Centre Hôspitalier de St Denis, SMUR, Saint Denis, France.
Hôpital privé du Vert Galant, Urgences, Tremblay en France, France.
Int J Med Inform. 2022 Jan;157:104573. doi: 10.1016/j.ijmedinf.2021.104573. Epub 2021 Sep 17.
Telemedicine and videoconferencing distance examination are new and growing swiftly. Distance alters the patient-physician diagnostic context interfering with the traditional methods used to collect and interpret medical signs, introducing new constraints and opportunities. This study is an early contribution to the exploration of the changes in medical semiotics introduced by telemedicine.
The main objective is to characterize the impact of telemedicine on medical semiotics and to analyze its consequences on distance medical examination.
On empirical bases, an inductive reasoning was built on the observation of telemedical practice and personal experience analysis and supported by the research of existing models and literature.
The impossibility to touch the patient is the main constraint of telemedicine. While history taking and listening to the patient's symptoms depend on videoconferencing technology, for physical inspection, two main options exist: a helper-mediated physician-patient interaction and a direct physician-patient interaction without third-party intervention. In the latter case, the physician has to rely either on devices and-or on the patient becoming the physician's hands. This enhances the physician-patient partnership in the diagnostic process increasing the role of communication and means that the diagnostic tests usually performed by the physician need to be transformed to allow self-execution. Paradoxically, modern distance examination imposes a return to classical semiotics and puts the patient at the very core of the examination process through his/her active participation. The live use of connected medical devices and the direct access to computer facilities offer new opportunities for improved signs gathering and synchronous medical collaboration.
We define telesemiotics, a special branch of medical semiotics mostly centered on self-performed physical examination, improved physician-patient communication and the use of computer facilities, that needs to become an integral part of medical training. It is hypothesized that the multiplication of empowered patients, actors of their own health, physically and intellectually participating in the diagnostic process, may lead to deep positive public health and societal repercussions.
远程医疗和视频会议距离检查是新的且快速发展的。距离改变了医患诊断环境，干扰了用于收集和解释医学迹象的传统方法，引入了新的限制和机会。本研究是对远程医疗引入的医学符号学变化进行探索的早期贡献。
主要目的是描述远程医疗对医学符号学的影响，并分析其对远程医疗检查的后果。
基于经验基础，通过对远程医疗实践的观察和个人经验分析进行归纳推理，并通过对现有模型和文献的研究提供支持。
无法接触患者是远程医疗的主要限制。虽然病史采集和听取患者症状依赖于视频会议技术，但对于身体检查，有两种主要选择：有帮助者介导的医患互动和无第三方干预的直接医患互动。在后一种情况下，医生必须依赖设备和/或患者成为医生的手。这增强了医患在诊断过程中的伙伴关系，增加了沟通的作用，这意味着医生通常执行的诊断测试需要转变，以允许自我执行。具有讽刺意味的是，现代远程检查通过患者的积极参与，强制回归到经典符号学，并将患者置于检查过程的核心。连接医疗设备的实时使用和对计算机设施的直接访问为改善迹象收集和同步医疗协作提供了新的机会。
我们定义了远程符号学，这是医学符号学的一个特殊分支，主要集中在自我执行的身体检查、改善医患沟通和使用计算机设施上，需要成为医学培训的一个组成部分。假设，具有更多权力的患者数量增加，他们作为自己健康的参与者，在身体和智力上参与诊断过程，可能会对公共卫生和社会产生深远的积极影响。
