Rise in demand for telemedicine

Many people consult doctors through e-consultation for common cold, cough and fever, to rule out Covid-19 symptoms

At a time when the norm remains to be ‘social distancing’, many hospitals in the city are opening up to the idea of teleconsulting. Though, the term is not new in the medical world, considering there are already a few dedicated platforms for online doctor consultation, the demand for telemedicine is on the rise amidst the Covid-19 scare.

Metrolife spoke to a few health experts to understand the need for this change, the benefits and the myths surrounding teleconsultation.

Bengaluru is a tech savvy city with a very high penetration of smartphones. Being home to many start ups offering video and e-consult softwares, telemedicine has a bright future in Bengaluru, says Dr Manish Mattoo, zonal director, Fortis Hospitals.

“Due to Covid-19, we have advised patients that do not require semi urgent or urgent care to stay at home and consult us on phone or our own video consult software. There is a 300 per cent spike in such requests this week,” he says.

Dr Mattoo anticipates that with the protracted lockdown, 40-50 per cent of all the out-patient consultations will be shifting to these platforms.

“While the ease of interaction makes this medium useful during prevailing conditions, there are a few challenges it brings with it; many state medical councils (including Karnataka Medical Council) haven’t yet legitimised these consultations and doctors can face medico legal challenges in future unless the law offers clarity. These consultations cannot be a substitute for in-person consultations because physical examination and assessment of vitals is not possible, although the latter can be still be solved using Bluetooth devices that can transmit basic health parameters,” he points out.

24/7 helpline

In the wake of the Covid-19 scare, Aster Hospitals have launched a 24/7 online COVID-19 portal to advice people seeking medical help if they suspect they have symptoms related to the disease.

“Recognising the need to provide assessment and counselling services to public at large, Aster CMI Hospital and Aster RV Hospital, as part of the Aster Volunteers initiative, has launched a 24x7 COVID-19 Support Centre for public. The Centre is equipped to assess the condition and provide appropriate guidance free of cost to all those seeking medical assistance. Anyone suspecting or showing symptoms related to Covid-19 can seek help through their phone,” says Dr. Nitish Shetty, chief executive officer, Aster Hospitals.

He believes that teleconsultation not only helps in increasing the access to quality care through enhanced patient engagement, it is a boon for geriatric patients as they can access quality care and consultation from hospital’s experts without stepping out of their homes
and adhering to social distancing practices.

“With the improvements in internet infrastructure and high penetration of smartphones, we believe that digital primary care can be a boon to improve access to healthcare experts and interventions,” he told Metrolife.

Providing cancer care online

Not new to the market of telemedicine, Navya, a Bengaluru-based clinical informatics company, has been providing online expert opinions to cancer patients across the world since 2015.

Talking about the rise in the percentage of teleconsulting since Covid-19 outbreak, Gitika Srivastava, founder of Navya, says that though their daily requests have nearly tripled, what is important to note is the nature of questions people ask now.

“Amidst the Covid-19 outbreak, cancer patients are most vulnerable to infection and subsequent complications. This is because patients have low immunity and they are prone to infection. We are receiving questions like, ‘Can the last cycle of radiation therapy be cancelled or postponed if the radiation center is closed? What about thyroid surgery; I just got diagnosed last week and was going to be operated next week, now the doctors are saying elective surgery can be postponed, is this considered truly elective, for example? These questions are crucial for us to answer; we take up each question as each case is different, in a fully informed and responsible way,” says Gitika.

Many myths to be broken

“It is a myth that patients do not take teleconsultations seriously and mostly demand face to face meetings. Over 80 per cent of our patients follow the Tata and National Cancer Grid opinion that is given remotely despite never meeting the doctor face to face. 80 per cent of our patients also share the remote expert opinion report with their treating oncologist. Patients are widely accepting this,” says Gitika.

Echoing Gitika, is Vijayrathna V, CEO Motherhood Hospitals. He feels that every person need to be met physically and assess for a very common problem. “If a person is able to give a reasonable amount of medical information on their self-assessment, consultation can be of a certain standard and they can feel better. They don’t have to rush to a hospital,” he says.

“The fundamental requirement currently is to first assess who actually needs a proper consultation in the hospital and who can be advised through telephone. We have to ensure that people do not end up coming to the hospital unnecessarily,” says Dr Vijayrathna.

In the absence of immediate help to answer their queries, many end up making non-essential trips to a hospital’s crowded OPD. With teleconsultation, doctors can now screen and alleviate anxieties, doubts and questions of their patients.

“This is the new way of functioning, the current situation is warranted that people adopt to this very quickly. Today, telemedicine is largely used in high-end tertiary case consultation but going forward even primary and secondary health care will start using this technology more frequently and in many more places. The reason is that the connectivity in India is far better than what it was when the concept of telemedicine was happening,” he anticipates.

Talking about the various limitations, Dr Yatheesh Govindaiah, unit head and assistant director, medical services, Apollo Hospitals, Jayanagar, says, “Teleconsultation has got its own limitations. Though it is said that one can virtually connect with patients, reassure, talk and instill some amount of confidence in patients, the flip side from a doctor’s point of view is that we are unable to do a complete examination and share the prescription. With the coming in of telemedicine, not just young doctors but senior doctor’s too need to be able to quickly adapt to this technology.”

Given the current scenario, people can meet experts without having to travel to hospitals (in case of regular checkups and follow-ups), through virtual consultation, contributing to social distancing.

Is self-medication the answer?

Do you have a stock of painkillers and cough syrups for sudden onset of ailments? Have you ever gone to your local chemist and asked him to give you medicine for the sudden sickness that has set in?

If yes, then you have indulged in self medication. While having a paracetamol to deal with pain or antacid to deal with acidity is harmless; doctors advise against reckless popping of pills.

The advent of the internet and the ability to get a diagnosis by googling your symptoms has led to lesser people going to the doctors. But this quick fix might not always lead to the right diagnosis. Which means, you might not be taking the right medication. Dr Bindumathi PL, senior consultant, internal medicine, Aster CMI Hospital, says that Googling your symptoms doesn’t do much harm and that access to information about your ailment can be a good thing. “The problem arises at the dispensaries, with chemists who are willing to give medicines without prescriptions or even advise patients on the kind of medicines they must be taking without a proper diagnosis. Sometimes even antibiotics are given without a prescription,” she explains. This is despite the fact that India has a defined list of drugs that can be sold over the counter, but it is not strictly enforced.

A prime reason self-medication is looked down upon is unintended side effects. Unsupervised use of many medicines can cause harm, especially when taken in combination with substances like alcohol. “There are many medicines that make one drowsy and sometimes these are bought over the counter by patients. Unaware of the side effects, they take them in the mornings before driving to work. This can cause trouble,” she says.

While drowsiness is a low-risk side effect, some medicines like Methotrexate which is used to treat rheumatoid arthritis and skin conditions can cause low haemoglobin, white blood cell and platelet count if not taken as per the prescription.

Dosage too, is another issue. Even the simple ibuprofen in high doses can lead to gastritis, affect the kidneys and even lead to heart failure. Sometimes a patient uses an old prescription to get refills on medicine as well. “Chemists should check the dates on prescriptions. Especially for medicines that control diabetes and high blood pressure. I’ve had patients come in with extremely high sugar only to find out that they have been taking medicines that were prescribed a year ago for a short time period,” she says.

Building up antimicrobial resistance is another reason to not indulge in this activity. With frequent and unmonitored intake of antibiotics, they become less effective over time. “They also destroy the antibacterial flora present in the intestines. This can lead to diarrhea, indigestion and make you prone to other infections which can be very severe,” she explains.

Dr Bindumathi says that even with the Covid scare, ailments like a running nose, very mild fever or sore throat can be treated with a paracetamol, and patients need not come running to the hospital.

But such self-medication does not work for everything. Even in case of the above mentioned, if they persist consulting a doctor is the next move and not the upping of dosage. Many are turning to teleconsulting as going to a hospital puts you at a higher risk of catching Covid-19.

(With inputs from Theres Sudeep)