Reader opinion Remote appointments lead to an increase in treatment errors – therefore telemedicine should be used with caution

Opinion|Reader’s opinion

In Helsingin Sanomat was written (28.12.) Kainuu health centers have largely moved to remote receptions. Due to the tightening of the care guarantee, telemedicine aims to maximize the number of care contacts without paying much attention to the quality of care.

Remote clinics bypass key steps in diagnosing diseases. A very important part of the diagnosis is the physical examination of the patient. Based on this and the symptom description, an idea is formed about the cause of the discomfort and the overall situation of the patient. Based on these, the need for further research and treatment options will be assessed. Assessing a health problem remotely leads to assumptions and an increase in uncertainty and misdiagnosis.

In the telemedicine model described, physicians and nurses are instructed to perform at least 80 percent of treatment procedures remotely. In the case of remote contact, important aspects of diagnostics and treatment that could be detected at the reception are left unattended. This is particularly the case for elderly and multi-ill patients, whose health problems are often very complex. It is precisely in primary care that it should be possible to take the patient’s care into account holistically.

For telecare the associated disappearance of treatment queues is often apparent – queues are transferred from the health center to emergency or specialist care outpatient clinics or to the private sector. The approach directs to superficial remote contacts, the health benefits of which may be negligible, and the patient’s ailment will not be truly treated. The encounter and hearing of the patient will not materialize. Patients with reduced mobility in particular feel discarded. Treatment is not fit for purpose and is ineffective.

The widespread use of telemedicine has already been seen to lead to treatment errors and delays in diagnosis. The model results in overuse of laboratory and imaging studies and inappropriate staggering of treatment, leading to an increase in overall costs. The way of working against the doctrines and ethics of medicine and the limited opportunity to influence work arrangements have led to redundancies across Finland.

Telemedicine should be used critically to the extent and in situations where it genuinely supports the success of treatment in a high quality and safe manner. As a rule, it is not suitable for reliable diagnosis of acute diseases, but it can be used in the treatment and monitoring of long-term health problems and public diseases. It is useful to appoint a caregiver for the patient – this has been done in the past in the GP system.

Decision-makers in future welfare areas need to realize that an attractive-sounding way to meet demand may not ultimately work. In Kainuu, too, people are not satisfied with the model, which is probably evidenced by Kainuu’s decision to end co-operation with a consulting company that was implementing the change.

Merja Ruha

General Practitioner, Kuhmo

Jekaterina Miloserdova

General Practitioner, Kuhmo

Atte Veteläinen

General Practitioner, Kajaani

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