The advancement of remote service, in any service, is something irreversible in the world: from banking, education, retail and now in healthcare. This is digital transformation.
The physical and digital have never been so close, creating what we can call “phygital”. In medicine, it is no different. Telemedicine emerges to brilliantly and efficiently unite these two worlds. But how can this be done if there are still barriers to its full potential in the post-pandemic period?
With the definitive regulation of telehealth imminent, two central points are in question, raised by the Regional Medical Council (CRM).
Brazil, unlike what happens in the rest of the world, intends to maintain a limit on the first consultation and require that it be exclusively in person.
Countries in Europe, the United States, India, Canada, South Africa, Mexico and Argentina allow the first consultation to be carried out remotely. They set the limits in order to give the doctor and the patient the autonomy to decide whether that initial consultation can, in fact, be carried out remotely.
The NHS, the British healthcare system that served as an example for the creation of our SUS, advocates exactly the opposite and advises that the first consultation should preferably be digital.
This is because it recognizes that telemedicine has the property of placing the right patient in the right place, avoiding waste, improving the patient experience and accelerating diagnosis, making more assertive interventions in shorter times and avoiding delays.
Another point is the issue of territoriality, which has no legal support in the country.
What defines this aspect today from the point of view of medicine in Brazil is a law from 1957, which establishes that, when a doctor moves from one state and goes to another to provide care, he must inform the CRM that he is providing care in that state and the location.
However, considering that in telemedicine the professional remains at his/her address and receives the patient remotely, this does not change the fact that the service is provided in the location where the doctor's office is established.
Not surprisingly, Complementary Law 116/2003 determines that the place where remote services are provided is the place where the provider is located.
THE PATIENT AND THE DOCTOR DETERMINE
It turns out that, in my view, both questions make no sense at all. As a telehealth specialist, I affirm that it is not the first consultation, the follow-up consultation or any other consultation that should or should not be done via telemedicine.
The person who determines this is the patient, first and foremost, followed by the doctor, using the available technology and scientific knowledge.
Not to mention that telemedicine can be even broader and the platforms can be used not only during remote consultations but also in person, face to face with the patient. In this case, the doctor can contact a specialist, seek support for his/her clinical decision, etc.
It can bring people closer together and humanize them. Yes, that's right: it doesn't push them away or dehumanize them.
After all, what is more humane, treating a patient via telemedicine or forcing them to go in person and travel ten days to see a specialist? That is the time, for example, it takes for a person who lives in São Gabriel da Cachoeira to travel to Manaus to see a specialist, using a boat as a means of transport.
Furthermore, I have countless reports of people who have been waiting for three years for a neuropediatric appointment and today the waiting time for an appointment is three days. And telemedicine has changed this scenario.
This is just one example of the advantages. But it is a fact that if we limit medical practice in telemedicine by territory, we will keep different categories of citizens in our public health system, going against what everyone in this country wants to change. This is not equity and cannot be an egalitarian public policy.
Therefore, we cannot allow Brazil to continue to lag behind. Technological advances in telemedicine in our country have been stagnant for about 20 years, given that the last regulation was in 2002.
Until then, there was no clear determination of what could or could not be done, causing legal uncertainty. And, without legal certainty, there is no technological development or training of professionals.
We believe in comprehensive telehealth and its vital role in achieving our goals and ensuring dignified, quality, yet agile, efficient and rational care for all Brazilians.
It is up to each patient to decide whether or not to have remote care, and it is up to the doctor to assess whether or not the consultation carried out remotely using technology is appropriate.
It is this autonomy of choice that should guide the act of caring for people. We, as Brazilians, cannot allow this right to choose to be usurped from us.
We need to once and for all be clear about the idea that the future of medicine and telehealth are one and the same – after all, the world we live in today is already “phygital”.
The issue is not just about the future. If we maintain the restrictions, we will be condemned to live in the past, with no prospect of improvement for the current present.
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Gynecologist Eduardo Cordioli is the medical manager of Telemedicine at Hospital Israelita Albert Einstein and president of Saúde Digital Brasil (Brazilian Association of Telemedicine and Digital Health Companies), an entity whose goal is to expand patients' access to doctors through the use of technology.
