Introduction

A.C., a friendly Italian man, received coronary stents 8 years ago and had been feeling well until 3 months ago. He then had progressive breathing difficulty with tightness in his chest. He had loss of appetite and lost 4 kg in that period, but continued to work with good disposition. He had been to two hospital visits, in which he was informed that his lung was normal, based on X-ray. They had not reached final diagnosis, so he came to the office. His general appearance was normal; no abnormality was found on visual inspection. He had normal vital signs; no pallor to suggest anemia. The lungs, heart, abdomen and lower limbs were normal on examination, and resting ECG revealed no abnormalities either. As I palpated his neck, I noticed a mass on the left side. Subsequent examinations proved that a tumor compressed the trachea, which explained his respiratory difficulty. This is a typical example of a case in which only complete clinical examination leads to diagnosis. Telemedicine (TM) would not allow this, as simple inspection did not give any clues, and the clinical history suggested several possibilities, such as heart disease, pulmonary disease, diabetic decompensation, uremia or anemia.

There is now a major debate, both at the health system and at the individual telemedicine level. Telecommunication technologies have long been used in teaching, in science, in the formation of groups for the study of diseases, in the transmission of diagnostic or therapeutic medical procedures, in imaging interpretation by specialists, in teleconference with undisputed efficiency, and will not be considered here. An interesting fact: many even said that, with the Internet, medical conferences would be emptied, because everything could be seen from a distance.

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