Telemedicine and rural care

Telemedicine can be a marvellous bridge between rural hospitals and tertiary centres, but the spectacular case recounted by Bruce Campana and colleagues¹ may not illustrate this point well. Telemedicine works best when it does not degrade local care. The article seems to imply that the rural hospitals involved would deny patients proper care without the video presence of an urban specialist. This implication insults the staff of rural hospitals without access to telemedicine, who competently handle a variety of serious conditions with outcomes equal to or better than those achieved by their tertiary care counterparts.

Drilling a burr hole, although a rare procedure, is not a skill requiring advanced neurosurgical expertise. Rural doctors have sometimes had to do craniotomies themselves, the skill being swiftly acquired.² Perhaps the local hospital described by Campana and colleagues lacked training and equipment, given that many rural facilities are becoming triage centres that also offer geriatric and palliative care. More likely, however, the telemedicine — while providing a measure of reassurance for what is probably a superb rural hospital — reinforced the authors' notion that burr holes, trauma or any advanced care cannot be handled competently without an urban specialist.

No one knows the financial cost of making telemedicine widely available in rural Canada, but enhancing local skills and equipment (through provision of CT scanners and operating rooms along with well-trained generalists) could probably be achieved at a fraction of that expense. The latter option would improve morale and outcomes more than images on a video screen. Telemedicine could then be used in a more selective, effective manner than the authors' “protean” hopes.

Keith MacLellan Rural physician Shawville, Que.