Teledentistry and Ethics of Public Health

1
Teledentistry and Ethics of Public Health

• Brian Dolan, PhD, Dept. of Anthropology, History
  and Social Medicine
• UCSF

2
I. Context for Research

• Disciplinary background History and Philosophy
  of Science Science and Technology Studies in
  Medicine
• Project Development and Impact of Medical
  Technologies
• Focus Impact on Clinical Skills and Decision
  Making
• Imaging technologies PACS

3
Telemedicine

• Telemedicine refers to integrated systems of
  health care that use telecommunications and
  information technology as a virtual proxy for
  contact between patients and providers
• tele technologies - telehealth, telecare ?
  teledentistry, telenursing, telepsychiatry, etc.

4
Brief historical background

• 1950s teleconsultations for the Papago Indians
  from a reservation in Arizona
• 1967 Dr.Kenneth Bird creates interactive
  television link between Bostons Logan Int.
  Airport and Mass Gen Hospital
• 1994 Teledentistry tried by US Army
• 1997 California Telemedicine and eHealth Center
  (CTEC)

5
Present Research Questions

• How does telemedicine challenge/change concepts
  of underserved populations?
• What are the ethics of using/relying on a
  particular communication system to open up
  access to health care?
• What concerns or problems cut across medical
  disciplines but are inherent to the medical
  technology common to them all?

6
II. The Uses of Telemedicine

• Professional Excitement
• Patient Comfort and Trust
• Resistance to the Use of the Technology

7

• A teledentistry system can allow dental
  professionals to share patient information.
  Radiographs, both periodontal and hard tissue
  charting, treatment notes, photographs and any
  other needed drawings or information can be
  transferred between multiple providers. When a
  dental hygienist has a patient who presents with
  a painful perioapical abscess, the dental
  hygienist could send a radiograph of the area, an
  intraoral photograph, all charting and health
  history information, and then consult with their
  dentist.
• Sanchez Dils, et al, Int J Dent Hygiene (2004)

8
(No Transcript)
9

• Teledentistry has the potential to expand the
  oral healthcare being provided. It can be
  utilized by any dental care professional who
  wishes to gain advice, improve diagnostic care or
  determine referrals. The prospects of
  teledentistry are enormous. It has the ability to
  alleviate many barriers that currently exist in
  access to oral healthcare.
• - Sanchez Dils, Int J Dent Hygiene (2004)

10

• Telehealth may thus be seen within a wider
  process of empowering citizens and workers,
  democratization of public institutions and making
  service delivery process more localized and more
  responsive to peoples needs. Thus telehealth
  can, at times, promote a view of communities and
  individuals as more active participants in the
  health process, not passive receivers of medical
  treatment, and be developed and used with the aim
  of limiting social exclusion. Dabrowska, 2002,
  p. 16

11
III. Telemedicine and the Patient Experience

• Technology dehumanizes the clinical encounter
• Telemedicine a lifestyle technology
• Telemedicine as territorial technology

12
What does history suggest will be the impact on
patient satisfaction as a result of diagnosis at
a distance?

• Medical technologies often unfamiliar and
  formidable to patients
• Trust in physicians dependent upon cultural
  attitudes about human skill and cognition
• Two different relationships doctor/patient and
  patient/computer

13
IV. Resistance to telemedicine

• Fear over the loss of business
• Expense of the system
• Fragmentation of professional identity
• Ethical issues
• Issues over jurisdiction, regulation, and
  licensing

14
V. Changing conceptions of regionalization in
medical care

• Not every patient considers computer use a
  lifestyle technology
• Communication systems that linked the metropolis
  to province, or capital or imperial territories,
  lent themselves to ideas of access, fairness, and
  governmental rationality does that mean the
  relationship is good?
• How can good clinical practice be calibrated
  across the whole telemedical divide?