This new way of treating oneself was acclaimed during the Covid crisis. Consultation in the cabin is now commonplace and the practice is promoted by local elected officials in medical deserts. But do we really have a diagnosis worthy of the name?
For: Dr Luc Téot, plastic surgeon at Montpellier University Hospital, founder of Domoplaies
Teleconsultation is comfortable and reassuring for the patient
We were pioneers in assisted teleconsultation with Domoplaies. Our service founded in the 2000s was initially a city-hospital network in Languedoc-Roussillon: it allowed patients with complex wounds to be cared for at home or in nursing homes thanks to the passage of specialized nurses in less than forty- eight hours. Assisted teleconsultation has simplified this system by bringing together the patient and the nurse or attending physician on one side and an expert team on the other.
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This remote assistance obtained results comparable to a face-to-face consultation, supported by scientific studies. The exchange of images during the videoconference allows the exploration of the depth of the wound by the local caregiver guided remotely by the expert. A Domoplaies nurse takes special care of technical assistance, a facilitating element deemed very effective for health professionals. Teleconsultation offers comfort to the patient who no longer has to move and is reassured. If there is a concern, we go to face-to-face, or day hospitalization.
For a long time, I managed the severe burns department of the Montpellier University Hospital and did telemedicine without knowing it. Telephone or exchange with the doctors announcing a serious burnt thus sometimes made it possible to call the ambulance instead of the helicopter… This is what the samu do. Opening teleconsultation options upstream of the emergency room can slow down the flow.
Against: Dr Jérôme Marty, President of the French Union for Free Medicine (UFML)
Terminals pave the way for the commodification of care
Teleconsultation is both the best and the worst of worlds. The best because, as we saw during the Covid crisis, it can bring comfort to the doctor and the patient, especially the elderly or those with a loss of autonomy, as soon as the practitioner knows his patient. The lack of clinical performance of the examination is compensated by the knowledge of its history, its way of life, its antecedents… which makes it possible to avoid errors. It also allows the active retired doctor to keep a link with medicine and with his local patients, even if he has left the territory.
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But the bad side comes from the openness to a certain commodification and financialization of care. Teleconsultation platforms have seen the pandemic as a windfall effect and are multiplying acts without considering ethics and the quality of care. The knowledge of the patient is non-existent and the duration of consultation, of five minutes. It is low cost medicine. It is inadmissible to see cabins placed in improbable places such as shopping malls flourish.
All of this is misdirection. Health authorities recognize that it is the Wild West, but do not want to curb this movement because of the existence of medical deserts and pressure from mayors. But there is no reason that some French people only have access to digital medicine. Everything must be done to make liberal consultation attractive everywhere in order to improve facilities and attract doctors.
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