Visiting a hospital during a pandemic for consulting with a doctor is a tough call. One is tempted to use telemedicine in such situations. There is little doubt that telemedicine has distinct advantages during a contagious pandemic and the resulting national lockdown. It can help in reducing exposure of both healthcare workers and patients to a contagion. It can also be beneficial for people living in far flung areas of the country and in villages with sparse medical facilities.
However, we need to exercise great caution while using telemedicine even during a lockdown. The tendency to find quick solutions during a crisis is inevitable. But it is also our responsibility to ensure such solutions are effective and beneficial in the long run as habits we develop during a crisis often tend to outlast it. Telemedicine is no exception.
The Medical Council of India in association with the NITI Aayog formulated new guidelines to facilitate the effective practice of telemedicine in India on March 25, 2020. The report defines telemedicine as:
“… the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.”
In case of people with chronic ailments, doctors advise them to keep a detailed record of their symptoms. They also point out that patients can make telemedicine more effective by communicating about their symptoms in detail, recording the patterns, and presenting a history of the illness as accurately as possible.
A video call may prove to be much better than a phone call for effective diagnosis using telemedicine. When it is not possible to make a video call, one can send pictures of the patient to the doctor accompanied by a brief history of the ailment, said Dr Pawan Yadav, a paediatrician.
While doctors emphasise the importance of visuals in aiding diagnosis and treatment protocols, both doctors and patients need to keep privacy and data security issues in mind. Both parties need to ensure that health-related documents are stored safely and that data is not compromised under any circumstances. Also, we must acknowledge that while some people may find it convenient to monitor their illness and record their symptoms using various apps and digital devices, others may find it overwhelming.
When using telemedicine, a patient also needs to keep in mind that without clinical examination and proper investigation, there is little a doctor can do over the cell phone, especially if the condition becomes serious.
“For instance, if a pregnant patient says she feels a decrease in foetal movement, it needs to be examined personally by the doctor,” Dr Surya Narayan Mohanty, a gynaecologist, said. “In other cases, if the patient says she has abdominal pain, one may initially prescribe a muscle relaxant. But if the pain does not subside, a clinical examination is a must.”
In cases where a local physician is looking for expert medical opinion, telemedicine can also prove to be useful. After clinically examining the patient, a local physician can present the preliminary findings to an expert who may then prescribe additional investigations before making a diagnosis, said Dr Bikash Mishra, a neurologist.
Some may believe telemedicine can be more useful in the case of patients who are following up on their treatment than in the case of new patients. However, one should also consider the fact that a new patient may present a simple problem to the doctor and an old patient may suddenly develop a major health complication.
In this regard, the recently-formulated guidelines on telemedicine clearly state that the doctor will take a decision based on the complexity of the patient’s health condition:
“Every patient/case/medical condition may be different, for example, a new patient may present with a simple complaint such as headache while a known patient of Diabetes may consult for a followup with emergencies such as diabetic ketoacidosis.”
In case of emergencies, the guidelines specify what a patient can do:
“Telemedicine services should however be avoided for emergency care when alternative in-person care is available, and telemedicine consultation should be limited to first aid, life-saving measure, counselling and advice on referral. In all cases of emergency, the patient must be advised for an in-person interaction with [a registered medical practitioner] at the earliest.”
Dr Yadav elaborated on some such emergency situations. “When someone has breathing difficulties, chest pain, trauma, seizure, or severe diarrhoea, one should rush to the hospital immediately,” he said.
While it may seem convenient to dial a doctor for a cure, it has its own set of benefits and drawbacks that need to be considered on a case-by-case basis. The challenge is to be selective about using telemedicine. After all, nothing can replace all the information a doctor can get by clinically examining a patient.
Smeeta Mishra has a PhD from the University of Texas at Austin and studies digital cultures, including online health communication. She has taught communication at management institutes such as IIM Ahmedabad and IIM Calcutta.