With telemedicine as bridge, no hospital is an island

When Sarah Cohen's acne drove her to visit a dermatologist in July, that's what she figured she'd be doing—visiting a dermatologist. But at the hospital on Nantucket, where her family spends summers, Cohen, 19, was perplexed.

"I thought I was going to see a regular doctor," she said, but instead she saw "this giant screen."

Suddenly, two doctors appeared on the video screen: dermatologists in Boston. A nurse in the room with Cohen held a magnifying camera to her face, and suggested she close her eyes.

Why? she wondered—then understood. The camera transmitted images of her face on screen, so the doctors could eyeball every bump and crater. "Oh my God, I thought I was going to cry," Cohen recalled. "Even if you've never seen that pimple before, it's there."

That, she realised, was the point. Technology, like these cameras and screens, is making it affordable and effective for doctors to examine patients without actually being there.

More hospitals and medical practices are adopting these techniques, finding they save money and for some patients work as well as flesh-and-blood visits.

"There has been a shift in the belief that telemedicine can only be used for rural areas to a belief that it can be used anywhere," said Dr. Peter Yellowlees, director of the health informatics program at the University of California, Davis, and a board member of the American Telemedicine Association. "Before, you had to make do with poor quality, or buy a very expensive system. Now, you can buy a $100 webcam and do high-quality videoconferencing."

The technology is especially being embraced in professions like ophthalmology, psychiatry and dermatology, which face shortages of physicians. At Kaiser Permanente, dermatologists "sit in a suite in San Francisco" and tele-treat patients throughout Northern California, Yellowlees said. "It's much more efficient than having 20 hospitals, each with a dermatologist."

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