iDoc. You patient.


With technologies like EMRs and telemedicine, physicians can find out everything they need to know about their patients -- without ever having to see them.

I wish I was the first one to make note of the latest medical phenomenon—the iPatient. This term refers to the new reality of doctors hunched over computer terminals looking up everything they need to know about their patients without ever having to see them. Hence, the new electronic record generated, Internet Patient.

How does this work?

The ED calls with your new admission. You log on, look up the ED nurse's intake note for the chief complaint along with the list of current meds. You scan the tests ordered for clues to what the ED physician is thinking. You check lab test and X-ray results on line. You bring up the electronic file containing the past medical admissions and discharge histories, along with all the consults dictated by previous specialists. All done in the past, all dutifully dictated and now accessible with a click and a password.

You now know the allergies, medications, social and family history, the treatment plans, code status, and an entire past medical history with consultant opinions.

At the same computer terminal you enter the admissions orders, notify required consultants, schedule IV antibiotics or what have you, and order tomorrow's lab studies and maintenance meds.

If this is the new reality—the iPatient—does that make me the iDoc?

We have witnessed the birth of telemedicine—the remote diagnosis and treatment of patients by telecommunication technology. Teleradiology exists, with overnight X-ray readings performed half way around the world where the sun is still up and the English-speaking foreign physicians are outsourced. We have Teleneuro, where wheeled monitors with camera attachment are brought to the bedside for emergency "Code Grey" stroke evaluations. We are watching the dawn of robotic surgery performed at a distance by academicians with clean hands electronically connected to ball jointed probes.

I have access to the electronic medical records of my patients, and I can see all, know all, and order all. All at a distance.

At the opening session of the United Nations in 1945, Harry Truman said, "We must build a new world, a far better world—one in which the eternal dignity of man is respected."

We have resurrected the trope of the all-powerful physician who likes to play God. I can now practice as "an invisible spirit with power over human fortune; the creator and ruler of the (medical) universe and source of all authority; a supreme being."

iDoc. You patient.

It is true that you still have the option of visiting the patient at the bedside, if you are so inclined, out of respect to tradition.

In truth, and with full disclosure, I admit that I am embellishing and exaggerating this last observation.

As a physician, you still must see the patient at the bedside—if you plan on billing for services.

-alan berkenwald, md

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