With the constant increase in number of COVID patients in the Philippines, teleconsultation has become an alternative way of seeking medical help. Here are some informative facts answered by University of the Philippines Informatics Unit:
- Which patients will benefit from telemedicine?
More often than not, it is still the physicians who decide which patients can benefit from telemedicine.Luz (2019) has called for preserving humanism while using telemedicine to improve medical care. He believes that telemedicine will not fully replace traditional care and that the first visit should be in person. He also advocates regular in person re-evaluations.
Telemedicine, however, may be useful:
- To reassess or monitor known patients. Such as when to readjust or check the medications adherence, or answer simple questions.
- To share information on lab results or tests administered.
- To a avoid unnecessary hospital visits, such as to get results of simple tests, in which case medical advice can be given at a distance, saving time and discomfort in addition to reducing costs.
- To advise on the choice of specialists for specific cases.
- To reduce hospitalization time – such as when monitoring patients after discharge.
- To facilitate or redirect overwhelmed public healthcare in cases where there is a long line waiting for consultation.
- To help patients in remote regions where there is no access to healthcare.
- Who can accompany the patient during teleconsultation?
Teleconsultation may proceed with a patient companion or caregiver. The Medical Council of India defines “patient companion” or “caregiver” as either a family member or an individual authorized by the patient to represent him or herself.
Caregivers may be useful in : 1) assisting elderly patients how to use technology during teleconsultation 2) caregiver is consulting on behalf of the patient 3) care giver is learning how to use monitoring devices at home or how to administer the medicines for the patient.
- Are there requirements that the patient has to do since the doctor cannot physically examine the patient?
Patients must be informed that there are limitations to a physical examination done during teleconsultation such as palpation and auscultation (Weinstein et. al 2018). Assessment devices such as blood pressure cuffs or digital stethoscopes would not always be available. The following are helpful in maximizing teleconsultation:
|
Organ System |
Additional Examination on the Patient during Teleconsultation |
|
Constitutional |
Use of electronic communications that collect and send information to foster remote patient monitoring e/g/ vital signs or blood glucose levels. |
|
Eyes |
Eye chart tools to evaluate visual acuity |
|
Ears, Nose, Mouth, Throat |
Inspection of the external appearance of ears, notes, color of lips, mouth, mucosa, symmetry of tracheal position. |
|
Respiratory |
Assessment of respiratory effort such as intercostal muscles, pursed lip breathing, sentence completion, audible wheezing; COPD test questionnaires. |
|
Cardiovascular |
The presence of edema can be observed. |
|
Gastrointestinal |
Recruit family members/companion to do abdominal examination, assess for tenderness and localize the pain. |
|
Genitourinary |
Testicular self examination. |
|
Skin |
Camera angle perpendicular to skin lesions, use autofocus and several views, use tape and press back to show skin changes in hairy areas. |
|
Musculoskeletal |
Redness, warmth, swelling can be observed or documented by the patient. Household items with known weight can be made available within reach to use for strength evaluation. |
|
Neurological |
Standardized examinations can be administered; Range of motion. |
|
Psychological |
Physical exam are generally limited. |
|
Hematologic, lymphatic, immunologic |
Mobility and firmness or lumps and bumps. |
- What is the process flow for teleconsultation?
First step: Schedule a teleconsultation with his/her physician.
Second step: Read and sign the informed consent.
Third step: Prepare for teleconsultation by downloading the applicable software.
Fourth step: During teleconsultation:
- Come on time
- Full cooperation and active participation during history taking and physical examination
- Make notes and ask questions
Fifth step: After consultation:
- Give feedbacks and evaluation
- How can doctors address patients’ expectations of the teleconsultation?
Patient concerns on technology are usually rooted in lack of familiarity and uncertainty of using technology correctly. These may be addressed by proper explanation and demonstration. Discuss the issue of recording the teleconsultation with patients as doing so without consent can harm the physician patient relationship. Patients may feel that teleconsultation is inferior as it lacks physical human interactions. Promoting a natural environment may help improve patient perception on teleconsultation. Explaining the intrinsic limitations of telemedicine may also properly set the expectations of the patient.
- Concerns that teleconsultation is somehow inferior
Some patients may feel that they are receiving a substandard level or care due to impersonal nature of telehealth as it lacks physical human interactions.
Moreover, because teleconsultation relies heavily on visual observation, this limits physicians from performing their assessment completely. Patients with movement disorders, for example, are difficult to assess especially in terms of postural instability and rigidity. Neurological examinations were particularly difficult to perform.
