a new doctor. This is different from in- person visits, where you are more likely to see the same medical provider.

Response from a Reader about the Use of Telemedicine :

I have only had two telemedicine visits in my 18 years of incarceration: one time with a psychiatrist, and one time I needed to get checked for skin cancer on my back. The latter was a disaster, and the former extremely uncomfortable and somewhat demeaning. Since the one for skin cancer came first, I’ll start there. I waited three months while the process of approval took place. Then, when I finally got an appointment, the camera did not work, so the doctor could not get a close-up of the spot on my back, so I had to wait a full month more to be re-seen, at which time once the teleconference was established and I correctly identified myself, I was dismissed within 30 seconds! “Benign,” that is what he said. “Nothing to worry about.” I’ll explain why that was so uncomfortable momentarily.

My regular psychiatrist was in limbo somewhere and my three-month appointment time had come, so I had to see a psychiatrist from another facility. The screen at first showed the psychiatrist, asking if I could hear him. I could, but he could not hear me, so he got up and left, and I heard him tell someone to reboot the whole thing. So I waited about five minutes or so, and he came back and we could hear each other — with another annoying problem. All through the teleconference with him, the screen kept freezing up. Now, the reason I said it is dehumanizing is because 90% of the conversation between two people is nonverbal communication. Without body language, you are taking the most fundamental human aspect of a conversation away. We are not robots, we are humans. We are not video screens, we are human! Humans need body language and human contact.

—Ronald Leutwyler

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