In 2020 with the nearly overnight adoption of telemedicine we experienced a variant what 20th century media theorist Marshall McLuhan called the transitional moment. It basically suggests that when we are faced with a new media we tend to use it in a way that reiterates the old media. The early use of YouTube, for example, mimicked television. It took years before users were able to truly leverage the power of YouTube as its own creative medium and platform.
Doctors are no different. When we adopt a new technology we tend to see it through the lens of the way we’ve always done things. The adoption of telemedicine is a great example.
Seeing new technology through a 20th century lens
While McLuhan’s iconic quote was referencing media, the transitional moment applies to our response to telemedicine. In our telemedicine encounters we tend to frame this new kind of connection in the context of a real-life encounter. We have a hard time imagining a different structure or paradigm for connecting with patients. So we seek comfort in the old constructs and shape telemedicine visits that evoke images of our clinical spaces.
The telemedicine platforms in use today make skeptical physicians comfortable with a distant doctor-patient connection. Developers bake in skeuomorphic elements that conjure up images of the square, UV-lit exam room. Waiting rooms and reassuring pop up messages suggesting that the doctor will see you shortly have us seeing the remote video connection as a virtual iteration of a comfortable analog process. Some doctors even appear on screen as if they are physically in a 20th century exam room complete with a stethoscope around their neck.
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The next wave of telemedicine
The next wave of remote care will involve taking the telemedicine encounter to a new level. Its own level. Rather than working to mimic an IRL office visit, the evolution of remote care will involve shaping a patient experience that draws on the uniquely defining strengths of a virtual connection. Point of care patient monitoring will make the telemedicine encounter look very different. More importantly, the expectations of both provider and patient will evolve such that the emotional comfort zones of exam rooms and reception areas will become part of healthcare’s pre-digital history.
Telemedicine at that point will just be medicine again.
The next phase of 21st century medicine will also recognize that the continuum of connection between doctor and patient will range from an asynchronous text exchange to the actual laying on of hands. Despite the convenience and excitement of remote care by video, we will default back to the reality that there are some things that require human touch. And as new forms of virtual connection emerge, defining what kind of doctor-patient connection best serves what kind of problem will occupy our professional discussions.
Care as a continuum rather than a series of episodes
Just as the connection between doctor and patient will not be restricted to a single medium, it will similarly not be restricted to a single point in time. The relationship between a patient, her data and the health system will become something that happens closer to real-time rather than during the episodic yearly physical or even spot telemedicine encounter. The players who can create the technology that supports this perpetually-connected clinical environment will shape the future of health practice as well as the future of the empowered patient. Our success as health professionals will be defined by our ability to adapt to and function in this new connected environment. More importantly, professional success will be assured by our active participation in the process of imagining and shaping the future of the clinical encounter.
When McLuhan suggested, “We look at the present through a rear-view mirror. We march backwards into the future,” he might as well have been describing our awkward first steps into telemedicine. This is medicine’s transitional moment. We can build on this moment or continue to see our relationships, encounters and even our technology through the comfort of the rear-view mirror.
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