 Good evening. Has anyone of you heard about the shortage of doctors in the state of Brandeburg? The situation is actually quite serious because there are a lot of rural areas and the country doctors are getting quite old and gradually retiring and it's very difficult to attract new just graduated fresh country doctors to the region. And as a result it can get very challenging to access healthcare. You might need to drive a very long way to consult a doctor. And yeah, as the population is aging it becomes very problematic to access healthcare. And this problem is not unique to Brandeburg but basically in any rural area there's a challenge to drive to a doctor when you have on the other hand medical emergency or it's something not so serious so you can't be bothered to drive 50 kilometres to a doctor. There is a technological solution to this problem. It's called telemedicine and telemedicine means that you consult a doctor at distance. So for example there is a video connection and you tell your concern and then you get treatment that way. And we were really puzzled in our project why isn't this technology used for example in Brandeburg or in Germany that often and the reason for this was actually legal because long distance treatment until last year was prohibited in Germany so you couldn't do it. And it seems quite counter-intuitive so we tried to look a bit into the background of this regulation. Why is it there? It doesn't seem to make sense. And we did find something. We found out that actually the history of this prohibition starts with Lifestyle magazine in 1850s and at the time the educated emerging bourgeois class was very interested in health advice so they were reading magazines which featured questions and answers from doctors and they could send letters to these doctors. And actually it was a very popular practice so doctors were advertising treatment by mail correspondence treatment services and so it was a widespread phenomenon. And of course it kind of raises a question whether a letter can actually transmit so much information. So you tell, you have a headache, you send the letter to a doctor how informed is he or she actually about what's going on with you. And the general assembly of doctors at the time were not really fond of this practice so they decided to distance self, it wasn't kind of favourable for their profession it wasn't very favourable for the patients either and gradually this like hesitance towards long distance treatment was codified in the law. So in 1897 Saxony prohibited long distance treatment by letters and gradually this became kind of more accepted feature of healthcare and on more level of whole Germany in Weimar Republic the long distance treatment was prohibited in 1927 but this law specifically prohibited the treatment of sexually transmitted diseases with letters and they're contagious so it does make sense and you can observe that with this law of the 20s there was a public health interest behind it because there was an epidemic at the time. So from Germany you can really see that there's a reasonable grounds to prohibit long distance treatment when you use technologies such as letters and this kind of stayed with the legislation so gradually all states prohibited long distance treatment and it stayed this way until now. By contrast in the US the history of prohibited long distance treatment is much younger than in Germany it's almost 100 years younger and it started with problems caused by the internet because once it became more popular medium it became very easy to write to a doctor that you have very bad pain and get a prescription for a medicine which can be used as a narcotic. So there was a problem of misuse of control substances that are addictive and overdoses death and in 2008 then the government of the US decided that it's time to intervene with this and prohibited long distance prescriptions to control substances so you needed actually to have a relationship with a doctor they needed to know you and you had to have a physical examination before you got these drugs with a prescription to them and it all seems to make sense it appears proportional there's public health interests you protect the patients you protect also misuse of doctors of their position but in the US you may also observe legislation on telemedicine which is not directly influenced by the health interest so in the last years there have been prohibitions specifically of telemedical medical abortions so medical abortions means that you take a pill to carry out the procedure and I didn't know it but actually there's no difference in safety whether it's carried out by telemedicine or in person so this legislation one can say that it's not motivated by health interest but there's a political reason with it and this year we have heard of other attempts to ban abortions so it belongs to that discourse which I will not discuss further here but just to highlight that there can be other motivations to regulate telemedicine than just healthcare of course telemedicine can't solve all healthcare problems so if you have a wound that requires stitches you can't really use a band-aid on it and also with telemedicine it's not fitting for all circumstances but it's still as a palette of healthcare services that we have it has benefit for rural populations it has benefit for those who have limited mobility just an example and the regulation of it should be based on the other hand by the actually evidence based standards what's good healthcare and on the other hand what are the limitation of technology at use and opportunities and I mean in Germany it does make sense that we enact legislation which targets letters and doesn't really address the opportunities of video technology and indeed last year the federal medical chamber relaxed the rule on the prohibition of long distance treatment and it allowed it in special cases this rule needs to be implemented on the level of the states and 30 states allowed telemedicine one allowed it with reservation and two decided to maintain the prohibition and Brandeburg was actually one of them the state with one of the states with most rural population a shortage of doctors doesn't really make sense but at least the patients in Brandeburg can consult now physicians from other states so part of the legal obstacles have been removed thank you