Step up to the Automated Tele-Medicine (Au-T-M) screen on your home computer or sidewalk kiosk (with personal sound and sight privacy). Insert your personal health card. Select your symptoms from a touch screen menu. Insert your finger in the sensor. In a matter of seconds you will receive the most likely diagnosis, a suggested treatment plan, what to expect from treatment, the predicted course of your illness, the prescription medication or prescription form, or a referral to a health clinic or Au-T-M health facility. Au-T-M will even make an appointment with a health provider for personal attention.

Far fetched? Not at all. Some of this is all ready on-line. All of it is in the development phase. In 50 years from now, or less, I predict the days of going to the doctor's office for routine illnesses will go the way of vinyl records, selectric typewriters, and the slide rule.

The Au-T-M system will have an impressive patient data set for each individual. It will contain a person's complete health history such as current medications, allergies, lifestyle information and health goals. To preserve confidentiality and privacy, all health information will be on a personal identification card that the individual keeps. The Au-T-M process will start only when the person inserts their card into the Au-T-M machine.

For health problems that require more than an electronic evaluation of symptoms and a sensory probe, the Au-T-M is still the preferred screening method. Your home Au-T-M, or community Au-T-M facility, will allow audiovisual interaction with a health care provider. The provider will direct the person in the use of additional sensing devices that will allow the provider to listen to your heart, lungs, bowel, and other sounds; look into your mouth, nose, ears, or at other parts of the body; feel resistance to pressure to evaluate sensitivity and motor responses; and to electronically interpret smells and tastes. The audiovisual interaction will provide most of the information that is exchanged in a doctors office.

How much will the Au-T-M system be used? To the extent the public can set aside their technophobia, it will have wide use. As long as waiting times to see a health provider remain long and there is pressure to drive down health care costs, the interest in a faster, cost effective, and customer convenient health system will continue. Like the popularity of financial ATM machines that allow banking at all hours, the medical Au-T-M system will allow health services to be provided at all hours and without the patient having to wait.

Diseases and Methods: Technology is depended upon to solve many problems, including medical ones. Having just attended the 25th reunion of my medical class made me pause and think about the changes that have happened in just a short time. Legionnaires disease was yet to occur. The human immunodeficiency virus would not surface for another ten years. The idea that much of ulcer disease may have an infectious etiology would have been blasphemy. The emergence of drug resistant tuberculosis and some of our standard infectious agents was just a possibility. Who could have imagined the complete mapping of the human gnome in this century, widely available magnetic resonance imaging, laser and laproscopic surgery? The increased accuracy of laboratory analysis is way ahead of where we imagined standards would be, and it is certainly way ahead of where we thought it would be -- in the home. The advances in home laboratory testing will go a long way to help patients adjust to an Au-T-M health system. All this was beyond the imagination and technology of just 25 years ago.

There is no doubt that the future holds new diseases that are undiscovered and evolving, and there will also be new difficulties treating disease that we now successfully manage. The synergism between technology and human health will lead to wonders not yet conceived and beyond our imagination. What can be imagined is possible, our only limitation is our imagination.

Behavior and Health: Forty percent is the figure used to describe the amount of illness and death that is directly related to the results of personal behavior. Regardless of the advanced technology that will be brought into the health arena, it will never completely compensate for bad health habits. Whether it is smoking, drinking, driving too fast, or what and how we eat, those behaviors and others have very predictable and numbered probabilities for adverse health outcomes. Behavior will continue to have a greater and greater impact on health. New technology will help people achieve their personal health goals only when combined with an individual commitment to healthy lifestyle and behaviors.

Medicine is not only technology and an Au-T-M health system. Medicine is a system of caring. There is so much that we can do to take care of ourselves in the privacy of our home, but we must not lose the human touch. Referring to a technological health assistant as Dorothy's favorite aunt helps, but it still keeps Auntie Em in the crystal ball. Sometimes the best medicine is having someone there with you. An audio-visual representation of a health care provider or a sensory probe cannot convey compassion, concern, and caring.