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While doctors always need to look their patients in the eye, often they need to peer other places — into knee joints, down the throat, or, in the case of UC Davis dermatologist Dr. Robin Alexander, close up at lesions on the skin.
One July morning, Alexander is in videoconference with a shy 15-year-old Spanish-speaking boy with bad acne at a clinic in the town of Hughson, 74 miles away. "Let’s take a look," Alexander says to a clinician who is off-screen, and the image of the boy is replaced by one created by a "dermcam": a close-up zoom on the boy’s brown skin. "Focus on those really red ones on the glabella."
The dermcam’s field of vision wanders to the bridge of the teen’s nose, and angry craters fill the screen. The dermcam’s images are more sharp and color-true than the views she gets in person, Alexander says. Indeed, dermatology is so well suited to distance treatment that Alexander’s sessions have accounted for more than a third of UC Davis’ videoconsultations over the last four years.
The next few years will probably see the rise of medical practices designed around other popular specialties, such as radiology, and geared to serve the remote areas of an entire state or region, says Jonathan Linkous, executive director of the American Telemedicine Association.
Of course, video visits often don’t work well in fields like rheumatism or general physical therapy, where touch is often required. But many of UC Davis’ clinics are equipped with dermcams and endoscopes for peering in the eye, nose or throat. "We can’t extend touch yet, but we can extend sight and sound, and extend it by a couple hundred miles," says Ravi Nemana, technical lead for UC Davis’ telemedicine program.
For many practitioners, such as psychologists, talking to the patient is all that’s required, which explains why mental health is one of videomedicine’s most popular uses. The Department of Veterans Affairs operates 20 remote centers to work with Post-Traumatic Stress Disorder patients, and UC Davis’ program to work with childhood obesity is in high demand.
When it comes to videomedicine, all the normal problems of providing video on the Internet — security, color fidelity, reliability and bandwidth — are at their highest premium. Few endeavors have more stringent demands for quality, since the price of a fuzzy or off-color image might be a misdiagnosis.
Technical standards for telemedicine are now evolving. What, for example, is the minimum refresh rate necessary for a doctor to detect Parkinson’s-type tremors in a patient?
An additional task is moving the videoconference from a designated part of the hospital to any desktop where a doctor might be. UC Davis’ Nemana has to make videoconsultations as easy as possible for physicians. "Doctors are very busy people, and they are very nomadic," he says. "It’s hard enough to get you and the physician in the same room at the same time. Imagine adding a specialist."
With almost 3,400 videoconsultations in its first four years, UC Davis’ telemedicine program is probably just getting underway. And while its infrastructure is growing, it’s not keeping pace with demand. Video-dermatology appointments are already being scheduled five to six weeks in advance.
But the growth will come, if only because of the experience of patients like Steve Craig. At the end of his meeting with Dr. Prescott, both wave and smile as they sign off. Though it’s only Craig’s first appointment, he’s not fazed that he might never see his doctor in person.
"On my work schedule, it’s very hard to get, say, down to Sacramento," Craig says. "It takes a whole day. Besides, the traffic gets my blood pressure up. It’s worth more than money not to have to deal with it."