May 15, 2012
Knowledge Pyramids in Telecare
In circumstances where it can take clinicians and therapists a long time to reach the patients who need them, or where patients need to travel long distances in order to see a specialist, telemedicine comes into its own. Telecardiology or teleradiology allow specialists to receive and assess data from remote locations, giving instant feedback if the communication infrastructure is in place. Thus, telemedicine bridges a gap in knowledge and expertise.
This can be extended to medical education, as Mark Barr from Intel showed at the recent Med-e-Tel conference in Luxemburg. In his presentation, he drew up a knowledge pyramid, where specialists have the highest level of knowledge, followed by generalists, medical nurses, and health workers. Medical education was one of the ways of bridging this knowledge gap.
However, I think that there are really two knowledge pyramids – one of medical knowledge required to help the patient, and one of implementation knowledge required to make sure the patient can get the help they need and implement the required measures. Fitting them both together leads to a continuum where one source of knowledge increases and the other decreases.
For example, if the specialist recommends regular exercise, such as brisk walking for thirty minutes a day, the local health worker can tell people about good routes and point them to local walking groups, if they exist. If the specialist recommends a healthier diet, the health worker can help with suggestions of cheap, nutritious meals, local sources of good ingredients, or cookery classes.
The specialists do not need the local knowledge just like the health workers don’t need the specialist knowledge, but both ends of the continuum need to work together for best results. A top-down conceptualisation of telemedicine, where education just flows along the medical knowledge path, but not back along the implementation one, is – to my mind at least – deeply flawed.