Abstract
A number of years ago, I was serving as a Fulbright Specialist, part of the James William Fulbright Foreign Scholarship Board, with the United States Department of State's Bureau of Education and Cultural Affairs and Council for International Exchange of Scholars. My assignment was with the University of Saints Cyril and Methodius in Skopje, Republic of Macedonia. Skopje is also the childhood home of Mother Teresa. The university is named after two Byzantine missionaries who are often credited with establishing the Glagolitic alphabet, the foundational root of the Cyrillic alphabet used in many eastern European counties, including Russia.
As a Fulbright Specialist, I was serving as a bridge between my academic center in the United States and the University in Skopje and an academic center in Tetovo, in northern Macedonia near Albania. I was teaching and mentoring the medical faculty, family medicine physicians, medical students, all types of graduate and postgraduate students, and many others on telemedicine and e-Health and aerospace medicine. As a Fulbright Specialist, there are also cultural activities that are integrated into the busy academic routine. I had heard there was an ancient aqueduct in Skopje, so I asked one of the professors and other colleagues where this bridge from the past was located, and whether we could visit it. Turns out, it was literally <10 min from his home and he had never ventured to see it.
Known as the Skopje Aqueduct, its date in antiquity may be Roman (ca 100 CE), during the reign of Justinian I (ca 527–565 CE) or during the early years of the Ottoman Empire. It may well have been repaired over the centuries. Falling out of use in the 18th century, this rivulet or artificial watercourse was a bridge that linked societies to one another in need of a natural resource, in this case, water.
Visiting this site got me thinking about how bridges connect us and, in many cases, make travel less obtrusive. Just look at the Suez Canal back in late March. One ship affected the entire world's economy. There are many bridges around the world that make life more convenient. Some are simple and some are complex. Some cut travel time to minutes rather than hours. Nevertheless, they help us get to where we are going.
Telemedicine is also a two-way bridge between us and our providers. The infrastructure for today's “information” bridge is not stone or hand-hewn bricks but wireless waves. Of course there is some “hard” infrastructure such as satellites, cell towers, and switches but the information is all coming to us and our devices wirelessly. Over a year ago, there was literally only one way to see your physician and that is the bridge telemedicine is and can provide.
Consider the convenience factor: I can be anywhere and talk with my provider or I can travel some distance to his or her location and wait in my car until I can be seen. I am not sure that will fly much longer. Recall the ship, Ever Given, stuck in the Suez Canal. There were ships waiting in the Mediterranean and in the Red Sea that might have very well have to try the old fashion way—an arduous journey around the Cape of Good Hope in southern Africa. Inconvenient, costly, challenging, this is comparable to health care. Yes, there are things for which you absolutely have to see a provider in person. If that is the case, do not delay.
Bridges and yes, canals such as the Suez and the Panama, have each made international trade better and timely. Telemedicine and telehealth are also making health care more convenient and timely.
One area of telemedicine that has seen significant growth is telemental health. According to the American Hospital Association, May is Mental Health Awareness Month. 1 Why is this important? According to a report from FAIR Health, a group that looks at insurance data, psychotherapy (CPT—90837, 9083) has been in the top 3 nationally and jumped 21% from January 2020 to January 2021 to make it the number one use. 2 The FAIR Health website uses dashboards to inform users about a variety of data points, including claims data, diagnosis by region, etc. Although this is one source, we have all seen indicators that telemedicine and telehealth in nearly every discipline have grown rapidly in the past year.
One last story about a bridge. While I was attending a G-7 conference at the Hôtel-Dieu Saint-Jacques in Toulouse, France, our international group was to take a picture on a balcony that stretched out over the Garonne River. On opposite side of the river was an exact replica of the platform we gathered on. The question was asked what it was. As you can imagine, it has been a bridge that remained standing for hundreds of years. This early bridge was replaced 500 years ago by the Pont Neuf stone arch bridge. This bridge opened for traffic in the 15th century and remains in use today. The point here is that although the bridge was replaced with another, the objective was to get to the other side, for business, for pleasure, for medical care; for whatever reason, the bridge was convenient.
The bridge, metaphorically speaking, that we are using for telemedicine is flexible, durable, and safe to cross.
As we continue to move forward and out of this pandemic, the bridges we have built will likely be replaced by new bridges, simply because we need to get to our destination in a timely an efficient manner.