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This article provides an overview of some of the practical applications of Telemedicine in remote populations. It discusses some of the key advantages and disadvantages and a potential role that can help improve the quality of care in modern society.

The Current View of Telemedicine 

"Any physician worth his weight will be able to plan his next 4 moves after he performs his patient interview and physical exam."  These wise words for our instructor during our Cardiology rounds depict the classical state of health care where medical decisions are made after a patient comes for a visit, answers some questions, and then is examined by the doctor before a course of action in his management is charted.  Since the emergence of the Internet, healthcare has undergone a gradual shift from the classical approach where patients no longer have to travel to the local doctor's office to receive medical advice.  Enter Telemedicine, a new-aged standard of care where patients can log onto their computers from home, call a physician from a regional hub, and then receive a diagnosis and the proper therapy for his condition.   This is very radical shift from the standard of care and obvious questions into the merit of this style of Medicine have begun to surface.  

I had the unique opportunity to take a course in Telemedicine during my  Medical School Training.  I was skeptical at first, like most of my colleagues, based on the absurdity of the concept.  How could you possibility treat a patient effectively through a Skype call?  In the medical world, it is common to have relatives or family members call for medical advice for the 2-day head-cold or the upset stomach and expect a detailed diagnosis and therapy because "you're a doctor" while giving very nonspecific clues.  The phone calls often resolve in laughably incomplete medical histories and no form of medical evaluation whatsoever just so you don't have to spend another painful minute dealing with your mother-in-law.  At least with family, however, it is possible to have a vague idea of the general medical condition of your own "flesh and blood"  after meeting up during any holiday gathering.  In Telemedicine scenarios, this is essentially the same concept but the medical conditions are often more serious and patients are complete strangers.  

During this course, we were presented with several unique scenarios that demonstrated the benefits of Telemedicine and this ultimately shifted my perspective of this growing field.  Our instructors pointed out several scenarios where this video-call could be a valuable resource for patients in rural communities who had limited access to healthcare.  I completed my medical schooling in a large city in Europe and often had patients come to the University clinic with stage IV cancers or gangrenous ulcers from surrounding villages.  Patients would typically either ignore their symptoms or reveal that they hadn't been to a doctor's office in over 10 years.  More difficult still, elderly patients often have a negative perspective of hospitals already because many of their friends and family did not survive their inpatient stay making them less likely to seek treatment themselves.  This negative stereotype pushes these patients to neglect their symptoms and often level physicians with end-stage diseases and no feasible medical therapy.   Had Telemedicine been an available avenue, patients would have been more comfortable discussing some of their symptoms with physicians earlier on in the disease course and would have undoubtedly had a more positive outcome.  

Another Useful Telemedicine​ Avenue to Consider 

Another alternative to Telemedicine that has its place in modern medicine can be seen in the vast expanses of the Siberian tundra.  Russia is the largest country in the world and populations that are not found in key cities like St. Petersburg and Moscow are often found in remote settlements scattered across this barren landscape.  Patients are often located thousands of kilometers away from the closest regional medical center so if any serious condition occurs, communities are often left on their own to treat their ill member.  Heart attacks and strokes in these areas are usually death sentences.  

The Russian Government has realized the difficulty in dealing with such a dispersed population and has created a solution to deal with this adversity.  Mobile hospitals have been constructed in the form of railway cars and these hospital trains often over 4 kilometers long traverse the barren Siberian landscape providing medical care for the isolated populations of Russians living in these areas.  These trains are fully staffed with doctors, nurses, and other healthcare providers to provide medical advice for people who would otherwise not receive it.

  The trains are divided into different wards like Pediatrics, Geriatrics, and even have cars specifically designed to provide some minor surgical procedures.  If a patient is gravely ill, he can be admitted to the Inpatient ward and can travel with the medical staff to a larger medical center that can provide more specialized care based on the patient's needs.  Patients will be able to visit physicians free of charge for yearly check-ups and can get imaging studies like X-rays and even CT scans during their visit.  The trains are often stationed in each town for a week at a time and populations have the opportunity to travel from their dwellings in a much more convenient set-up than if they needed to go to a larger city 3,000 miles away.  They spend 6 months travelling across the region and then return to their beginning point allowing for two visits throughout a year for patients if needed (1.)   

Although the classical cascade of patients traveling to a doctor in seek of medical advice is still the most desirable situation, the reality of society is that some patients will not be served based on limited access to medical consultations if they live in remote locations. If patients are unable to travel or have insufficient transportation to reach a medical center, technology should be used to bridge the gap.

Physicians can communicate with patients in remote locations using Skype and have meaningful conversations that would have been missed otherwise in most situations.  

Patients may receive life-saving advice after revealing some of the 'red-flag symptoms' they may have been experiencing and can have an adequate work-up to make a difference potentially if advised to go to a regional medical center urgently. Other nations should also mirror government-sponsored health-programs like the one run in the Siberian tundra.  A government should be responsible for the wealth-fare of their citizens and provide resources to all even if the infrastructure is lacking like in Siberia.  If train tracks over 6,000 kilometers long were able to be constructed over the unforgiving Russian topography, it should be much easier to bring this ingenuity to other parts of the world.  Telemedicine and mobile hospitals can work in synergy to improve the quality of healthcare in underserved and remote populations and benefit those who would have no hope based on the current medical model.  

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  • 1.) Yaffa, Joshua. "Siberian Medical Train." The National Geographic. June 2014.
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