The film “Up in the Air” is — ostensibly — all about George Clooney. Ryan Bingham (George Clooney) travels across the country 300+ days of the year and fires people for a living… Because bosses get scared and emotional ex-employees tend toward regrettable actions.

But “Natalie Keener” (Anna Kendrick) truly steals the show.

Natalie is the young hotshot character. She’s convinced Ryan’s boss to replace the guys’ jet-setting ways with New Technology: firing people over the computer screen. She’s going to make Ryan irrelevant, and the firees along with him.

Now replace “firing people” with “seeing patients”. Does the funny feeling grow?

This is the major reason “telemedicine” sets off alarm bells left and right.

We can accept pushing the “tele-” prefix onto other words. But not “medicine”. Medicine is sacred. Why? Because it should never be impersonal.

When I explain to my peers the idea of medical appointments conducted by telephone, email, or videochat, I usually get a bunch of descriptors like those offered up in Dr. Dappen’s recent post:

• impersonal
• shoddy
• second-rate
• dangerous

Of these, impersonal is key. Because I think it’s the hardest to refute.

We can show quality of care somewhat objectively. We can look at the statistics on a company like Hello Health.

We can, like Dr. Dappen, dissect how little of the agenda actually requires a face-to-face appointment (referring to his post-heart-attack care):

I don’t need her listening to my heart or checking an EKG. These will provide no relevant data regarding my care. Instead the face-to-face visit with a 10 second heart exam satisfies a single objective. It justifies a billable service to the insurance company.  No heart exam, no billable service.

But how do you measure “impersonal”? “Impersonal” is a feeling, a je-ne-sais-quoi. A feeling is only felt. Its presence means that the technology still has a ways to go, that the users aren’t quite using it right, that we fear something about the idea. That the fear isn’t even being communicated.

For Natalie in “Up in the Air”, it takes hitting the road with Ryan and “letting go” real people to see the je-ne-sais-quoi.

She was correct in her initial pitch, of course – you can fire people over the screen more efficiently, and you save money on traveling. But the job of firing people is not the entire job. That’s why “Up in the Air” hits so hard—as we emerge from a most disheartening economic downtown, we are realizing that we need to treat people better, treat people like people.

In medicine, we don’t “see patients” just to see them on an LCD monitor.

In my opinion, going to a doctor’s appointment is a mutual investment and mutual vulnerability. We go see doctors when we are at our worst and of course we would like them to be at their best… But also at their most human, which perhaps necessitates vulnerability on their part.

Let me say it again. “Being there” truly is a vulnerability on the part of the health care practitioner. They can’t walk away. We want them to be there entirely, body and mind.

I’m all for the medicine 2.0. For me, the physical presence is not imperative. However, the physical presence is highly preferred because it is the most immediate and obvious way to say, “Look at me! I’m here! Listen to my problem! Take my hand if need be…” So I like it. I like it a lot.

How urgent could I ever be over email? By adding a smiley? TYPING IN CAPS?

But I have hope for telemedicine too. For some—like those in remote areas or who require long-term home care—telemedicine is much more personal than letting the patient flounder alone. We also see the benefits of interprofessional teams working together to care for a patient from all angles: telemedicine could bring together the proper experts from wherever their location.

What I mean to say is: telemedicine might not be shoddy, but it could still be impersonal.

Whether this sinks or swims is on us. So let’s do it right.

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