Wednesday, June 27, 2007

Locality Rule and Telemedicine

In 1881, the medical establishment refused to wash its hands before inserting fingers into wounds. Today, it may be telemedicine.

I have demanded the scientific evidence from Dr. Lewis that national standards serve patients better than local standards. She is shunning this demand. Why? There is no straightforward rule or evidence of the superiority of one over the other.

A doctor practices in a rural location where patients must drive long distances in snow for routine care. They do their follow up care over the internet. The patient may take their own blood pressure, and the doctor may recommend a change in medication, called into the local pharmacy. Something goes wrong. The patient sues the doctor for negligence. The well paid expert from Hopkins has never run a medical practice over the internet. He testifies an in person examination is the national professional standard of due care. The jury agrees with his persuasiveness. A massive verdict goes to the plaintiff, with exemplary damages to deter such telemedicine.

Now, this doctor stops seeing patients on the internet. Other doctors learn from his verdict, and they stop seeing patients on the internet. Now, aged, frail people are driving long distances in the snow, causing many horrendous accidents on snow covered roads. Far more people are now hurt, some not driving to doctors' appointments.

The application of a retrograde national standard has now hurt many more people than the local standard of care ever had.

Dr. Lewis has to address the scenario where the local standard is better than the national standard.

This has a 100% certainty. All advances came from isolated local standards, adopted years later at a national level.

Not only will the proposal of Dr. Lewis hurt people, it may crush innovation.

I have patience. I will await her data showing national standards help patients more than local standards. Otherwise, the reverse should be implemented. States recognizing national standards as the standard of due care, should reverse their rule, and return to the reliance on local standards.


Matric said...

The debate about standards of care are intensive. In the case of the patient in the rural area, he or she can never have the same care as the person near a major center even with telemedicine. This debate has already been seen in other areas of medicine. For example, if you have acute chest pain in a major city, you get sent to the hospital and then staight to the cath lab and possible stent or bypass surgery all within hours. In a rural area, you get to a hospital, it does not have a cath lab, you hope that you can be transported in time to somewhere else all the while your heart is dying. Did the rural hospital commit malpractice, or did the urban hospital overpractice? Where do you want to draw the line?

Supremacy Claus said...

Matric: Question. Do the patients of the rural hospital want it closed by the ruinous litigation that Dr. Lewis proposes?