SPREADING AND HEARING THE WORD:
SCIENTIFIC, ECONOMIC, AND ETHICAL DIMENSIONS

Vital P. Costa, MD

Director, Glaucoma Service, University of Campinas, Brazil
Associate Professor of Ophthalmology, University of Campinas, Brazil
Associate Professor of Ophthalmology, University of São Paulo, Brazil

As ophthalmologists, trained at teaching Institutions such as Wills Eye Hospital, it is our mission not only to provide high quality care to the patients within our communities, but also to spread the word and try to allow people in other communities to benefit from our experiences, and to multiply the knowledge we gain throughout our lives by educating ophthalmologists and patients. There are several ways to accomplish these tasks, but Telemedicine has emerged as one of the cheapest and quickest technologies that may help us achieve these goals.

There are isolated populations, with limited access to health resources. The Northeast area of Brazil, for instance, has one doctor for 1500 inhabitants. Even, in developed countries, the distribution of health resources may not be homogeneous. Take the state of Georgia, for example. Among its 159 counties, 9 have no physician, 85 have no pediatrician, and 140 have no child psychiatrist. Add to this scenario an increasing cost of public and private health care.

Telemedicine has been proposed as a solution to part of these problems by employing technology able to enhance the capacity of health assistance to populations in need. The same technology may be applied to help educate physicians all over the world, eliminating more and more the enormous gaps between levels of health care. Finally, telemedicine can and is being used to educate our patients, allowing them to better understand their disease, possibly enhancing compliance.

It appears that telemedicine will be an increasing part of our futures as physicians, teachers, students, and patients. Limitations and barriers do exist, and they are numerous. The rural, physician-poor areas, where telemedicine would be more useful, are also the ones with limited access to technology. Ways to reimburse for a teleconsultation need to be discussed. Insurance companies are concerned that the easiness of access to health care may increase their costs, instead of reducing them. There are important ethical implications of sending medical data via the Internet. How secure is the system? What happens to the doctor-patient relationship via Internet? Is the artistic aspect of Medicine lost? The purpose of this talk is to provide an overview of telemedicine, its advantages and disadvantages, its limitations, and its future.