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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 11  |  Issue : 4  |  Page : 197-198

Teleconsultation in COVID-19 pandemic: A miracle or mirage


1 Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi, India
2 Institute of Anaesthesiolgy, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
3 Department of Paediatrics, Santosh Medical College, Ghaziabad, Uttar Pradesh, India

Date of Submission09-Jun-2021
Date of Decision01-Jul-2021
Date of Acceptance06-Jul-2021
Date of Web Publication21-Aug-2021

Correspondence Address:
Dr. Naresh Dua
Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi - 110 060
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmrp.cmrp_58_21

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How to cite this article:
Verma C, Dua N, Verma M, Mangal M. Teleconsultation in COVID-19 pandemic: A miracle or mirage. Curr Med Res Pract 2021;11:197-8

How to cite this URL:
Verma C, Dua N, Verma M, Mangal M. Teleconsultation in COVID-19 pandemic: A miracle or mirage. Curr Med Res Pract [serial online] 2021 [cited 2021 Oct 22];11:197-8. Available from: http://www.cmrpjournal.org/text.asp?2021/11/4/197/324253



Dear Editor,

The raging COVID-19 pandemic has brought the medical infrastructure down to its knees, wreaking havoc on the healthcare system. We had to fight this COVID-19 pandemic on two levels: keeping a safe distance from the virus and providing health support to patients who were at greater risk of being infected (immunocompromised, diabetic and cancer patients). These patients are unable or opting not to reach out to doctors for consultation due to the global pandemic-imposed lockdown. The tsunami of COVID-19 cases has paved the way for teleconsultation and telemedicine which is an alternative yet effective means of treating patients.

The term telemedicine was coined in 1970. According to the WHO, telemedicine is defined as the provision of online healthcare services when the distance between a service provider and a patient matters.[1] Telemedicine has been an invaluable tool to deliver health-related services and medical care using the latest technology and informatics to minimise the risk of cross-contamination and transmission of COVID-19 caused by close contact.[2]

Telemedicine or teleconsultation can be delivered in one of two ways: [3]

  • Synchronous – when the doctor communicates with the patient in real time via computer or telephone.
  • Asynchronous – when data, images or messages are recorded to share with the doctor later.


By bridging the gap between physicians and the healthcare system and allowing the general public, especially symptomatic patients, to stay at home, telemedicine has reduced exposure to the highly infective virus. It is an efficient way to deal with non-emergency cases and for patients to receive care for their ailments. An overwhelming number of people are actively seeking medical help remotely via telemedicine. For chronic patients, it provides routine care and management and has also mitigated the risk of exposure which otherwise might be very detrimental to their health.

Today, telemedicine can help manage conditions such as diabetes, hypertension, long-term lung diseases as well as the end-of-life care patient's care in cancer or other terminal diseases in home care settings.[4] It is also an effective screening and triaging medium for patients with suspected or established COVID-19, thereby protecting other patients, clinicians and our community from getting infected.[2],[4]

Telemedicine overcomes hurdles of medical consultation by digitalising counselling sessions via e-prescriptions and history of a patient in the form of images and videos that can be stored in network clouds and can be accessed by doctors as well as patients.[2] Measurements such as weight, food intake, blood pressure, heart rate and glucose levels in the blood can also be monitored online either manually or by using wearable devices such as fitness trackers, smartwatches, wearable electrocardiogram machine and wearable biosensor (self-adhesive patch) that allows patients to move around while collecting data on their movement, heart rate, respiratory rate and temperature and send the readings to the user's doctor as well as to detect arrhythmias and managed for the same even when your doctor is not with you physically.[5]

During pandemics, telemedicine has streamlined outpatient visits, reducing overcrowding and costs of healthcare. Communication between patients and a physician is not bound to a physical healthcare infrastructure, but telemedicine expands to rural areas with the help of simple devices such as a cellular device or a computer.

A considerable number of people are actively seeking medical help remotely via telemedicine as most hospitals do not have enough resources and personal protective equipment to defend against the surge of emergency room admissions and hospitalisations. For chronic patients, it provides routine care and management and has also mitigated the risk of exposure which otherwise might be very detrimental to their health.

However, the efficacy of telemedicine depends on various factors with the compliance of the patients playing a major role. Furthermore, certain conditions should be factored in to facilitate this process of online consultation.

Telemedicine comes with certain limitations:

  1. Unavailability of proper setups


    • The major stumbling block to teleconsultation is the availability of internet facilities in rural areas and other remote locations
    • Knowledge to access the gadgets and overcome the operational hindrance for individuals with special needs.


  2. No alternative for classical approach


    • Restriction of services for critical patients who require hospitalisation, proper medication and regular monitoring
    • The limited accuracy of diagnosis since the medical practitioner is not present for physical examination. This misdiagnosis is one of the factors that may influence mortality and morbidity rate.[2]


  3. Financial constraints


    • While some insurance companies are covering the cost of telemedicine during the COVID-19 pandemic, some services may not be fully covered, leading to out-of-pocket costs
    • Insurance companies apathy to accept telemedicine.[2]


  4. Psychological impact


  5. The traditional faith and relationship that a doctor and a patient share cannot be replaced by a virtual physician. The treating doctors feel morally responsible for the patients they treat, making them irritable and psychologically exhausted.

  6. Ethical constraint


The security of patient's health data transmitted electronically is a concern. The widespread use of the internet, E-mail and smartphones today has further underlined the significance of ethical issues in telemedicine.[6]

We can overcome the ethical acceptance of telemedicine by addressing the following issues:

  • The despoliation of the doctor–patient relationship
  • Safeguarding patient's privacy and data confidentiality
  • Informed consent
  • Satisfaction with telemedicine
  • Medico-legal issues
  • Tele-examination.


A lot needs to be done about the upgradation of the existing infrastructure to aid telemedicine. There is a serious need to set ethical rules and regulations and include these in the academic curriculum to train fledgling doctors to utilise them.[7]

Gradually, telemedicine will be an important facet in the healthcare system of the future as it offers a convenient, time-saving and cost-effective way to consult a physician regardless of patient location in any province, state, city or village without physically going to the clinic or hospital.

Acknowledgement

We would like to thank Ms. Priya Yadav, our research officer, for her help in preparing the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dye C, Reeder JC, Terry RF. Research for universal health coverage. Sci Transl Med 2013;5:199ed13.  Back to cited text no. 1
    
2.
Burroughs M, Urits I, Viswanath O, Simopoulos T, Hasoon J. Benefits and shortcomings of utilizing telemedicine during the COVID-19 pandemic. Proc (Bayl Univ Med Cent) 2020;33:699-700.  Back to cited text no. 2
    
3.
Telehealth: The Advantages and Disadvantages. Available from: https://www.health.harvard.edu/staying-healthy/telehealth- the-advantages-and-disadvantages. [Last accessed on 2021 May 29].  Back to cited text no. 3
    
4.
Perrone G, Zerbo S, Bilotta C, Malta G, Argo A. Telemedicine during Covid-19 pandemic: Advantage or critical issue? Med Leg J 2020;88:76-7.  Back to cited text no. 4
    
5.
Alicia Phaneuf. 2019. Latest Trends in Medical Monitoring Devices and Wearable Health Technology. Available from: https://www.businessinsider.in/science/latest-trends-in-medical-monitoring-devices-and-wearable-health-technology/articleshow/70295772.cms. [Last accessed on 2021 May 29].  Back to cited text no. 5
    
6.
Parsons TD. Telemedicine, Mobile, and Internet-Based Neurocognitive Assessment. Clinical Neuropsychology and Technology. Denton, TX, USA: Springer; 2016. p. 99-111.  Back to cited text no. 6
    
7.
Vanegas-Serna J, Perez J, Andrade-Caicedo H. Managing heterogeneous medical data: Learning from experiences in telemedicine. In: VII Latin American Congress on Biomedical Engineering CLAIB 2016. Bucaramanga, Santander, Colombia: IFMBE Proceedings; 2016, 2017. p. 670-3.  Back to cited text no. 7
    




 

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