An interview with Angelika Walliser, general practitioner, surgeon, and head of Reutlingen Emergency Room
Have you ever consulted a doctor as a telemedicine patient? Or do you have your doubts about telemedicine? Do you see telemedicine as a good way to provide medical services in rural areas and deal with doctor shortages, or do you feel strongly that doctors and patients should meet personally to provide proper treatment? TRANSFER magazine talked to Angelika Walliser, who runs her own doctor’s office in a rural area, about telemedicine, the new options it opens up to us, but also people’s reservations. Since last year, Walliser has been taking part in the docdirekt pilot project in Baden-Wuerttemberg. She talked about her experiences with the project during the second #techourfuture event.
Hello Ms. Walliser. Why do you believe it is important to inform society about future technologies?
It’s tremendously important. Progress can be unbelievably quick sometimes and overtake us on the outside rail. Patients have to find things out for themselves if they want to stay up to date. That’s not something we can help with as doctors during consultations. So it’s really important that patients get to know modern technology and start using it. For example, we’re already seeing what’s becoming possible during video consultations or over the phone when it’s not possible to reach a doctor or receive medical care immediately.
What prejudices do you hear about new technology in the course of your work?
I’ve been taking part in the Baden-Wuerttemberg telemedicine pilot project – docdirekt – for one year now. In conurbations, it’s often difficult to quickly find an appointment with a doctor, and in rural areas you have to travel long distances. It can be quite worrying for patients. Is my complaint urgent, or can it wait? Should I go to the hospital right now, visit a doctor’s office as soon as possible, or should I wait? Understanding such questions and weighing up the situation can be extremely difficult for patients. Using telemedicine is a pretty good way to assess such issues. The patients that have already used the docdirekt service have given us positive feedback. But of course it will still take a year or two to see how the patients who used the telemedicine service did afterwards. One issue that will need clarifying is how many patients actually went to see a doctor afterwards. Another is who has access to certain information and were there any problems with data privacy. That said, this is a data protection issue they have in all medical practices.
Of course people have reservations, but that’s what happens when something new comes along. People are used to holding on to things they trust. The reservations I hear people express in the course of my work as a telemedicine provider are often quite straightforward. You just have to tune in carefully to patients and examine them properly to understand how to help them on the phone or via video. Of course sometimes people have an illness or symptoms that you can’t simply clarify through a video call, for example something like chest pains. You need a stethoscope and usually lab backup and an ECG. But in lots of cases treatment via video call works quite well, for example if someone needs to treat a wound or they have a cough or cold. The way the consultation or treatment works is that the patient describes his or her symptoms on the phone and if necessary makes sure they have a picture or video. But of course it’s also important to ask the right questions. With docdirekt, the first questions are posed by medical specialists who work for the association of statutory health insurance physicians, and it’s they who decide whether to call a paramedic or whether a patient should be taken straight to the hospital. Of course people have reservations that the patient might be misunderstood during a telemedicine consultation, but that can also happen in the doctor’s office. In my experience, telemedicine sessions typically take longer than they would face to face. One thing I noticed during the coronavirus pandemic is that patients have taken well to the service. They’ve realized that there are lots of things that can be done over the phone. The current pandemic has played an important role in getting patients to accept new technological possibilities open to us.
Are there any other technological developments you could imagine making their way into the everyday business of doctors?
Lots of patients measure their oxygen levels, temperature, or blood pressure themselves. It would be useful if this information could be sent automatically to their doctors. Especially now with a pandemic going on, it would have been important to keep an eye on their measurements and raise the alarm if something doesn’t look right. Or doctors could ring patients if they see that their measurements are beginning to worsen, because often patients don’t notice that themselves. That would really lighten the load on doctors.
Which new technologies in the field of health and medicine would you use yourself?
I’m fundamentally open to new developments. I like finding out more about them and then I decide if I’m either for or against them. But of course patients also have their doubts about certain things and they’re worried they’ll only be treated remotely, but I’m convinced telemedicine won’t be a substitute for visiting the doctor, it’ll complement it. I already have patients in my medical practice that I speak to on the phone. So there’s not actually anything new about the idea. The only thing that’s really new about docdirekt is that we treat patients we don’t know, whereas when you’re running your own practice, you’re on the phone to your own patients. With your own patients, you know their medical history, whereas with docdirekt patients you don’t have that previous knowledge. That’s new.
One thing that’s also really exciting is remote medical emergencies. The telemedical emergency doctor helps the paramedic remotely. This is really important because there aren’t that many emergency doctors anymore. Data is transmitted to the control center at the Red Cross, for example ECG readings, and then the emergency doctor decides there and then which drugs should be administered and what the paramedic should do next.