“Telemedicine is good, but doctor-patient relationship is something else”

Not only telemedicine, but also electronic health records, medical apps, the management of big data, up to the so-called “digital therapies”, the last frontier of medicine. These are the themes at the center of the webinar entitled: “Digital Health. Innovation in the treatment of chronic autoimmune rheumatological and dermatological diseases “, promoted by Ucb Italia, which saw the participation, among others, of Emanuela Omodeo Salè, scientific director of Sifo (Italian Society of Hospital Pharmacy), Andrea Conti, representative of the Board of SIDeMaST (Italian Society of Medical, Surgical, Aesthetic Dermatology and Sexually Transmitted Diseases), Francesco Cusano, president of Adoi (Association of Italian Hospital Dermatologists), and Roberto Gerli, president of Sir (Italian Society of Rheumatology).

“Dermatology – says Francesco Cusano, president of Adoi – by its intrinsic nature offers a starting point of great interest in the field of telemedicine and computerized systems. However, the apparent ease of access to this system is a double-edged sword. It is necessary to develop services that allow these technologies to be used in most dermatological situations, but the doctor’s skills are needed to recognize the particular stages of the various pathologies. It goes well in already known patients with pathology already under control and in specific, well-coded conditions. But we must always remember that the doctor-patient relationship is very important. We are dealing with a person in his complexity, not images, not a diagnostic quiz. This tool is useful but I don’t think we can replace the doctor-patient relationship in the first visit with telemedicine “.

The role of digital medicine is different “in the field of rheumatological diseases – affirms Roberto Gerli, president of SIR -. Because the rheumatologist is an internist and it could be more complicated. Systemic immune diseases have a general interest and the need for a face-to-face visit. Therefore telemedicine can be useful in monitoring these patients. We need to differentiate teleconsultation: we continually need to have relationships with other specialists within the hospital and with primary care. Unfortunately, we are a federated nation from a health point of view. I had to deal with various regional health departments and in this way I became aware of completely different realities for telemedicine “.

“As Sir – he continues – we were the first to propose a telemedicine platform in the field of rheumatological diseases with all the Italian centers that want to use it. Emilia-Romagna, on the other hand, has a regional platform that does not provides indications for specialist pathologies. This is one of the many problems to be solved. When we talk about interoperability we talk about this. It is clear that the platform that I create as a rheumatologist is aimed at our pathologies, our interests. The one that can interest to the cardiologist and the endocrinologist can be differentiated. This must be considered together with the problems of the literacy of doctor and patient. There are hospitals that still work with paper files “.

For Andrea Conti, representative of the SIDeMaST Board of Directors “in dermatology, digitized images can be evaluated remotely, also for a comparison between specialists – he explains -. During the pandemic we needed to monitor our patients in chronic treatment for psoriasis and atopic dermatitis or other topical rare diseases. In particular in Emilia-Romagna where I work, platforms have been activated that allow video consultation or teleconsultation to monitor chronic patients. A report is still carried out and we send it via email to the patient and the attending physician, a way that has allowed us to avoid access to the hospital at the peak of the pandemic by maintaining constant therapy and therefore adherence to treatment “.

With the pandemic, continues Conti, “telemedicine has guaranteed contact with the patient and the continuation of therapies. As SIDeMast we have seen that the percentage of those who abandoned care during the initial phase of the health emergency was very low. However, I remain convinced that the first visit cannot be made with this instrument “.

The pandemic has also been a test case for hospital pharmacists. “The doctor-patient relationship cannot be replaced – explains Emanuela Omodeo Salè, scientific manager of SIFO – but technologies can help us and the hospital pharmacist can act as a link with the local colleague with whom the patient interfaces. The pandemic for hospital pharmacists was important. We have lived the experience of home delivery achieved also thanks to the collaboration with companies but it must be said that home delivery is not just the delivery of a box of medicines “. According to Omodeo Salè “in the course of treatment, the tele-pharmacy for pharmacists should also be recognized. We are not luxury warehouse workers, we have an important role in patient management “.

For Gerli, despite the many critical issues, “we are moving towards a digitalization and IT system that will change our lives. It is true – concluded the president of SIR – we are still in a primordial phase but I am convinced that within 3-5 years the management of medicine will change as it happened in the 1980s. Undoubtedly, digitization is a transformation that proceeds with exponential steps and therefore we must continually update ourselves not only from the pharmacological point of view. The important thing is the digital education of the citizen and of the doctor himself “.


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