Telehealth and medicine

For centuries, it has been a well-known fact that meeting a doctor in person has the potential to heal most illnesses. In fact, doctors also like meeting patients in person.

In the pandemic, we now live in a different world. In-person visits are no longer possible, we are left to lean on to new forms of technology-- telehealth and online medicine. This technology has found a new boom during the pandemic. Who knew this would become the norm in medicine? On the other hand, if we were to face the pandemic in the 60s or 70s, before internet connectivity, what would have happened?

In developed countries, due to advances in medicine, there is reduced opportunity for essential procedures, hence, there is a huge push to practice these skills on plastic dolls (mannequins) that resemble human patients. It is worrisome that one may stand to lose physical examination and communication skills on patients. If a newborn baby not passed urine for several hours, how can a paediatrician be expected to examine this newborn on camera? Maybe he could, but how effective that would be?

Could one assess an elderly with joint pain or severe back-ache? How do you come up with a good list of differential diagnosis? How is one supposed to feel the pulse and listen to the heartbeat to diagnose heart failure or if a patient is slipping into shock? The list goes on. This could lead to either over-treatment, since doctors may try to curtail the anxiety of patients or under-treatment if the patient does not understand the gravity of the situation. Some patients may not communicate well with doctors leading to disastrous consequences. This technology can be a double-edged sword. But, how can we solve this new mode of consultation, especially with an uneducated population that resides in underprivileged areas of cities and villages?

Doctor-patient interaction in-person not only builds trust but also creates a lasting bonding between them. An experienced doctor may see a rash or a particular finding and be done with it in a few seconds. Now, with online consults, he may have to spend more time depending on the connectivity, camera resolution etc. Then the question of time spent and payment options arise. Many doctors may not even like to connect to those patients who do not have the option to pay digitally. Patients in resource-poor areas may have no online facility to pay the doctors. The next issue challenge for is that the new method of interacting with patients to diagnose and treat patients puts the physician into a realm of losing his or her bedside manner and physical examination skills to diagnose a mass, cyst, abscess, sinus. Can these practices continue with online technology? Are patients ready for this and is the medical community? Or do both the parties have no choice until the pandemic is completely brought under control?

In India, where doctors are revered, will this technology transform doctors into godlike figures who can be reached only via phones? Of course, technology has benefits. Patients can communicate with their doctors from their homes and get treated without risking themselves to exposure to the pandemic. Other advantages can be saving money and time on travel, lodging or boarding. But, while we may exhale in relief, we must worry about freshly graduate doctors who are coming to hospitals and communities without much training from experienced seniors and losing out on learning crucial communication skills with patients.

However, there is always a brighter side to every story. As we pray and watch carefully how things unfold, time may heal everything and time will teach us new things to get used to new challenges. One thing is for sure, we need medical institutions to adapt to these rapidly changing times and incorporate these deficiencies into medical school and residency curriculums so that graduating doctors come with confidence and continue to provide best possible care to patients.

(The writers are doctors based in Dallas, Texas)