Notes from the field: Telemedicine and AI
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This month’s cover story is both enlightening and distressing.
An esteemed group of colleagues — including Maria Danila, MD; Rebecca Grainger, MB, ChB, PhD; Grant Hughes, MD; Lesley E. Jackson, MD; Dominique Feterman Jimenez, MD; and R. Swamy Venuturupalli, MD — have elegantly outlined the benefits of telemedicine. However, they also focus on the systemic problems limiting the growth and proliferation of this important patient management tool. I clearly concur with many of the stated obstacles — social determinants of health, language barriers, technical limitations based on internet service availability, patient privacy and beyond.
However, one of the most troubling conclusions from this roundtable was the near universal agreement that any solution to the systemic inadequacies surrounding telehealth must start with policy, followed by technology and other systemic remedies. Changing policies at the national or even international level is clearly beyond the scope of nearly all clinical practitioners. Therefore, I must remain hopeful that professional organizations across all specialties will step up to advocate for reforms.
Having said that, I want to briefly reflect on my own use of telemedicine, which before COVID-19 was literally nonexistent. I now view it as a platform that can be both powerful and rewarding in the right settings.
We last discussed telemedicine in the July 2022 edition of Healio Rheumatology, amid the fever pitch moments of the COVID-19 pandemic (“Telemedicine and rheumatology: Where is empathy in the digital encounter?”). At that time, I pointed out how research was urgently needed to explore the relationship between telemedicine and empathy. Given recent data again demonstrating that patients’ symptoms, especially chronic pain, appear to respond more favorably in the context of high-perceived empathy from their practitioner, I assert that it is urgent to know whether we can communicate empathy just as well via telemedicine as we can in person.
A quick interrogation of OpenEvidence, a free large-language artificial intelligence database, and the leading AI medical information data source, concludes that empathy can be effectively conveyed through telemedicine whether via video, chat or telephone, and that patient perceptions of empathy in telemedicine can be comparable to those in traditional in-person consultations. I find this heartening and encourage the rheumatology community to study this specifically in patients with both inflammatory and noninflammatory rheumatic disorders, particularly those attended by chronic pain, fatigue and other subjective symptoms.
(Full disclosure: I am a medical adviser for OpenEvidence, and I encourage readers to check it out at https://www.openevidence.com and please share your experiences with me.)
From my own perspective, I informally find myself appraising each patient as to whether I believe they will be great, average or subpar candidates for telemedicine visits during their care journey. The things I look for in making this highly subjective assessment are driven more by my gut than data. People who are medically literate, with technical savvy, doing relatively well and with a paucity of serious psychologic comorbidities appear to be the low-hanging fruit.
Mind you, I am not disparaging those who suffer from social determinants of health, language barriers and mental health issues. It is out of my deep personal desire to meet them where they are, one-on-one, that makes me want to see them in person if at all practical. I am sure all of you recognize that each patient has their own needs, and for some it is, as written in The House of God, to have “the hand in their hand, the sense that their doctor could care,” and that must be in person. For many, empathic communication is nonverbal, and I wish I had a magic formula to determine which of my patients would do best by telemedicine or in-person visits.
To end this discussion, I turned to AI and asked OpenEvidence, “Who is the ideal patient for a telemedicine visit?” Its answer: “The ideal patient for a telemedicine visit is one with a stable chronic condition, good internet access and logistical barriers to in-person visits, who is comfortable with technology and has a private setting for the consultation.” I must say that I generally agree with this answer, but in the end I was hoping it would tell me about the need for a “hand in their hand.”
That is my take, and I would love to hear yours. Please share your thoughts with me at calabrl@ccf.org or at rheumatology@healio.com.
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- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
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