Telemedicine and the Brazilian reality

This article was exclusively written for The European Sting by Ms. Adriane Menezes de Medeiros is a 25-year-old student of medicine at the city of Blumenau, located in the state of Santa Catarina, Brazil. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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Never in the history of humanity have we been so connected as now. In medicine, it could not be different. The usage of modern information and communication technologies (ICTs) have brought significant changes to the addressing of health problems worldwide, such as replacing medical paper records with Electronic Health Records (EHRs), responsible for reducing healthcare costs in hospitals and for providing data to create an unprecedented storage information in cloud computing. This mechanism, viable only through the internet, uses hardware and software systems to provide new means to safeguard and access the patients’ information quickly and at lower costs¹. Based on the evolution of ICTs, the history of telemedicine begins circa 1960s, with the increment of communication tools, such as videotape recorder and television. Because of these, it became possible to stablish the beginning of non-physical interaction between specialists and patients, to provide material for later studies and prognoses for treatment². However, telemedicine goes beyond this. According to the World Health Organization (WHO), telemedicine can be defined as “the offering services related to health care, where the distance is a critical factor”³. This distance can be reduced by stablishing an interaction between health professional and patient with the use of several types of media, including text, audio, images and videocalls. Although the theory of telemedicine presents high expectations on success, it still encounters the barrier of approaching this reality in medical schools around the world, and it is not different in Brazil. A study shows that, among all the medical schools in Brazil, only 27,9% have potential to implement this approach. This data reveals some important problems faced by the government, due to its initiative of implementing the Brazilian National Telehealth Network Program (“Telessaúde Brasil Redes”; TBR), a program launched by the Brazilian Ministry of Health (MS) which aims to improve the quality of basic care services in the Unified Health System (SUS)⁴. Most of these problems relate to the preparation of the student as a future health professional. According to the Ethical Code for Medical Students⁵, the activities and subjects must be based on the ability to fully prepare the student to professional enrolment, which includes, for now, telemedicine. Enabling the student to approach the patient ethically is crucial, and an individualized, respectful medical appointment is vital. Besides that, most of Brazilian medical students are not prepared to deal with possible ethical pitfalls brought by telemedicine, brought by the new virtual relationship between professional and patient, the breaches of confidential information etc⁶. It takes time to identify and correct errors related to new medical procedures. It is still too soon to call it a success or a failure, and time will show the best option for the students and what needs to be adjusted according to the reality of each region. To sum up, even with the traditional health care system or the implementation of telemedicine, the patients’ well-being is the objective which physicians and students alike aim to achieve. References ¹ BANOVA, B. The Impact of Technology on Healthcare. American Institute of Medical Sciences & Education. Nova Jersey, 24 abr. 2018. Disponível em: https://www.aimseducation.edu/blog/the-impact-of-technology-on-healthcare/. Acesso em: 18 maio 2019. ² Benschoter RA, Eaton MT, Smith P. Use of videotape to provide individual instruction in techniques of psychotherapy. Academic Medicine, 1965, 40(12):1159–1161. ³ Steinman, M. et al. Impact of telemedicine in hospital culture and its consequences on quality of care and safety. Einstein. São Paulo. v. 13, n. 04. Oct./Dec. 2015. Disponível em: http://www.scielo.br/pdf/eins/v13n4/1679-4508-eins-S1679-45082015GS2893.pdf ⁴ Neto, E, et al, (2017) Telemedicine in Graduate Medical Education:  A vision of the Medical Courses in a Developing Country. J Int Soc Telemed Ehealth. 2017;5(GKR):e34.  Disponível em: https://journals.ukzn.ac.za/index.php/JISfTeH/article/view/267/pdf. Acesso em: 19 de maio 2019. ⁵ CONSELHO FEDERAL DE MEDICINA. Código de ética do estudante de medicina. Brasília: CFM, 2018. Disponível em: http://www.fm.usp.br/biblioteca/conteudo/biblioteca_1622_ceem.pdf. Acesso em: 19 maio 2019. ⁶ ETHICAL Practice in Telemedicine. American Medical Association. Disponível em: https://www.ama-assn.org/delivering-care/ethics/ethical-practice-telemedicine. Acesso em: 19 maio 2019. About the author Adriane Menezes de Medeiros is a 25-year-old student of medicine at the city of Blumenau, located in the state of Santa Catarina, Brazil. Living in Blumenau is her second experience living outside home, which is Campo Grande. Her first experience was in Canada, where she could take one year and a half of an exchanging program while coursing her previous undergraduation course, architecture. Although spending many years in the study of architecture, she has always been passionate about medicine, so she quit the course and started following her dream of becoming a regardful and great physician.