The development of technology is not only helping medical imaging to evolve faster but also has an important impact on other aspects of patient care. There has been an ongoing problem of assisting patients in underserved areas. Not many physicians like to relocate to rural areas and the demand in those geographical locations continues to increase. Also, the same applies to serving third world countries. Big cities have been always attractive to physicians and scientists in general due in part to the convenience of accessing resources.

Telemedicine allows doctors to practice medicine at distance. By saying this, physicians can continue to live in urban locations and practice in rural areas using telemedicine. Technologies such as video conferencing and others, is making this possible. Of course, there are aspects of medicine that do not permit the practice at distance, but certain practices do so, such as- reading imaging scans or pathology slides; following up chronic patients, etc.

Adolfo Cotter, MD

Jul 02/2012

Neurology and Legal Medicine

I find this combination of specialties fascinating.

In my opinion, Neurology has been, and still is in large part a diagnostic specialty, whereas the main goal of medicine is to resolve patients clinical problems. Hopefully with more R&D, neurological treatment will become more useful. Unfortunately, up until now where the practice of Neurology has been used to affect clinical outcomes, practitioners and patients are often hampered by unacceptable medication adverse event profiles to achieve symptomatic relief, and outright cures are seldom achieved. This is why Pharmaceutical and Biotechnology R&D in this area is crucial and is thankfully now moving forward faster than ever before.

In the meantime, combining neurological knowledge and diagnosis with a discipline such as legal medicine for example would allow physicians in this field to be more useful to their patients. In this context, neurologists who otherwise are not surgeons would be able to diagnose illnesses and use their legal tools to help patients better. For example, what about using their expertise to help patients get insurance benefits or resolve medico-legal or medical malpractice issues? Ideally this could be combined with the practice of Neurology itself.

Adolfo Cotter, MD

Aug 03/2011

Analogy between the use of the Calculator and the Tablet sheds light on how we should train our new Physicians

It really wasn’t that long ago that engineers, scientists and other professionals needed to do complex calculations by hand or slide rule. Once the calculator and computer were invented this activity became obsolete almost overnight, in favour of machines that were much faster and more precise.

In my opinion, the same should apply to the access of up-to-date information on computers tablets and similar mobile devices. They are more efficient than just relying on our memory. By doing this, we not only have quick access to credible information but we also get up to date knowledge. I see this application particularly important in the practice of Medicine. Many of the top medical textbooks are becoming available on mobile devices. I think that even if we have a good personal knowledge of medical information, it is good practice to always access up to date and reliable data with this technology. This should improve the quality of patient care.

By saying this, the training of new physicians should emphasize deep understanding of the information and refining the medical judgment instead of just remembering the information.

Adolfo Cotter, MD

Oct 05/2012

The Instant Information Age should Transform the way we Learn and Educate

Today, very large amounts and varieties of data are instantly available to any budding scientist or clinician, more and more so even on mobile devices. While this can sometimes be overwhelming and as I mentioned in my previous blog, too much knowledge can be counterproductive for creativity, there is an upside to this “information overload” that represents an educational opportunity.

With so much data so readily available, the training of new professionals can now emphasize “understanding” the concepts and the inner structure of the field of study, learning how to look at the information critically, and learning how to think. Also, a very good knowledge on how to use the new technology is crucial.

While too much information bombarding our minds is not fertile ground for creativity, if we learn to use the technology properly, it allows our brains to be more creative and even more efficient. This could be a big step forward in how well we learn. I think our educational system should adapt to this new change.

Adolfo Cotter, MD

Aug 03/2011

The Number Mania

There are numbers used everywhere these days. Numbers are important, but they have their specific utility. Life is not all about numbers!! For example, clinical medicine has become a number game….but nothing can replace a true and good clinical judgment, a history well taken, and a thorough and detailed physical exam… Many doctors see patients in 5 min or less and don’t even know their names….Medicine is about patient care, we don’t see it often enough these days… 

 In relation to Brain Imaging, numbers are very important, even more important than in clinical practice, but we have to step back and allow our intelligence and creativity to work as well and not only become machine operators…..

 We as humans tend to go to extremes. Numbers have become better used in research and medicine but I think we are now going to the other extreme and looking everything from a number perspective, which can be very dangerous.

Adolfo Cotter, MD

Dec 24/2010 

About Publishing and Publishers

In general, I find publishers quite annoying. How can somebody freely express their ideas, if publishers impose so many rules regarding the number of words, number of pages, style, content, etc….? The rigid structure only inhibits creativity. Also, a lot of politics is involved in order to publish with many of the publishers.

As I have been saying on previous blogs, creativity loves flexibility. We certainly do not see flexibility in our current peer-reviewed publications. However, the good news is that we are seeing an explosion of new forums for publishing such blogs, social media etc. I applaud this change. The next step is to allow a filter to be in place for scientific literature so that we can read quality publications. New ventures such as one I recently joined, called Vengeo, look very promising. 

Adolfo Cotter, MD

Sep 03/2010

Era of Addictions

Marketing is a business tool to excite people and make them enthusiastic to buy. If the product or service we are selling is worthwhile for society and for people in general, marketing is a blessing. On the other hand, if what we are selling is of low quality, or harmful in some way to us, then marketing is a lie. We are addicted to being entertained and informed by advertising regardless of product virtue.

On top of this, it is alarming to many people including myself, that many businesses currently also use techniques and methods to make people physically addicted to what they are selling in order to continuously keep making money! It is clear to me that those businesses want to keep making money even if they know they may be hurting people’s physical and mental health. To me this amounts to a huge criminal activity. There is currently no law to stop businesses from doing this. For example, cigarettes, alcohol, even food are making many people sick and killing a huge number of them as well.

Currently there is also an epidemic of using narcotics even when they are not clinically indicated, and a big number of medical doctors just prescribe them, or even make a business out of it and many patients sell those narcotics to help them pay their bills.

In what I call the Era of Addictions addictive behaviour is not limited to clearly addictive substances like narcotics, alcohol and cigarettes, but to our modern music, our modern movies, our modern way of seeing relationships and sex, recreational and sports activity our food addictions are all around us. We view our lives through lenses like if it feels good to do and go to the max.

This is very alarming to me since it could become a way of self destruction for our society and human nature at large. We need to put limits on personal gratification.

Adolfo Cotter, MD

May 24/2013

The True Cost of the Business Oriented Practice of Medicine

As North America continues a multi-year struggle with an extended economic downturn, and tight budgets have become the new normal, this is impacting the provision of healthcare as well. The resources to diagnose, treat and take care of patients are becoming scarce. In consequence, this is seen as a business opportunity by some, helping develop a relatively new field (at least in Canada), which is the business of medicine.

I understand the need for this new field in order to improve the well being of our patients, but what I am currently seeing is that this model is being abused in many occasions to increase the income of business people, irregardless of the outcome and the quality of patient care.

In other words many medical businesses are pushing hard to increase their profit by doing activities such as: reducing the time to evaluate a patient to a number that is irealistic and makes impossible to truly deal with sick human beings, pushing techniques or treatments that might be harmful to patients, etc.

What may pass for cost-effective methods in providing healthcare on paper, and in turn providing healthy profits, may in fact have a negative impact on patient care in the real world, especially when we consider long-term outcomes on an individual and societal basis.

Adolfo Cotter, MD

Oct 16/2013

Politics and the Economy are Interfering with Medical Teams’ Delivery of Patient Care

Despite some positive economic metrics as of late, most people feel we have all seen better times, and this impacts the decision-making of individual medical care providers as they try and balance economic pressures with quality patient care.

During economic downturns it is common to see an increase in mental problems such as anxiety, depression, drug addiction, insomnia, low morale etc. These conditions are present in both patient and the medical teams that serve them. Even in the past when our economy has been better, there has been a history of political conflicts and disagreements within the medical care team. In my opinion, those conflicts are significantly higher presently since our current life stressors have been significantly higher as well.

Also, the amount of paperwork the medical care team needs to compete has been increasing significantly over the last few decades. This is distracting the focus away from patient care and consuming a lot of energy and time.

On top of this, economic pressures have made many people increase their desire to make profit as their only or most important goal when practicing medicine. In the end, our ONLY goal as a medical team should obviously be patient care. Patients are humans with illnesses who are suffering. They also tell us confidential information and they put their lives on our hands. They also pay us significant amounts of money for our work. Some doctors even call them clients, which I also think is certainly not a good term. It is alarming and shocking to me to see that the goal of many health care workers has shifted so much from our one and real goal, which is to focus on the patient’s well being, ONLY.

In my day-to-day encounters, and in what I read, it is very clear to me that all of the above issues are having a significant negative impact on the quality of medical care and the patient outcomes today.

Adolfo Cotter, MD

Mar 30/2016

Telemedicine Usefulness and Risks Considered

Worldwide, the practice of telemedicine has been growing very fast over the last decade. As with other service delivery models, a number of market factors have converged to influence this rapid growth – aging demographics and a related increase in chronic illnesses, technological developments and the pressure to deliver more cost effective services, to name a few.

In April, I attended the American Telemedicine Association, 2017 2.0 Telehealth Conference in Orlando. The exposition hall was quite large and the event well-attended, which is one measure of how far the industry has come. In discussion with other professionals I met, I learned that compared to previous meetings, the attendance, including exhibitors has been growing rapidly.

Further to this anecdotal exchange, resource material from the American Telemedicine Association mentions that while US and global markets have seen rapid growth, the market size statistics for telemedicine shows variability depending on the source.

From my vantage point as a medical doctor practicing in this emerging field, I do believe that telemedicine can improve patient care, but there are also risks. In this time of rapid change and growth, telemedicine should not completely replace the face-to-face practice of medicine, but we must recognize it as a value driven approach, appropriate to augmenting or filling the gaps and deficiencies of our current health care system.

By way of example, balancing prudence with practicality, I remember a mother that called me because her two-year-old daughter had been having shortness of breath and she was by automatic inclination requesting a steroid. I strongly suggested to the mother that she first take her daughter to the nearest children’s hospital. On the other hand, I also do believe that once assessed properly, conditions such as acute pharyngitis can be treated safely over the phone.

A solution for reaching those remote

The application of technology can allow a medical team to access patients in remote areas, diminish congestion of ER and Urgent Care centres, with conditions such as flu, urinary tract infections and sinus infections for example. Also due to the lack of availability of certain specialties in remote hospitals, practitioners will be able to access patients with telemedicine services.

Of course, one of the challenges of doing telemedicine remotely is that the patients must have technology at their location such as a computer and internet connection if they prefer to do video conferencing or transmit data.

In some cases, patients do not get a refill on their medications due to provider negligence or abuse, or other reasons such as inefficiency of pharmacies or insurance claim problems. Telemedicine should be able to facilitate or better still, fix these type of problems. I have had frequent instances where I ordered a medication for a patient by calling the pharmacy but the pharmacy kept saying that they didn’t receive any order.

Many times the insurance provider decided not to cover certain medical services or treatments. I have been continuously receiving increased notices from insurance companies that they will refuse to pay for certain medications

Cost effective, but not put patients at risk

As mentioned earlier, one key advantage of telemedicine is cost savings. Actually, some insurance companies will only cover patients for telemedicine services. In my experience, from practicing telemedicine in the USA, from a cost effective point of view, it is not always necessary to examine patients in order to diagnose or treat some conditions, such as acute otitis media or acute pharyngitis.

On top of this, with the use of technology, we should be able very soon to get signs of symptoms from a patient, which are the findings we get by doing the physical exam, in a way that could be more accurate and economical than with the traditional physical exam. This data could be quickly transmitted to a provider through a secured network, without the need for the doctor to be in person with the patient.

Yet there is high potential for abuse by using this service. Until we are certain that it is thoroughly safe to practice telemedicine, we should use a conservative approach, and only use this service for conditions where we do not put patients at risk. I think the biggest risk in using telemedicine is to assume that this new and rapidly emerging service works efficiently where we still do not have enough evidence for the conditions as presented by the patient.

Adolfo Cotter, MD