Teleconsultations in medicine

by Dr. B. J. C. Perera-June 10, 2020, 7:26 pm
Specialist Consultant Paediatrician

As it appears, we need to be, and can even definitely be, quite sure of the fact that SARS-CoV-2 virus, which causes COVID-19 disease, has virtually come to stay, at least for the time being and into the immediately foreseeable future. There is anxiety, fear and uncertainty all over the place. There are various types of embargoes imposed on people and travel has become a real problem. These are likely to remain for quite some time, in view of the situation where this evil little bug has hit countries and people like a cataclysmic tsunami. It has swept aside everything and even anything in its relentless march. It came, it saw and it conquered. Some patients with the disease have unfortunately succumbed to the terrible and nasty effects of this virus. To compound matters further, it has been very difficult for patients to get medical attention when they needed it most during these troubled times.

Still for all that, even dark and gloomy clouds could have some silver linings and there could be little bits of light at the end of the tunnel. One of these is the use of electronic communication portals for patient care. Telemedicine in its broadest sense has been around for quite a while. Yet for all that, people in Sri Lanka used some components of these only sparingly in the days gone by. One reason for this is the fact that many in our country preferred to meet the doctor in-person for the consultation. In the current scenario of many restrictions imposed on the people, one component of telemedicine that has come in handy in the present crisis is teleconsultations with a doctor. This was of course through sheer necessity. There are several platforms available to the general public, through which a person could have access to an audio, a video or a combined audio-video facility, to consult a doctor.

A primary benefit of teleconsultations is the fact that it is only just about second to a formal face-to-face consultation with a medical professional but with the added advantages of not having to travel to a hospital or a medical facility for the session. It would also have the most acceptable advantage of having sufficient time at one’s disposal for the event to take place agreeably. It could be undertaken from the comfort of the home of the patient as well as at a mutually convenient time. It completely eliminates the necessity to spend hours on end at medical facilities to be seen by the doctor chosen by the patient. This is sometimes complicated by the doctor being unavoidably delayed through unforeseen circumstances brought on by other ill patients. The teleconsultation could be very satisfactorily accomplished by a smart phone, an iPad or a personal computer. As the steps involved are quite simple, one does not need to be a really skilled electronic expert to make use of one of these devices for a successful and fruitful medical teleconsultation.

However, in spite of all this, it is necessary for the patient or the parent of an ill child to be properly prepared for such a teleconsultation to enable them to derive the greatest benefits from the event. It would be useful to have all questions and queries written down prior to the consultation, just in case some of these are forgotten during the event. If the patient is a child, he or she should be available for the doctor to see the little patient. Good frontal lighting in a quiet environment for a video consultation is an essential prerequisite for a productive event for both sides of the session; the patient as well as the doctor. It is obviously necessary to reduce background noise to a minimum during the process so that all conversations are clearly heard on both sides. This is vital as the initial phase of the session would consist of the doctor getting a proper history or the story of the presenting complaints. In all forms of medicine, the history of the illness and the way in which it has progressed are very important for the purposes of making an accurate diagnosis. It is generally necessary for the doctor to ask some direct as well as indirect questions during the process to enable him or her to get a proper idea of the problem at hand. During this process it is very useful to have a look at pre-recorded events in a video format, if these are available. A case in point is a child who has had a seizure or a ‘fit’. Even if the patient or the parents are not computer savvy to the necessary extent, recordings from other smart phones too could be usefully employed for the doctor to get a reasonable idea of the recorded event.

The next step is the physical examination. Although a proper and absolutely complete physical examination cannot be made in the circumstances, a lot could be done by the doctor observing the patient or the body area in question. In the case of children much can be achieved through observation, which really is one that is scrupulously employed by most doctors even during an in-person consultation. This is also the reason why good frontal lighting is so essential. Colour differences in the skin, tell-tale changes in the face and eyes, skin rashes, any significant changes in breathing patterns, limb abnormalities, undue prominence of certain areas of the abdomen, amongst many other features, are the ones that a doctor would be on the lookout for. The doctor could also ask for any results of tests done for the current illness as well as those done previously.

At the end of these antecedent processes the doctor has to make up his or her mind as to whether a diagnosis could be made? Whether it is possible to issue a prescription to treat the disease? Whether further tests are necessary? Whether the situation needs a second opinion and whether the patient should be taken to a medical facility as a matter of urgency. Generally, especially in paediatrics, what is needed is reassurance of the parents and the use of simple medications. As in the case of even in-person consultations, reassurance to relieve parental anxiety is the main thing that is required. If further tests are needed these could be ordered through the same electronic portal. In the case of in-person consultations, most of us would not charge the patient to see the results of tests subsequently but in teleconsultation platforms the patient may have to pay again to show the reports as that is the way the systems operate. However, the expenses of travel and saving of the time spent to show reports in-person are distinct advantages. When a prescription has to be provided, some platforms provide the facility directly while others make use of applications such as WhatsApp Messenger to enable a prescription to be sent through the portal provider.

Teleconsultations may also be a useful facility even for some of our people who elect to take the 50th number when there are 49 others waiting to see a very busy and popular doctor in situations of in-person consultations. They need not waste hours kicking their heels in hospitals till their turn arrives. Sometimes following treatment as in an in-person consultation, the doctor may want to see the patient for review after a week or ten days. The patient will have to come to hospital to see the doctor again. The review can be easily undertaken through a teleconsultation, with minimal disturbance to the normal life of the patient, or if it is a child, to the parents.

There may be some concerns about the confidentiality and privacy apprehensions on the part of patients who use the teleconsultation platforms. It is generally assured by the service providers that adequate steps have been taken to ensure confidentiality and privacy of patients. There may also be some legitimate concerns of the legal responsibilities of the doctors treating through teleconsultation platforms. If transparency is ensured, proper advice provided and all these are documented, there should not be any anxieties on the part of the treating doctor regarding legal responsibilities and even litigation.

During the height of the COVID-19 pandemic, some doctors in certain government hospitals provided improvised free teleconsultation services using mobile tele-messenger services. Their patients benefitted a great deal through such magnanimous gestures. It served the purpose during those trying times. However, it must be noted that the commercial teleconsultation platforms provide a much better streamlined service.

It is believed by many that teleconsultation services will form an important and even an indispensible arm of healthcare in the future. Government free health services too need to look at such services as a tool designed to minimise overcrowding in hospitals and provide a satisfactory service to the patients. Information and Communication Technology (ICT) will be the thing for the future and in that sense, teleconsultations might become a sort of norm in the New World of the future.