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Introduction

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Since early human history, accessing a healer or someone with “expert health knowledge” was considered beneficial in helping illnesses. Healers such as shamans, priests, and medicine men are known to have been part of prehistoric cultures. These healers normally required communication with the patient and ideally visualization of the patient to diagnose and treat them.  In many cultures, with time, healers became known as physicians. The first acknowledged physician, an Egyptian named Imhotep, lived during the 27th century BCE.  By 420 BCE, medicine began to develop standards. Hippocrates initiated the age of “rational medicine.” That era had the idea that diseases have natural causes and the concept of ethics in medicine originated.  

The Asclepeion temples became some of the world’s first health centers.Pilgrims traveled great distances to these temples to seek medical advice, prognoses, and healing.i  In the later era in India, specific structures were constructed for health care with basic sanitation standards.The Romans founded buildings called valetudinarians for the care of sick slaves and soldiers.  With the fall of the Roman, Greek, and Egyptian civilizations came a decline in the formal study and practice of medicine in these cultures. 

Medical care improved in the early middle ages (6th to 10th century ) when an infirmary became an established part of almost every monastery. Also during that time, the first medical schools were opened. During the late middle ages (beyond the 10th century) monastic infirmaries continued to expand, and public hospitals were opened. Specialized institutions also initiated at this time. ii  

Healthcare evolved from home remedies and traveling doctors to one complex system of care. The work of Benjamin Franklin and Dr. Thomas Bond led to the establishment of the Pennsylvania Hospital, which became the first hospital in the continental United States in 1751.  This was followed by a New York Hospital, which was chartered in 1771.  

During the 1800s, significant advancements began to occur, including the development of the stethoscope, antiseptic surgery, anesthesia, germ theory, and vaccines. During this time, Johns Hopkins and other academic centers were built. However, despite the development of formal hospitals, physicians generally performed medical care in the homes of their patients, a practice that continued throughout that century.  As the equipment and treatments became more sophisticated, physicians began to open offices or treat patients in hospitals. Only 40% of physician encounters were conducted via house call by 1930. By 1950, house calls decreased to 10% of visits, and less than 1% by 1980.iii  

The shift of care delivery from the home to clinics and hospitals was also partially the result of the growth of third-party payers and increasing liability concerns.However, throughout the history of healthcare, obstacles have delayed access to the right expertise at the right time and in the right place. Hence, a desire emerged to make expertise more widely available through distance communications.