In telemedicine, challenge is not technology but patients’ mindsets: Doctors

In the current situation, the idea of healthcare going digital seems more attractive than ever. Online consultations can prove to be a major relief for healthcare workers.

The medical industry, for the most part, functions on physical interaction, with a doctor checking the pulse, using a stethoscope, feeling for lumps or peering into the mouth for possible telltale signs. However, such practices are largely suspended as of now given the coronavirus pandemic.

With Covid-19 becoming more unpredictable than ever, healthcare systems across the world, including that of India, are strained. As per the National Health Profile- 2019 data, there are 7,13,986 government hospitals’ beds in total, which accounts for 0.55 beds per 1,000 population. Besides, a number of hospitals have been sealed due to workers testing positive. On April 6, Mumbai’s Wockhardt hospital, for example, was sealed when the count of health workers and doctors testing positive for Covid-19 rose to 54.

Amid this scenario, telemedicine is emerging as a feasible option. Anil Vinayak, GCOO of Fortis Healthcare, told the, “The use of telemedicine technology allows healthcare to become more accessible, efficient, and convenient for the patient.”

 The concept of virtual healthcare has been around before the world was struck by the pandemic. Back in 2015, the government had launched the Social Endeavour for Health and Telemedicine (SEHAT), a pan-India health initiative to connect 60,000 health structures throughout the country and provide the service irrespective of the geographical location.

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In the current situation, however, the idea of healthcare going digital seems more attractive than ever. Online consultations can prove to be a major relief for healthcare workers. The results are being seen globally too.

In an article in The Economist, it was stated that “America’s medicare programme, which covers more than 60 million elderly people, has said it would allow online patient visits. Also, federal rules were eased to allow American doctors to work across state lines, which is seen as a boon to remote consultations.”

For India, it has been seen that “there has been significant week-on-week growth since online services were enabled after the guidelines by the government were published as part of the COVID response. “At a pan-Fortis level, tele/video consultation accounts for 10 per cent of our pre-COVID OPD consultation volumes,” said  Vinayak.

Scope of virtual healthcare wide but caution is key

However, Dr Kaberi Banerjee, Medical  Director, Advanced Fertility and Gynaecology Centre, New Delhi says “even when the scope of virtual healthcare is wide, its selection has to be wisely done.”

“Any consultation where a decision cannot be taken without physical examination of the patient cannot be done through virtual healthcare,” said Dr Banerjee. Ishan Singh, a writer, who recently opted for a video consultation, told, “I found the entire experience somewhat disorganised and the advice conflicting. I had a severe injury and did two different consultations. This happened because the doctor was not able to examine the injury properly.”

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Digital healthcare – Awareness, Access, Affordability

Telemedicine has the power to fill in the gaps that have been exposed due to the current situation. Just like video-conferencing solutions did not mean people stopped travelling to work, but it made for a smarter option when required. “It has the potential to solve three major issues that healthcare in India faces – awareness, access, affordability,” remarked Akshat Seth, Chief Operating Officer, CK Birla Hospital, Gurgaon.

For starters, virtual healthcare can easily help in providing primary care like follow-ups, getting a second point of view and, most importantly, screening patients to see if they need an in-person consultation. ”It also increases operational efficiencies for doctors, reduces the load on hospitals and healthcare facilities, while providing assurance for patients with improved support and feedback,” said Seth.

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In India, providing in-person healthcare is challenging given the large geographical distances and relatively limited resources. In fact, “doctor population ratio in India is still 1:1800. This is significantly lower than the 1:1000 recommended by the WHO. Nearly 60% of hospitals, 75% of dispensaries and 80% of doctors in India are located in urban areas servicing just about 28% of the population causing severe accessibility problems,” added Seth.

But with strides made in virtual healthcare and rapid advances in ICT, India has the potential to completely change the way healthcare is delivered in the country. “With over 687 million internet users and 629 million mobile users as of January 2020, India is the second-largest online market in the world,” said Seth.

The Aarogya Setu app is an example of a cost-effective digital infrastructure that has been made available widely. The app was launched in order to trace the transmission and saw at least 50 million downloads since its launch.

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‘Challenge is not technology but people’

The call for action amid the pandemic is to practice social distancing as much as possible. “More video consultations mean less physical crowding in hospitals, leading to improved social distancing as well,” said Vinayak. However, there has to be a change in mindsets. The issue is not technology but people. “The myth that teleconsultation is not as good as face-to-face consultation has to be dispelled. A change in mindset is essential to make virtual consultations a success,” added Dr Banerjee.

While there can be inhibitions on the patient’s part, said Sharmishta Das, an IT professional (name changed) who recently consulted a doctor virtually said, “I was not comfortable with showing the dermatologist my skin issue over the video call because I honestly felt he wouldn’t be able to diagnose much behind the screen.”

“The best way to solve this is to induce trials, and the current Covid-19 situation is a catalyst to drive greater acceptance and adoption,” said Seth. On the other hand, the doctors feel that patients often have no consideration for their time when the consultation turns virtual.

 Dr Banerjee said, “After the consultation is done, the patient feels free to call the doctor any time to clarify doubts. We must realise that this is not how it works.” She also agreed that these mindsets will not change overnight.

Seth, too, remarked, “The biggest challenge is not technology. It is people who need to accept, both doctors and patients, who have to get used to these newer ways of working.”

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