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Telemedicine: a cautious welcome

BMJ 1996; 313 doi: (Published 30 November 1996) Cite this as: BMJ 1996;313:1375
  1. Richard Wootton, directora (
  1. a Institute of Telemedicine and Telecare, University Floor, Belfast City Hospital, Belfast BT9 7AB

    Telemedicine is a major new development. Having become technically and economically feasible, it deserves proper investigation. Rushing into equipment purchase, however, is almost certain to prove counterproductive. Face to face contact is fundamental to health care and enthusiasts of telemedicine should recognise that it is not as good as the real thing (and unlikely ever to be). However, constraints on time and resources will make face to face consultation increasingly expensive, and telemedicine has the potential to produce major efficiencies in the diagnostic process. The goal of current research is therefore to marry medicine with technology, capitalising on the advantages of telemedicine and producing a robust system that delivers an acceptable service at an appropriate price.

    Telemedicine will do for health care what the personal computer has done for the office. Or so its proponents believe. Its opponents believe that it represents a threat to the doctor-patient relationship and is an intrinsically unsafe way of practising medicine. What is more, they suspect that its costs vastly exceed its benefits and that it is yet another example of “toys for the boys.” Like many new developments in health care, telemedicine seems to have a polarising effect on the medical profession, producing either evangelists or Luddites. Perhaps the real challenge, therefore, is to try and preserve a disinterested position and ensure that it will be the healthcare profession that influences the introduction of telemedicine, rather than it being driven by interested parties such as equipment manufacturers.

    What is telemedicine?

    There are various definitions of telemedicine. The most general one (“medicine at a distance”) covers the whole range of medical activities, including treatment and education.1 There are many successful examples of distance education in medicine, including the continuing medical education programme run by the Mayo clinic and delivered by satellite2 and the teaching of …

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