Doctor’s Day: Is telemedicine here to stay, post Covid-19?
In the midst of the swirling storm of coronavirus, some aspects of everyday life, predominantly healthcare, are witnessing a paradigm shift. Telemedicine, for instance, has been gathering momentum like never before. Virtual consultations are the new norm helping doctors and patients avoid the risks of the pandemic not to mention the wait at the hospitals.
Some myths about telemedicine are being broken and a new confidence is slowly building in the patients.
“The obvious advantage now is that the patient doesn’t have to come to the hospital, during the Covid-19 situation and it is a great thing,” says Dr S Venkatesh, chief of cardiology, Aster-RV Hospital, Bengaluru.
He narrates how he found telemedicine pretty different from what he had imagined it to be.
“In the pre-Covid-19 era, I use to frown upon telemedicine apps saying that they would not work as there is no real patient contact in it. But surprisingly, it has been quite the contrary,” he says.
“We are attending a lot of webinars. The learning has been much more intense when we are online than we are present physically,” he says adding that “the commonality is, as there is no other distraction, we are looking at the screen with our undivided attention and hearing what the patient says.”
The importance of telemedicine and the prospects it holds in primary health care cannot be overlooked. Apart from the convenience factor, Dr Venkatesh lists out other positive aspects of virtual consultations.
He says that when the patient comes to the hospital or clinic for consultation, "the doctor is, sometimes, either busy writing down or there are people are coming in and going out of the consultation room.”
“In teleconsultation, you can focus on what the patient says and because of that the quality of consultation has been quite good. Patients are also careful in getting all their doubts cleared,” Dr Venkatesh says.
While telemedicine seems to pave a new path for healthcare in the country, there still remains the debate on its acceptability by both doctors and patients. The absence of proper physical examination has been a cause of concern for some doctors who are not quite content with mere virtual consultation.
Moreover, there are hiccups like poor connectivity and lack of access to digital technology especially in the rural areas of our country that stand in the way of an effective virtual consultation.
Dr Deepak Krishnamurthy, senior consultant, Interventional Cardiology, Sakra World Hospital while pointing out the advantages of telemedicine says, “the reach is immense and people can consult from the comfort of their homes and at their convenience. It can reduce the load especially on public hospitals.”
The disadvantages, Dr Deepak informs, include net connectivity issues and the inability to communicate properly. “No direct interaction between doctor and patient can hamper the quality of care,” he adds.
Elaborating the limiting factors, Dr Venkatesh says that one needs to have a reasonably good phone. “A very low-end phone that does not allow video connectivity will be a problem.”
“But a large majority of users today are using smart phones. Even a call through WhatsApp can be a way of consultation. Some of the apps which are available now with a low transmission speed also helps,’’ says Dr Venkatesh.
Nevertheless, he says that where the patient does not have a phone and have connectivity issues, it becomes a problem.
Elaborating on how easy or tough would it be to have virtual consultations for the rural populace, Dr Deepak says,
“It depends on connectivity. “While some villages have seen entry of telemedicine in patches, a large population still has no access. But with cheap data plans this is changing fast,” he adds.
On a person level, Dr Deepak says he is content with virtual consultations for follow-up patients.
“But for first time consultations I still feel it's not so satisfactory. The amount of info a doctor gathers on seeing a patient in person cannot be overemphasised,” says Dr Deepak.
Although the days of remote diagnosis are here, many do not agree on giving up the physical examination in the hospital for digital consultation.
In telemedicine, “there is no physical consultation and that cuts in two ways. In virtual consultation, one takes more time to elicit the patient’s symptoms. That there is no physical examination is a disadvantage,” says Dr Venkatesh.
“There are purists,” he says, “especially professors of medicine who would disapprove of what I am saying now, but the physical examination part plays a definite role but a small role.”
He adds that “sometimes there is no substitute for physical examinations but at many times physical examination is just cursory.”
He cites examples. “if the patient reliably measures a blood pressure and sends it to me, it as good as me checking. If a patient gets a chest X-ray and uploads the report, it’s as good as me examining the patient,” he says.
He emphasises the big role that a patient’s history and symptoms play and the big role that the tests have in diagnosis. “In between these, the physical examination forms a small part,” adds Dr Venkatesh.
There are situations and cases, however, where physical examinations cannot be ruled out in the name of telemedicine.
“Definitely there are things like, say a wound that has to be examined… then it has to be touched or a lump which has to be felt to see if it’s hard or soft,” says Dr Venkatesh
“Barring that, in a large number of cases, fever for instance, physical examination is redundant,” he adds.
“Where we are able to judge correctly, a significant number of patients can escape coming to the hospitals,” he says
Telemedicine offers the convenience of not depending on somebody else to take you to the hospital. The difficulties faced by the elderly to reach hospitals simply cannot be trivialised.
“Even post-Covid-19, a lot of patients may want to stay at home. If the quality of consultation is good and the patient’s issues are addressed, they don’t have to come to the hospital,” says Dr Venkatesh.
This, especially includes the elderly people and those who are dependent on others to bring them to the hospital. “That is an area where telemedicine is good,” says Dr Venkatesh.
Telemedicine seems to be here for a while. However, much more needs to be done to make it a comfortable option for both doctors and patients in future.
“Medico legally provisions have to be brought in to make it a valid/legal form of clinical practice,” opines Dr Deepak.
“As of now temporary measures are in place due to Corona outbreak,” he adds. All said and sone, is telemedicine going to be the way forward?
“It eventually boils down to the economics of the whole thing,” says Dr Venkatesh.
“If the hospitals and doctors want the patients to come to the clinic, this whole electronic movement which have started will die down,” says Dr Venkatesh.
“But if they realise that telemedicine can break geographical borders, that will spur it,” he says.
He adds that eventually it depends on how much the patient wants or insist on electronic consultation and if the doctors don’t mind seeing them electronically.
“There has to be some kind of acceptance of this fantastic technology. Eventually, if it doesn’t happen in this generation of doctors, it will happen in the next generation of doctors,” adds Dr Venkatesh.
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