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Medical Consultations: Visit to Doctor’s Clinic vs Tele-medicine!

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One of the off shoots of the COVID 19 scare and lockdown and that many of my colleagues and I are witnessing is the growing use of TELEMEDICINE.

It is not without reason that most good hospitals are now offering tele-medicine services, and many patients are benefiting from it.In fact, I thought it makes perfect sense for a patient of Chronic Hepatitis B who is doing well under my treatment with oral medications for the last 4 years and residing in a remote small town of Uttar Pradesh for example, not to spend time, travel cost and effort to visit me in my clinic to show his reports, have a 10- minute consultation, and get a fresh prescription, all that he may now get on-line by telemedicine using his smart phone.

Telemedicine is emerging as the in-thing nowadays across the world where people are reaping the benefit of technology, having a face-to face consultation (without masks!) on video with a doctor after having shared all reports with him in advance. And you can do it from the comfort of your home, receive an e-prescription for tests and medications! The only thing missing of course is the “physical” examination.Examples can be picked up from every discipline. Why does a patient of long standing hypertension on medications need to take time off and travel long distances to throng a doctor’s clinic or hospital to get his BP checked and get a “repeat” prescription, if the same (BP checked and recorded with a machine that costs Rs 1000/-) can be done at home more frequently ,and can help the doctor adjust the dose by telemedicine? Why does a patient who has had a convulsion 2 years ago, and is well controlled on regular anti-epileptic medications need to go to his doctor’s clinic to get a refill prescription? The list is indeed endless.

Many symptoms and ailments do not necessarily require a physical examination. I was amused to see a police-circular enquiring from patients whether their doctor had performed a “physical examination” when he had gone to a COVID Clinic with symptoms of sore throat and fever and a history of suspicious contact or travel, for COVID testing. I was left wondering what aspect of the “physical examination” might help the doctor decide.

Telemedicine will have its limitations and cannot always replace a “proper” consultation and physical examination. In fact it requires more discretion on part of the doctor to decide when to insist on a physical examination rather than scribbling or texting a treatment.Clinical conditions where a “physical” is a must include breathlessness (bronchial asthma or wheeze), chest pain requiring evaluation of the heart or chest, neurological symptoms where the doctor has to undertake a thorough examination, or abdominal symptoms where examination of the abdomen is essential to detect a lump and many such.

It would indeed be risky if telemedicine is taken to mean ringing up a busy doctor or sending him a message on phone and seeking a revert. But if properly done, it is convenient, comfortable and cost-saving and can solve many problems.
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