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Healthcare tuning towards digital consultancy. Is India Ready?

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Are we ready to get online consultancy from the doctors and stay satisfied in getting treatment across the screen?

SUBURB spoke to some doctors and patients giving and receiving healthcare consultancy virtually. Below is what we found…

The world has changed, and one can categorically divide the pre-Covid19 era and post Covid19 years to come. Some activities which, as Indians we could just not have imagined before, have become a new normal. Among the others, the two drastic changes include online schooling and medical practitioners giving consultancy sitting in front of the patient but across the screen.  

We as Indians back in the day has a history of going to Hakim Saheb, who would check pulse and without patients speaking much about their health issues, the Hakim would have had the readings of the body, and ​medicines were prescribed ​to the patient ​accordingly.

“Pulse taking is still an integral part of medical practice today, for the pulse is an important diagnostic sign and can be used to prognosticate the course of illness. A physician well versed in “reading” or interpreting the different characteristics of the pulse in disease is considered a “good doctor” in the past; now, only the nurse takes the pulse,’’ says Dr Devendra Taneja, senior physician in Gurugram.

In the same breath, he says, “but we all have to change with times. In last one year, patients and doctors, both sides have adjusted to the new ways of virtual medication.” Virtual clinics are increasing preventive & curative care as well and have shown good results.  

Compared to 11 per cent usage of telemedicine in 2019; today, 76 per cent of end consumers are comfortable using telemedicine.

The increase in population and decrease in healthcare workers have shined a light on telemedicine. Due to the Covid-19 pandemic, the situation has further worsened, bringing a sudden hype for telemedicine.

Vimed, Practo, 1mg, Doconline, Rijuven India ​are​ ​some ​popular telemedicine companies growing in the country given the current changed world scenario post the pandemic. The importance of telemedicine and its growth as an industry is significant given that the pandemic is far from being over.

Many healthcare companies are coming into the foray of telemedicine. Healpha, a Hyderabad based people-centric- connected digital healthcare startup, has recently launched its virtual clinic called the Health ATM. The new startup claims to take the treatment to the next level, where doctors sitting remotely can monitor a patient’s vitals like oxygen saturation, blood pressure, glucose levels and even ECG.

The two stakeholders in the process of telemedicine both have come to terms with the change since the pandemic hit. Physical meetings and medical consultancy in the doctor’s chamber is a passé now.

“Now we diagnose, prescribe medicines through virtual consultancy. As a paediatrician, I have to observe the child very minutely through the screen or rely on parents sharing symptoms of their ailing child. If there is an emergency or if I think I need to examine the patient physically, I say so, says Dr Rajiv Chhabra, a senior paediatrician.’’   

Telemedicine as a practice is not new in India though it has not been popular before the pandemic. “All medical ​conditions cannot be assessed over a virtual meeting like appendicitis may require a physical examination, and some allergies or inflammation also require in-person examination. On the other hand, some common complaints may not require a physical examination or even consultation in real-time. A complaint of headache or fever may not always require the doctor to examine the patient physically or audio-visually through a mobile or computer application. Thus, the decision to examine the patient physically or remotely is to be taken by the doctor on a case-to-case basis,’’ says Dr Renu Verma GP in Medical College Saharanpur. She smiles and adds, “people from Uttar Pradesh are way different than that of the cosmopolitan population, so online consultancy is far from being simple. As a doctor every other day, one gets varied experiences giving tele medicine-consultancy.’’ 

Inhibition of patients

In India, telemedicine is not as comforting as an in-person consultation from a patient’s perspective. There is a common complaint that patients have that the doctor was not audible enough or the patient could not understand what the doctor said. Some patients feared whether the person on the other end was, in fact, a doctor or not. A few worried about their privacy, as electronic communications over mobile applications or email can leave a trail. Importantly, as Indians, one to one discussion with the doctor is far more sustaining than online treatment.

Indian patients now will be able to hold doctors accountable to provide teleconsultation as per the Telemedicine Guidelines, which provide a clear set of dos and don’ts for doctors. A violation of the Telemedicine Guidelines will give patients an avenue to complain against the doctor before the appropriate State Medical Council for ‘misconduct’.

‘Medicines can cure a disease, but only doctors can cure patients.’ Suman Sarda recovering post-Covid, shares, “I have felt uneasy for a month after Covid with vague symptoms. Finally, I decided to meet my old doctor in person. I vented out, cried talking about how I felt. After a heart to heart conversation with the doctor who boosted my confidence. He heard me very patiently and got my blood works done to rule out medical issues, if any. I am already feeling much better. Seeing and believing in a doctor is healing.’’

Telemedicine Guidelines in India

The Indian Government has published Telemedicine Practice Guidelines (“Telemedicine Guidelines”) on March 25, 2020. These guidelines finally clarify India’s position on the legality of teleconsultation. It is now perfectly legal to provide teleconsultation by registered medical practitioners (M.B.B.S and above) in line with the requirements of the Telemedicine Guidelines. It has been clarified that the first consultation between doctor and patient need not be an in-person consultation and doctors in India can provide the first consultation to patients located in any State remotely through teleconsultation. However, from now on, all doctors who provide teleconsultation will have to display their registration number in all communications exchanged with the patient – for example, in emails or WhatsApp messages, on prescriptions and fee receipts.

As a thumb rule, prescribing medicines for chronic diseases (such as asthma, diabetes or hypertension) should be avoided during teleconsultation, unless it is an add-on or refill of an earlier prescription obtained during an in-person consultation less than six months ago.

If a prescription for chronic diseases is to be issued, then teleconsultation should be done strictly via video. A prescription can be sent through any electronic medium such as email, WhatsApp etc. as a photo| scan | digital copy of a signed prescription or an e-prescription.

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