plospmedplmePLoS MedplosmedPLoS Medicine1549-12771549-1676 Public Library of Science San Francisco, USA 10.1371/journal.pmed.003036706-PLME-C-0501 Correspondence Critical Care and Emergency Medicine Non-Clinical Medicine/Health Policy Radiology and Medical Imaging Non-Clinical Medicine/Medical Informatics Public Health and Epidemiology Health Services Administration/Management Medical Imaging Medical Informatics Medicine in Developing Countries Radiological diagnosis Telemedicine Complements Effective Health-Care Delivery but Is Not a PanaceaCorrespondence Sarin Rajiv ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai, India rsarin@actrec.res.in

The author has declared that no competing interests exist.

 8 2006 29 8 2006 38e3672006Rajiv SarinThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Telemedicine in Rural India The author received no specific funding for this article. citation Sarin R (2006) Telemedicine complements effective health-care delivery but is not a panacea. PLoS Med 3(8): e367. DOI: 10.1371/journal.pmed.0030367 <p>Like most health researchers in India, I share Sanjit Bagchi's enthusiasm and optimism about the potential of telemedicine in improving health-care delivery in our diverse country [<xref ref-type="bibr" rid="pmed-0030367-b001">1</xref>]. However, it is important to maintain a balanced perspective and debunk overstatements such as those used by Bagchi in his conclusion “This potential was well summed up by Dr. Devi Shetty: ‘In terms of disease management, there is [a] 99% possibility that the person who is unwell does not require [an] operation. If you don't operate you don't need to touch the patient. And if you don't need to touch the patient, you don't need to be there. You can be anywhere, since the decision on healthcare management is based on history and interpretation of images and chemistry … so technically speaking, 99% of health-care problems can be managed by the doctors staying at a remote place—linked by telemedicine.’”</p> <p>Maybe Devi Shetty, well known in telemedicine circles, has been quoted out of context, but it is not evident as such. In the wider context of the story, such conclusions as “If you don't operate you don't need to touch the patient”; “And if you don't need to touch the patient, you don't need to be there”; and “so technically speaking, 99% of health-care problems can be managed by the doctors staying at a remote place” are misleading. In the near future, online physicians or health professionals cannot replace the onsite ones for even 30% of all health problems, let alone 99% as pointed out by Shetty. Even for providing essential and readily accessible health services, we need to augment the number of onsite physicians and other health professionals with improved skill-mix, more pragmatic public health policies, and enabling of telemedicine. Though India has been a pioneer in evaluating telemedicine for improving health-care delivery [<xref ref-type="bibr" rid="pmed-0030367-b002">2</xref>,<xref ref-type="bibr" rid="pmed-0030367-b003">3</xref>], its rightful place can be established only through major coordinated research efforts [<xref ref-type="bibr" rid="pmed-0030367-b004">4</xref>].</p> <p>Free-access medical journals are a forum for debate on emerging health issues and have the responsibility to implement rigorous peer review and editorial control to prevent wide dissemination of any misleading statements or misquotes, as the case may be. Sweeping concluding statements from opinion leaders appearing in respectable journals may unduly influence those lacking insight in the challenges of health-care delivery in underserved regions and allow further propagation by medical journalists living in virtual reality.</p> <p>To realize its full potential, we need to identify more innovative applications of telemedicine and generate robust data on its cost-effectiveness in different health-care settings [<xref ref-type="bibr" rid="pmed-0030367-b004">4</xref>]. But first we need changes in skill-mix [<xref ref-type="bibr" rid="pmed-0030367-b005">5</xref>], which includes enhancement of skills among various staff groups, role substitution between different groups, delegation up and down a uni-disciplinary ladder, and innovation in roles. Until we have telemedicine models that are universally implementable, with proven cost-effectiveness and user satisfaction [<xref ref-type="bibr" rid="pmed-0030367-b006">6</xref>], we need a stance of cautious optimism.</p> </sec> </body> <back> <ref-list> <title>References BagchiS 2006 Telemedicine in rural India. Plos Med 3 e82 DOI: 10.1371/journal.pmed.0030082 KapoorLMishraSKSinghK 2005 Telemedicine: Experience at SGPGIMS, Lucknow. J Postgrad Med 51 312 315 DesaiSPatilRChinoyRKothariAGhoshTK et al 2004 Experience with telepathology at a tertiary cancer centre and a rural cancer hospital. Natl Med J India 17 17 19 WallacePHainesAHarrisonRBarberJAThompsonS et al 2002 Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations. BMC Fam Pract 3 1 BuchanJCalmanL 2005 Skill-mix and policy change in the health workforce: Nurses in advanced roles. Organisation for Economic Co-operation and Development. Available: http://www.oecd.org/dataoecd/30/28/33857785.pdf. Accessed 12 July 2006 WilliamsTLMayCREsmailA 2001 Limitations of patient satisfaction studies in telehealthcare: A systematic review of the literature. Telemed J E Health 7 293 316