Jacques Lucas: "Telemedicine is designed to improve the patient/doctor relationship"

Points de vue | 10 Dec 2010
The view of Jacques Lucas, vice-president of the French Medical Association (CNOM)

When the Telemedicine decree was published last October, Jacques Lucas, vice-president of the French Medical Association (CNOM), and head of health information systems, provided clarification on the concrete implications of this law.
Since telemedicine had been included in the law on hospital reform and on patients, healthcare and the regions as a new way of practising medicine (in accordance with the recommendations made by the European Commission to Member States), the implementing decree was highly anticipated. Now this law has been published, it is possible to practise medicine using IT tools, although only in specific situations: most notably when it proves necessary to treat patients in a particular health region. And this is why the decree prescribes that the organization of telemedicine in France will either be defined by a national programme set out by the Ministry of Health, or by regional contracts overseen by the regional health agencies..

Removing confusion and responding to misunderstandings

Telemedicine, and teleconsultation specifically, does not mean merely providing online advice.
Teleconsultation is a new kind of medical consultation, unlike any other. What actually happens is a qualified doctor, working within the framework of a regional healthcare organization, makes a diagnosis and then prescribes the appropriate treatment. Obviously, this cannot be done in all cases. For example severe abdominal pain, fits in children or gastrointestinal bleeding cannot be treated via telemedicine. Although in these situations, advice can be given while patients or their carers wait for the emergency services to arrive and a clinical examination to be performed. This option already exists when calls are made to the emergency call centres.
However, teleconsultation can be employed for patients in isolated areas – for monitoring chronic pathologies, for example, which saves patients from having to keep travelling to face-to-face consultations. All telemedicine activities will be subject to protocols and rules for good practice, defined in conjunction with the doctors concerned and other healthcare professionals (particularly nurses), and with the hospitals and/or clinics involved. The care provided must be of the same quality as in hospitals and clinics, while enabling (often elderly) patients to remain in their own homes or wherever they normally live.

A code of ethics must be applied to these new telemedicine practices

Since telemedicine is a medical intervention, all of the ethical obligations prescribed by the public health code apply.

First of all, the decree states that free and informed consent must be obtained from the patient.

At the same time, the doctor and any healthcare professionals assisting that doctor must be qualified, competent and identified. Medical confidentiality must also be observed and the IT tools used must guarantee confidentiality. These are mandatory conditions. The CNOM strongly supported these conditions in its white paper on telemedicine published in 2009. We are pleased that our recommendations have been included in the law and the decree. Why? Because patients being treated via telemedicine need to be assured that they are receiving treatment specially adapted to their situation from qualified, competent, dedicated and conscientious professionals.

Of course, the issues of responsibility and civil or administrative liability applicable to treatment must be specified and the funding conditions clarified.

In addition, good practice protocols will need to be produced by specialist committees, with methodological input from the French national authority for health.

The CNOM wants to remain a proactive participant in all of these areas, because they all relate to medical ethics.

Telemedicine is designed to improve the patient/doctor relationship

It is important to remember that telemedicine is simply the application of IT tools to medical practice. Has the telephone dehumanized the doctor/patient relationship? Clearly not. On the contrary. Many doctors speak to some of their patients on the phone every day, to give them advice or adapt their treatment. This creates a human bond – it does not weaken it.

Telemedicine does not involve turning a patient into some sort of “zombie” covered in sensors and monitoring equipment. The patient is a person first and foremost, and a vulnerable person because they are ill. Telemedicine practices can only be implemented with the patient’s consent, witnessed by their doctor and other healthcare professionals. Telemedicine gives a sense of medical presence, with the opportunity to liaise with a specialist consultant, and is reassuring for the patient, creating a virtual medico-social environment. It eliminates the need for people who are either disabled or reliant on care to make difficult journeys – on condition, of course, that their state of health enables them to receive the same standard of care via medical information technology as they would receive in a hospital or clinic.

Therefore, we need to be rational about this and not demonize telemedicine or praise it too highly. It should be employed when it is useful and allows patient treatment to be improved, in all areas of medicine. It is merely a new form of medical practice. It may well mean that the organization of healthcare has to be structured differently, but it should be viewed first and foremost not as a feat of technological prowess, but as a new resource that is being developed to help people.