When you spend years caring for patients in a community, you begin to see patterns of illnesses in chronic diseases, but more importantly, you see patterns in critically ill patients requiring immediate care. I would almost compare it to reading an EKG: difficult initially, but eventually it becomes pattern recognition, in part due to the sheer volume of cases. Regularly there will be a patient who presents with unusual symptoms. In the ICU making the correct diagnosis quickly can make a significant difference in the patient’s outcome.

I worked both in an academic setting, as a CCU Medical Director, and in private practice in a community ICU/CCU for many years. I thought I had seen the full range of challenging cases. Not until I became a tele-ICU intensivist did I start commonly seeing cases with unusual presentations or causes. Opening up your horizons via tele-ICU to pathology across the United States is like entering a new world. Each new case I see with tele-ICU care teaches me about future cases.

One evening I was called into the case of a young woman. She had incessant ventricular tachycardia (a life and death rhythm). I noted in her chart that she had been admitted to the ICU with an initial postulated diagnosis which does not typically present with severe cardiac rhythms.  After noting this inconsistency, it became apparent to me that the patient had in fact, overdosed on a common over the counter medication. The bedside nursing staff was able to confirm that this patient truly had taken the medication I suspected; the staff also shared with me that this particular medication overuse had been seen occasionally in their ICU as overdoses are a regional problem. Identifying the cause of the overdose and subsequent tachycardia allowed me to work with the bedside team to ensure the appropriate course of treatment which resulted in saving the patient’s life. Of course, this is one of many specific cases we could talk about that are novel initially but provide important, repeatable knowledge.

The experience that I can impart to the bedside team in other communities, drawn not only from lots of repetition but also from substantial regional differences, and the opportunity to save future lives in this manner is extremely gratifying.

There has never before been a time in medicine where information could be shared at this level. By having intensivists who treat cases across the country, we are closing the gap of healthcare inequity and ensuring that patients, regardless of location or resources, receive the care they need in the moment they need it.   Albert Einstein once wrote, “Wisdom is not a product of schooling but of a lifelong attempt to acquire it.” I have found this sentiment to be especially true as I practice medicine. We learn from each patient encounter and carry that wisdom to the cases that follow. As we continue to expand the reach of critical care I am proud of the difference tele-medicine is making across the country.