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News : Kiwis Can Have Global Health Checks from their Couch
Auckland, New Zealand, Jan 29, 2016 -- More Kiwis are getting their healthcare at the end of telephone or online than ever, sometimes from half a world away. Ben Heather asks whether more convenient healthcare is worth the risk.
Imagine visiting your doctor from your couch, showing her that nasty growth with your iPad, maybe even providing blood samples via your phone.
After the scans – perhaps also provided through a phone app – are processed overnight by a radiologist in Dubai, the growth turns out to be serious and you're booked into your local hospital the next day.
You are prepared for surgery, but you never meet your surgeon. She is hundreds of kilometres away, operating the arms of robot looming over you on the operating table.
Elsewhere, all these advances are already happening rapidly. In New Zealand, we are not quite there, but remote technology-assisted healthcare, or telehealth, is already shaking up how Kiwi patients are being treated.
A video, instead of a physical trip to the doctor, is now common in many parts of the country.
"If I have a problem as a patient, then why do I always have to drive out to my doctor?" Stephen Child, chairman of the New Zealand Medical Association, said.
"There are considerable numbers of patients where a lot of their consults can be done over video."
Auckland epileptic patients can see their doctor without leaving their home. Children on the West Coast are often seen, but not touched, by paediatricians in Christchurch, 250km away.
Some of this work is even heading overseas. Palmerston North Hospital's emergency department ran a trial last year in which a stroke specialist based in Wishaw General Hospital, near Glasgow in Scotland, was on call for the night shift, just a video link away.
Hawke's Bay DHB, and several others, send patient scans to a global radiology hub, which farms them out to radiologist based anywhere. That strange growth on your shoulder could have been diagnosed by a doctor in Mumbai, before being checked at your local hospital.
Doctors said the impact of telehealth would be profound and unpredictable. The changes could radically improve access to quality care for Kiwi patients no matter where they live – but they also held new risks.
On Thursday, the Medical Council of New Zealand revised its position on telehealth, making it clear overseas doctors treating New Zealanders remotely are required to meet local standards of care.
Council chairman Andrew Connollysaid at the moment not much could be done if an overseas doctor treating Kiwis remotely stuffed up.
That made it all the more important that doctors working remotely were registered "as if they had immigrated here".
"We've got to able to look the public in the eye and say, 'Everyone that is providing regular care to New Zealanders, either in New Zealand or overseas, is qualified to be doing what they are doing'."
Anna Ranta, a stroke neurologist at Capital & Coast DHB, was behind the trial in Palmerston North and is now involved in a bigger national trial with stroke victims, consulting over videolink.
There were still big hurdles – clunky technology and disconnects between different DHBs – but the potential to connect a small pool of specialised doctors with patients around country was huge, she said.
"Assessing someone by videolink is almost like you are there, by their bedside."
Christchurch paediatrician John Garrett, who chairs the National Telehealth Forum, sees about 100 child patients on the West Coast via video every year.
He believes the importance of trust and continuity between doctors and patients means telehealth will be mostly about making that relationship more convenient, rather than replacing your local GP with a medical call centre in the Philippines.
And while follow-up appointments can take place, doctors still need to do a lot of poking and prodding in person. Garrett makes the five-hour drive to the coast to see patients face-to-face every few weeks.
Child said, if anything, the changes meant the core skills that built trust between a doctor and patient would be more important that ever. "I think that caring, the empathy and the communication, will endure the test of time and technology."
* More than 2 million calls are made to the National Telehealth service a year, which could expand to include video calls in the future.
* Video doctors' appointments are already used by some DHBs, in some cases straight from home.
* Some scans of Kiwi patients are already sent overseas for diagnosis, to speed up turnaround.
* Robots, sometimes controlled remotely by a surgeon in another country, have already completed millions of surgical procedures overseas.
Posted by Veronica Silva Cusi, news correspondent
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About New Zealand Medical Association:
The New Zealand Medical Association (NZMA) is the main association representing doctors in New Zealand.
Published: Monday, February 1, 2016