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The girl is rushed to a field hospital and prepared for surgery. The surgeon, hundreds of miles away, his hands moving in a virtual reality environment, guides a remote-controlled robot to make the appropriate incision and locate the bleeding artery. The robot sutures the laceration; the girl lives. Her post-operative course is monitored by telesensors that record vital signs, fluid intake and output, and transmit video images of the wound. The German surgeon makes periodic rounds by downloading fresh video images.

Later the girl is flown to Germany to meet the doctor. Neither recognizes the other, yet both are emotionally overwhelmed.

Ask Dr. Bob Dr. Robert Burton, who is a neurologist and novelist, answers health questions every Monday in Salon Health & Body. Please e-mail your queries to him at AskDrBob@ salon.com.

Science fiction? Not at all. Welcome to the new world of telemedicine. Using the same technological breakthroughs that allow streaming audio and video, doctors are now able to communicate directly with climbers on Mt. Everest and astronauts in space. Couple the real-time transmission of medical data with the ability to perform virtual reality-guided remote robotic surgery and you have a glimpse of the future of modern medicine.

(During the war in Bosnia, the U.S. Department of Defense successfully field-tested an ultrasound system that fits into a backpack. And remote robotic surgery was first accomplished in 1996 when a Belgian surgeon performed a hernia operation on a patient in Holland, 200 kilometers away.)

There are many other examples of what's been accomplished already, most documented in the latest high-tech medical journal, Telemedicine and Virtual Reality.

A program in Greece brings the teledoctor to accident scenes where data such as electrocardiograms, blood pressure, oxygen saturation and images of patients can now be sent from some emergency vehicles in Greece. A teledoctor (a doctor at a console receiving the data) can then give immediate advice.

Canadian researchers have developed home dialysis programs, monitored by phone, that allow patients to be treated while they sleep.

At Texas Children's Hospital, a mobile van is equipped with a remote pediatric echocardiography (ultrasound of the heart and its valves) so that children in doctorless areas can be effectively technician-screened for congenital heart defects.

Accuracy, so far, has not been an issue. In a 1995 British study of teledermatology used to determine benign versus malignant skin lumps and bumps, the remote dermatologist viewing transmitted visual images of suspicious skin lesions did nearly as well as the dermatologist directly examining the patient. The two doctors had a 93 percent agreement rate -- essentially similar to what would have been expected if they had been examining the patient side by side. (And this was five years ago, long before better resolution transmission became available.) A recent study of the accuracy of teleradiology for urologic studies (kidney stones, tumors) was 97 percent.

If a medical situation can be converted to digital data, physical absence of a qualified pathologist, dermatologist or radiologist should no longer preclude first-rate care. A video camera, various scanners, X-ray equipment and some basic recording devices will be the backbone of the new rural physician.

Even certain hands-on procedures once performed by specialists now can be relegated to nurses or medical assistants. Consider the dreaded colonoscopy, the butt of a million bad jokes. A pilot study from London has shown that a nurse practitioner can perform the procedure with a video camera-equipped endoscope. The images are transmitted to a gastroenterologist at a distant medical center. He can guide the nurse if necessary. The patients, when interviewed, indicated they preferred "the local touch" as opposed to traveling to a distant, impersonal medical center. The clinicians felt that the images were excellent and reliable. Think of how many studies a first-rate gastroenterologist could interpret daily if he didn't have to insinuate his way up some reluctant alimentary canal. The actual operators could be hired according to coordination and gentleness, not MCATs and good-old-boy referral patterns.

Next page | Would you want a robot fiddling inside your brain?