Intended for healthcare professionals

Letters Why telemedicine is here to stay

Why telemedicine diminishes the doctor-patient relationship

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4348 (Published 10 November 2020) Cite this as: BMJ 2020;371:m4348
  1. Janet Menage, retired GP
  1. Llanybydder SA40 9YJ, UK
  1. janetmenage123{at}btinternet.com

Stokel-Walker says that telemedicine is here to stay.1

“Tele” is from the Greek, meaning “far off,” and a clinician is “a doctor having direct contact with patients.”2 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, percuss the chest, elicit rebound tenderness, or assess the reflexes using a screen or telephone? The doctor-patient relationship is more than a mechanical, data gathering exercise, replaceable by computer algorithms and implantable biosensors.3

Touch has the potential to communicate and heal, and medicine is diminished without it. Increasingly, direct doctor-patient contact is replaced by technological devices to diagnose and treat the patient. Doctors reach for the latest laboratory results rather than for the patient.4

Yet, therapeutic touch is pivotal in medicine. Can verbal skills replace the expert hands of a physiotherapist in relaxing tight muscles? Can words alone replace the touch of a GP who reaches out to a distraught patient to demonstrate empathy and recognise suffering? Touch can bridge the emotional and physical gap between physician and patient. It can express care and compassion. It plays an important part in the healing process, reinforcing trust and concordance, and triggering the body’s own capacity for self-healing.

Technology, on the other hand, violates human dignity by reducing people to the moral status of objects. Technology in healthcare reduces the body to an object devoid of subjectivity. The empathy paradigm, in contrast, is based on the moral primacy of subjectivity. Empathic touch establishes a clinical relation of intersubjectivity, affirming the dignity and worth that morally distinguish people from objects.5

This has seemingly been written out of the script in the rush towards technological “progress.” Will empty waiting rooms be quite as appealing when medical staff realise they have willingly participated in their own redundancy?

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