RIO DE JANEIRO, BRAZIL – The statement may seem too optimistic given the tragedy of the novel coronavirus pandemic, but there is an undoubtedly positive outcome from a medical standpoint. In addition to studies on antiviral drugs and the development of vaccines in record time, health reinvented itself in 2020 in its most basic aspect: that of contact between doctors and patients, this time through distance care.
The interaction between the two parties through smartphones, tablets and computers had always been taboo – but the taboo has been overcome. Until now, virtual relationships could not be made directly – only with the intermediation of a specialist. In other words: professionals in white met with professionals in white in the world of videos, but the sick were kept away from such an option; they could only see and be seen in person. This has changed. The approval to communicate without a mediator was officially granted in March this year by Brazil’s Ministry of Health.
The measure triggered an inevitable and revolutionary trend: since then, according to data from Startup Conexa Saúde, 1.3 million virtual consultations have been conducted in the most diverse fields – and in 80 percent of cases there was no need for live supplements. In the past, this resource was virtually non-existent, and at best hesitant.
Telemedicine imposed itself, as one of the aspects of the world that is being inaugurated. Telos, in Greek, root of the expression telemedicine, means distance. In the practice of pragmatic medicine in the United States, for instance, this distance has never been a hindrance – virtual consultation has long been established among Americans.
A breakthrough in that country occurred in 1967, when the Massachusetts General Hospital was linked to the Boston City Airport, with the purpose of attending any emergency that occurred between boarding and landing. In Brazil, where eye-to-eye has always been valued, particularly because social impositions have always favored outpatient medicine, there is resistance; but it is starting to be overcome, although it is just beginning.
Telemedicine was regulated in 2019. There was so much controversy, so much ado, that the Federal Council of Medicine (CFM) retreated and revoked the measure two weeks after it was announced. The spread of the virus seems to have inevitably changed the course of the practice. On Wednesday, September 30th, VEJA magazine observed a telemedicine procedure that combined science and affection in an exceptional way, conducted by the Sabará Children’s Hospital in São Paulo: the consultation of Lorenzo, one year old, suffering from a malformation in the intestine.
It was the first hospital evaluation after the operation and a period of hospitalization recently completed. The delicate consultation was accompanied by the infant’s doctors, online from Rio de Janeiro. Sidney Klajner, president of Albert Einstein, says: “There is no way to disagree with the obvious fact: increasing medical access is a form of absolute humanism.”
Incidentally, the Einstein Hospital in São Paulo, an institution that has used the resource since 2012 on an experimental basis, is an illustration of what is to come. Around R$25 million was invested in equipment and programs that provide security and ease of connection. Among the most outstanding equipment, there is a cell phone-controlled robot whose mission is to visit patients in ICU rooms. At the top of the machine, a screen displays the face of the doctor, who may be thousands of kilometers away.
In the Dr. Consulta conglomerate, a group of 45 private clinics focused on patients from social classes C and D, telemedicine has grown to the point of producing a booklet of good practices for professionals, with basic but extremely important guidelines, such as caring for the workplace (it must always be clear and organized), performing internet connection tests before appointments so that the service will not be disrupted unexpectedly in front of the patient, and to be on time.
The expansion of online consultations is now starting to transcend issues related to the pandemic. In the Prevent Senior network in São Paulo, which serves only elderly patients (and, in theory, those who should most resort to problems associated with Covid-19), the infection-related complications no longer reach 15 percent. The group has created a 350-square-meter room for doctors to virtually attend the most diverse specialties.
The group’s medical director Pedro Batista Junior says: “The agility provided by the digital tools is impressive, patients feel more comfortable and seek medical attention more quickly.” In England, a country with a tradition in telemedicine, the impact has already been proven in numbers. There, the speed of distance care services for the elderly with chronic diseases has reduced emergency visits by 15 percent and hospitalizations by 20 percent.
However, there is one great obstacle to be overcome in Brazil, a practical one: the lack of digital access in the country. According to the last census of the survey conducted by the Brazilian Institute of Geography and Statistics (IBGE), one in every five Brazilian households is not connected to the Internet. In rural areas, nearly half of homes are offline. How to establish telemedicine broadly in the North region, for instance, if only 70 percent of people are connected to the Internet?
“Offering access to those in areas where there is no infrastructure is crucial. These regions should be the most benefited”, says Donizetti Giamberardino Filho, CFM vice-president. Offering access implies what Albert Einstein and the Ministries of Defense and Health did together in July. They implemented virtual assistance to patients from a remote area, where indigenous communities live in the territory of the Upper Rio Negro, in Amazonas.
The project, which provided pediatric neurology, psychiatry, gynecology, cardiology, and rheumatology services to 44 residents, was an experiment to determine if it would be possible to use satellite internet for remote consultations in the area, surrounded by the Amazon rainforest. It worked, but required increased effort. There are obstacles, no doubt, but it would appear that extraordinary examples of telemedicine will be seen in the very near future.
Hippocrates (460 B.C.-375 B.C.), the father of medicine, perceived the need to detail the illnesses of those who sought him in order to reach a diagnosis, with thorough conversations and clinical examinations. This will continue – what changes, for the first time in history, and perhaps definitely, are the instruments used.
Source: Veja