Intended for healthcare professionals

Rapid response to:


Why telemedicine is here to stay

BMJ 2020; 371 doi: (Published 06 October 2020) Cite this as: BMJ 2020;371:m3603

Rapid Response:

Re: Why telemedicine diminishes the doctor-patient relationship

Dear Editor

‘Tele‘ is from the Greek, meaning, ‘far off’, and a Clinician is ’a doctor having direct contact with patients’ (1).

The term, ’Telemedicine’ is therefore oxymoronic unless ‘medicine’ now refers solely to the distribution of drugs and not to the clinical activity of examining patients.

How does one detect hepatomegaly, feel for lymphadenopathy, do a PR, percuss the chest, elicit rebound tenderness, or assess the reflexes, using a screen or telephone encounter?

The doctor-patient relationship is more than a mechanical, data-gathering exercise, replaceable by computer algorithms and implantable bio-sensors (2).

Singh & Leder (3) explain that touch has the potential to communicate, soothe, and heal, and medicine is diminished if it avoids the exploration and utilisation of the power of touch. Increasingly, the direct doctor–patient contact often gives way to a reliance on technological devices that help diagnose, and later treat, the patient. It is not unusual for a doctor to stride into a hospital room and, rather than reach for the patient, reach instead for the chart with the latest lab results.

Yet, therapeutic touch is pivotal in certain areas of modern and traditional medicine, including physiotherapy, osteopathy, chiropractic, and acupressure. Can verbal skills replace the expert hands of a physiotherapist in relaxing tight muscles, or those of a chiropractor realigning a contorted spine? Can words alone replace the touch of a GP who reaches out to a distraught patient to demonstrate empathy and to recognise suffering? Touch can be used to bridge the emotional and physical gap between a physician and patient. It can directly express care, compassion, and comfort. It has the potential to play an important part in the healing process, reinforcing patient trust and concordance, along, perhaps, with the ‘placebo effect’, triggering the body's own capacity for self-healing.

Gadow (4) points out that, technology, on the other hand, has the potential to violate human dignity to the extent that its use reduces persons to the moral status of objects. The prevalence of technology in health care is an extension of the scientific paradigm, in which the body is reduced to an object devoid of subjectivity. The empathy paradigm, in contrast, is based upon the moral primacy of subjectivity. Empathic touch - as distinct from instrumental and philanthropic touch - establishes a clinical relation of intersubjectivity, affirming in patients the dignity and worth that morally distinguish persons from objects.

This has seemingly been written out of the script in the rush to technological, so-called ‘progress’.

Will empty waiting rooms be quite as appealing when medical personnel suddenly realise that they have willingly participated in their own redundancy?

(1) Oxford Dictionary of English, 2nd edition, 2003: Oxford University Press

Competing interests: No competing interests

09 October 2020
Janet Menage
GP retired
Wales, UK