In Context
Lifeline Stijntje Bor graduated in 2007 from the University of Groningen as a medical doctor. At the University Medical Center Utrecht, she now combines her medical training to become a neurologist with a PhD project on unruptured intracranial aneurysms and screening for intracranial aneurysms in familial subarachnoid haemorrhage.
See Articles page 385
What inspires you? Talking to patients. It’s amazing how people are so similar and yet so very different; they can be strong and yet vulnerable. I’m lucky that my job consists of interacting with real people about things that really matter. If you wrote an autobiography, what would be the title? How to doubt everything, including this. If you had not entered your current profession, what would you have liked to do? I would have taught Greek and Latin to students, showing them that logic will untangle any mess, one step at a time. What would be your advice to a newly qualified doctor? Listen, and only listen, for the first 5 minutes that a patient walks into the room. The diagnosis, your treatment relation with the patient, and whether or not you run your outpatient clinic on time, are all decided in those 5 minutes. What is the best piece of advice you have received, and from whom? Advice from my great-uncle, a cardiologist: find a profession in which you like what you do all day. Do not choose a profession for the highlights, for those things will not decide your daily work satisfaction. What items do you always carry with you? A smartphone, a paper agenda, glasses, and a wallet with a one dollar bill and a 500 Indian rupee bill (so that I am never without money). What was the most memorable comment you ever received from a referee? “I do not believe this can be true.” I had done a proper study with a good design and correct statistical methods. It went against all my beliefs as a future scientist that a referee would say he did or did not believe something, as an argument for turning a paper down. You can have dinner tonight with a famous person of your choice (dead or alive), who would it be? Aletta Jacobs, the first woman in the Netherlands to go to university (to study medicine), the first female medical doctor, and a fierce human rights activist. Many laws had to be changed, just because she had the courage to believe in herself. What is your worst habit? I doubt. Everything. All the time.
350
Focal point 21st century telemetry Despite having been around in one incarnation or another since the early 20th century, as recently as 1995 the full potential of telemedicine—electronic dissemination of medical information over a distance— was still very much underappreciated. A Lancet editorial on the topic asked the question whether this was a fad or the future, and opined on what effect, if any, telemedicine would have on medical practice in the year 2000.1 Of course, such discussions could not have even begun to factor in the incalculable boost to be gained from improvements in telecommunications networks and computer-based applications that were just around the corner, leading to an expansion of the landscape of teleconsultation, tele-education, and even telediagnosis, that would be unrecognisable to even the most techno-savvy commentator back then.2 Some specialties and more visual disciplines, such as radiology and pathology, lend themselves better to telemedicine than others; accordingly, neurology is a natural fit with the advantages of telemedicine and has even coined its own subspecialty: teleneurology. While teleneurology has been applied to many neurological disorders, such as headache, dementia, movement disorders, and multiple sclerosis, it is in stroke that teleneurological applications have predominated;2,3 however, with new interface technologies comes more potential for telemedical applications in epilepsy.4 But as the initial problems based on the limitations of the technology platforms have been negated, a whole new tranche of obstacles to the wider adoption of telemedicine seem to have supplanted them, including the questions about the standards used to assess the economic benefits, the socioeconomic effects, the factors that promote uptake, the qualitative methods used, and the design of some of the reported studies.5 However, reiteration of the requirements still needed can only be for the good and make the wider integration of telemedicine achievable.
Steven Goodrick 1 2 3
4 5
The Lancet. Telemedicine: fad or future? Lancet 1995; 345: 73–74. Larner AJ. Teleneurology: an overview of current status. Pract Neurol 2011; 11: 283–88. Fassbender K, Balucani C, Walter S, Levine SR, Haas A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol 2013; 12: 585–96. Holmes D. Can technology reveal the ecology of epilepsy? Lancet Neurol 2014; 13: 347–48. Ekelend AG, Bowes A, Flottorp S. Methodologies for assessing telemedicine: a systematic review of reviews. Int J Med Inform 2013; 81: 1–11.
www.thelancet.com/neurology Vol 13 April 2014
Lifeline Stijntje Bor graduated in 2007 from the University of Groningen as a medical doctor. At the University Medical Center Utrecht, she now combines her medical training to become a neurologist with a PhD project on unruptured intracranial aneurysms and screening for intracranial aneurysms in familial subarachnoid haemorrhage.
See Articles page 385
What inspires you? Talking to patients. It’s amazing how people are so similar and yet so very different; they can be strong and yet vulnerable. I’m lucky that my job consists of interacting with real people about things that really matter. If you wrote an autobiography, what would be the title? How to doubt everything, including this. If you had not entered your current profession, what would you have liked to do? I would have taught Greek and Latin to students, showing them that logic will untangle any mess, one step at a time. What would be your advice to a newly qualified doctor? Listen, and only listen, for the first 5 minutes that a patient walks into the room. The diagnosis, your treatment relation with the patient, and whether or not you run your outpatient clinic on time, are all decided in those 5 minutes. What is the best piece of advice you have received, and from whom? Advice from my great-uncle, a cardiologist: find a profession in which you like what you do all day. Do not choose a profession for the highlights, for those things will not decide your daily work satisfaction. What items do you always carry with you? A smartphone, a paper agenda, glasses, and a wallet with a one dollar bill and a 500 Indian rupee bill (so that I am never without money). What was the most memorable comment you ever received from a referee? “I do not believe this can be true.” I had done a proper study with a good design and correct statistical methods. It went against all my beliefs as a future scientist that a referee would say he did or did not believe something, as an argument for turning a paper down. You can have dinner tonight with a famous person of your choice (dead or alive), who would it be? Aletta Jacobs, the first woman in the Netherlands to go to university (to study medicine), the first female medical doctor, and a fierce human rights activist. Many laws had to be changed, just because she had the courage to believe in herself. What is your worst habit? I doubt. Everything. All the time.
350
Focal point 21st century telemetry Despite having been around in one incarnation or another since the early 20th century, as recently as 1995 the full potential of telemedicine—electronic dissemination of medical information over a distance— was still very much underappreciated. A Lancet editorial on the topic asked the question whether this was a fad or the future, and opined on what effect, if any, telemedicine would have on medical practice in the year 2000.1 Of course, such discussions could not have even begun to factor in the incalculable boost to be gained from improvements in telecommunications networks and computer-based applications that were just around the corner, leading to an expansion of the landscape of teleconsultation, tele-education, and even telediagnosis, that would be unrecognisable to even the most techno-savvy commentator back then.2 Some specialties and more visual disciplines, such as radiology and pathology, lend themselves better to telemedicine than others; accordingly, neurology is a natural fit with the advantages of telemedicine and has even coined its own subspecialty: teleneurology. While teleneurology has been applied to many neurological disorders, such as headache, dementia, movement disorders, and multiple sclerosis, it is in stroke that teleneurological applications have predominated;2,3 however, with new interface technologies comes more potential for telemedical applications in epilepsy.4 But as the initial problems based on the limitations of the technology platforms have been negated, a whole new tranche of obstacles to the wider adoption of telemedicine seem to have supplanted them, including the questions about the standards used to assess the economic benefits, the socioeconomic effects, the factors that promote uptake, the qualitative methods used, and the design of some of the reported studies.5 However, reiteration of the requirements still needed can only be for the good and make the wider integration of telemedicine achievable.
Steven Goodrick 1 2 3
4 5
The Lancet. Telemedicine: fad or future? Lancet 1995; 345: 73–74. Larner AJ. Teleneurology: an overview of current status. Pract Neurol 2011; 11: 283–88. Fassbender K, Balucani C, Walter S, Levine SR, Haas A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol 2013; 12: 585–96. Holmes D. Can technology reveal the ecology of epilepsy? Lancet Neurol 2014; 13: 347–48. Ekelend AG, Bowes A, Flottorp S. Methodologies for assessing telemedicine: a systematic review of reviews. Int J Med Inform 2013; 81: 1–11.
www.thelancet.com/neurology Vol 13 April 2014
