JMIR Publications

ABSTRACT

Optimization of the clinical physical examination is still being explored in telemedicine. The scope of differences in approach to the physical examination is vast as there is no widely-followed criteria in the medical community. Neurology has been on the forefront of telemedicine implementation, initially utilized through stroke care and over time expanding into multiple subspecialities. However, utilization is growing faster than physical examination validation research. There have always been limitations in reliability and reproducibility of in-person examinations, which regardless, remain the gold standard. Here we present a framework for optimizing the history and physical examination process via telemedicine. This includes remotely examining a patient unassisted, having an untrained assistant present, or having a trained assistant present on the patient side of the encounter. We discuss the need for trained, certified assistants, who would serve as an extension of the off-site physician for history taking and physical examination. These certified assistants would be composed of allied health professionals who would perform high quality, cued patient examinations while under direct physician supervision, with no responsibility at all to diagnose or treat. This is in contrast to advanced practice providers such as Physician Assistants and Nurse Practitioners who undergo years of training to manage patients under supervision. This training process would ideally serve as a stepping stone for the introduction of dedicated certification programs into other medical specialties. Further research into training, costs, implementation, and longitudinal quality assessment is necessary.