A proposal was published in a recent edition of JAMA for the creation of a specialty of medicine, the “Medical Virtualist (MV).” The MV would be a physician who spends the majority or entirety of his/her time providing care via telemedicine, utilizing technology and implementing telehealth guidelines via online care.
This proposal is puzzling on a number of fronts:
- Other than a means of further complicating the world of medical terminology (yet another specialty whose function is unknown to patients), what further utility is there to adding another medical specialty? What specialty knowledge do these physicians possess?
- Medical specialties tend to fall into two categories: 1) Those who maintain a specific corpus of KNOWLEDGE relating to a population (i.e. pediatrics) or disease process (pulmonary hypertension, organ transplant) OR 2) Those who possess certain technical abilities unavailable to others in their field (interventional cardiology, PICC teams), or, often times, both. The MV possesses neither.
More importantly, it speaks to a different understanding of the role of telemedicine and medical technology in the arena of medical care. Many see telemedicine and new medical technologies as an entity distinct from clinical medicine, a distinct being that must somehow be incorporated into patient care, but only as the “other” – external, outside, foreign. Nothing could be further from the truth. Medical technology and telemedicine must be considered an important MEDIUM for improving (perfecting?) our clinical patient care. Just as there is no such thing as a specialist in “telephone medicine” or “EMR communication,” there should be no conception that a specialty must arise that functions exclusively through a more modern means of communication and interaction with patients, the MV. Quite the opposite – ALL physicians should become experts at 21st century patient interactions, should incorporate technology and telemedicine into their current clinical practice, and should use those crucial tools to herald an improvement in the way we care for our patients. By doing so we can make the proposal for another medical specialty whose sole expertise is utilizing technology as obsolete as logic would indicate, and sound the death knell of the MV.