Doctor will see you by webcam

FROM next year, doctors will be allowed to offer consultations over the internet. This is meant to be one solution to the problem of "medical deserts": rural parts of France that have too few GPs, doctors often preferring to set up in urban areas.

However there have been mixed reactions from doctors, who say that, while it will have its uses, there could be risks of misdiagnoses.

"Telemedicine [medical services over the internet] is not 'the' solution, but is 'a' solution," said the then health minister, Roselyne Bachelot, announcing a decree setting out rules on telemedicine. "The regional health agencies will authorise schemes taking into account the population's needs," she added.

The government has yet to fix the price of an internet doctor's consultation. However, it is planned that, unlike ordinary doctors' visits, reimbursed at 70 per cent, the reimbursement will vary by area, so, eg. it is larger where people are in areas where it is genuinely difficult to see a doctor in the traditional way.

A spokesman for one of the largest GPs' unions, Unof, Dr Michel Combier, said "teleconsultations" were not the most important part of telemedicine, which includes all forms of medical help over the internet, such as simple advice, called téléconseil.

"In theory, consultations will be allowed, but in practice it remains to be seen how it works. It puts extra responsibility on the doctor and there could be a risk of errors of misdiagnosis."

He said telemedicine would be of greatest use for follow-up. "It would be useful where people need advice about the right way to take their medicine, for example. There's a difference between an internet consultation with someone we know well and are used to dealing with, and someone we don't know at all."

He added actual diagnosis of new problems via webcam may be envisaged in some cases.

"However, the image is not always great and all you are going to be able to diagnose is skin problems.

"Even for checking colour, it would not be ideal. If someone were jaundiced, I'm not convinced you would pick it up over the internet. You would need very high-quality webcams and screens for the colours to be accurate."

He added that it was not certain it could help everyone in medical deserts because many patients are elderly, with serious problems, requiring in-depth examinations. Also some do not have the internet or cannot access broadband.

"One kind of telemedicine that will be practical is télésurveillance, that is you have equipment at the patient's home that they, or a nurse, can use, that allows the doctor to see in real-time, different factors that interest him, for example their blood pressure or sugar levels.

"A nurse could also send photos to the GP over the internet, for example of skin conditions, which would be clearer than looking at a webcam image, so the doctor can decide to visit or not and better organise his timetable.

"Another practical use would be a rural GP using the internet to consult a specialist, he could send X-rays and tests and then discuss the patient; that would be a kind of teleconsultation between two professionals. That does not exist yet, but it is likely the specialist would be paid directly by social security."

A spokesman for doctors' professional association, Cnom, Dr Jacques Lucas, said such consultations could, if necessary, include the specialist seeing and talking to the patient during a visit to their GP.

"For a heart patient, for example, rather than sending them 80km to a cardiologist, the GP can send ECG test results over the net, so a specialist in a hospital or distant clinic can give a response.

"It is excellent that we have had a decree allowing us to practise medicine without necessarily having the physical presence in the same room of both doctor and patient."

Dr Lucas said it was possible there would be direct consultations with the patient at home, but only if there is a formal scheme in place set up by the regional health authority.

Plenty of use could also be made of simple téléconseil. "Patients often phone their doctors for advice. That could be done over the internet instead. People have talked about what is done in Switzerland over the net, but there they just give advice, not dissimilar to what is done when people phone 15 [the medical emergency line]. In fact 80 per cent of these calls are not followed by a medical intervention: the doctor, after listening to their problem, is able to say 'Take a painkiller and see a doctor tomorrow'."