Last year I attended the sixth annual meeting of the Australasian TeleHealth Society, in Brisbane. The two-day event was titled Successes and Failures in Telehealth and provided a fantastic format to hear and learn from others who’ve forged a path (or attempted to) to better utilising the gift of modern technology in health practices.

It was exciting to find that the general consensus is that the evolution of telehealth has shifted the focus from determining whether to embed it in usual practice at all, but rather ‘how’.  

Is Telehealth too impersonal?

A common criticism of telehealth (or ‘digital health’) that crops up time and again is that it’s impersonal. But good service, of any kind, is often dependent on the people administering it. We’ve all seen or experienced it before; face to face service can be just as impersonal as it’s been implied telehealth could be.

At the SFT conference, a former nurse told me that over the course of her career she’s had to remind colleagues time and again not to refer to patients as Bed ‘X’ or Condition ‘Y or simply “dearie”. To her, this inability to refer to patients as people is symptomatic of an insidious problem. She’d witnessed graduates fresh out of school enter a hospital full of compassion and optimism only to become disillusioned when they see how things operate at ground level.

Dr Michael Wynne is the resident medical expert for Aged Care Crisis, an independent advocacy agency for those in aged care. He kindly agreed to share his view of telehealth and his insight into the way the healthcare system operates, and the issues that make good face to face care difficult.

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Although I have no direct experience of telehealth and lost touch with developments some years ago, I don’t see why it should in itself be impersonal. But if the consultant at the other end is paternalistic or does not relate well, then telehealth would accentuate this. As in any consultation, there are skills to be learned, and not everyone will be good at it.

Telehealth interests me because of my long interest in computer assisted inquiry learning where a similar impersonal criticism can be made.  I used to argue that it needed to be part of and related to interactive teaching and learning with tutors.  It should not be used instead of human contact, but to augment and expand on it. This would apply equally to telehealth.

We can ask ourselves whether people find exploring the world wide web to find answers to their interests and questions boring and impersonal.  Generally this is experienced as a “constructive framework” which they find stimulating. I would contrast that with the tedious impersonal and structured question and answer format of the 1960s when programmed and computer based learning became the province of the behaviourist educators.  This was a “responsive framework” which turned people off.  

As regards to professional impersonality, I think this is a cultural phenomenon that starts with role models very early in life when children first attend a doctor. It is often perpetuated during medical school years and sometimes by some consultants in hospitals.  It was always interesting to take a group of medical students visiting the hospital for the first time, introduce them to a selected patient, and ask one or two of  them to take a history.  Invariably, they would pull themselves erect and adopt the sort of professional expression they had in their minds, withdraw from close interaction and start formally asking questions. They were acting out their idea of what they perceived as professional behaviour.  

I tried to counter this by then getting them to bring chairs around the bed and we would then chat and joke with the patient, moving gradually to the patient’s history, asking about the illness, so that the history emerged spontaneously in a rather different way.  I like to think that that was useful, as we could then all chat to the patient about this tendency of doctors to be impersonally professional rather than personal and friendly but professional in conduct.

[Impersonality] is also perpetuated or inculcated in hospitals by a managerial approach absorbed at meetings – people start talking about Bed X or Condition Y.  Hospitals are no different to other places where labels are used in similar ways.  We often handle situations by generalising the particular, rather than addressing it directly.

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Telehealth and hearing aids

In health care in particular, it’s important to foster a system and an environment that enables humane and patient-centric care. Systems should leave both patients and care administrators empowered, dignity always in tact.

My company operates partly on a telehealth model (we call it ‘teleaudiology’) that saves users thousands of dollars with centralised expert audiology and technical support. It allows us to assist users all over Australia, and indeed the world, from wherever they have a phone or internet connection.

My friendly, highly trained and knowledgeable support team (comprising hearing experts and technicians) provide users with unlimited internet and telecommunications based assistance, assessment and rehabilitation. They can view a user’s adjustment settings and they will contact them if they observe setting changes that suggest an underlying or serious medical condition. We advise all new and potential clients to seek a doctor or hearing professional to determine the cause of their hearing loss, rather than simply masking it with a hearing aid.

Time and again we receive lovely letters from clients who are blown away by the caring, passionate telehealth support team and system that I’m proud to have put together.