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Telemedicine guidelines: What you need to keep in mind while tele-consulting with your doctor

Telemedicine guidelines: What you need to keep in mind while tele-consulting with your doctor

Telemedicine guidelines: What you need to keep in mind while tele-consulting with your doctor
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By Archana Shukla  Mar 27, 2020 10:55:00 AM IST (Published)

Doctors cannot insist on tele-consulting if the patient is willing to travel or requests an in-person consultation

The government on Wednesday released guidelines that allow registered medical practitioners to consult patients from remote locations through the use of technology, a practice known as telemedicine. Here is what you need to know when opting for tele-consulting with your doctor.

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Q: Which kind of doctors can provide consultation through telemedicine?
Only ‘Registered Medical Practitioner’ who are trained medical practitioners enrolled in the State Medical Register or the Indian Medical Register can consult through telemedicine. Practitioners must display their registration number on prescriptions, websites, electronic communication and receipts given to their patients.
Q: What can be the mode of communication on telemedicine? Does e-mail or phone call work?
Telemedicine includes all channels of communication such as voice, video and text. Doctors may choose any telemedicine tool for consultation e.g. telephone, video, chat platforms like WhatsApp, Facebook Messenger etc., or mobile health apps or internet based digital platforms like Skype/ e-mail/ fax.
The medical practitioner will decide the mode of tele-consultation as may be appropriate for the situation. In some cases, a simple phone call or text message may suffice, but for certain conditions the doctor may have to see the patient through video to observe verbal cues/symptoms.
Q. Do health apps come under telemedicine?
Yes. Those that facilitate online-consultations with registered practitioners come under telemedicine.
It is compulsory for all technology platforms like mobile apps and websites providing telemedicine services to check the credentials before listing doctors.
Technology platforms based on artificial intelligence/machine learning are not allowed to counsel the patients or prescribe any medicines to a patient.
Q: What type of health consultation can be done through telemedicine?
General health conditions like fever, basic cough and cold, mild rise in sugar, cholesterol, thyroid, the doctor may not require doctors to see patients in-person. Regular follow-ups of chronic illnesses like diabetes, hypertension, etc can be done through telemedicine.
However, in some cases like abdominal pain, giddiness, wound/injury over the body, non-healing ulcer, new symptoms/conditions in existing illness, in-person consultation is advisable.
Telemedicine can also be used for counselling. Such as specific advice given to patients for instance, on food restrictions, dos and don’ts for a patient on anticancer drugs, proper use of a hearing aid, home physiotherapy, etc to mitigate the underlying condition.
Q: Can consultations to check for COVID-19 case be done through telemedicine?
This depends on the discretion of the consultant physician.
Dr Shah of Zen MultiSpecialty Hospital says if that someone has an international travel history and is showing symptoms of cough, fever and throat pain, he would call him for testing to rule out COVID-19. However, for someone with flu like milder symptoms, tele-consultation can be done to prescribe symptomatic treatment and isolation. It helps when the practitioner knows the patient history.
Multiple mobile health apps have now started basic for online consultations for patients who may have flu symptoms, but are not sure.
Q: Can I call a doctor and ask for a tele-health consultation?
You may request, but it is for the doctor to decide. Every patient/case/medical condition may be different. Depending on the symptoms and initial conversation, the doctor or medical professional will decide whether a technology-based consultation is sufficient or an in-person review is needed.
For example, a new patient may consult for a simple complaint such as headache while a known patient of diabetes may consult for a follow-up with emergencies such as Diabetic Ketoacidosis.
Q: Conversely, can a doctor force me to consult remotely?
No. Doctors cannot insist on tele-consulting if the patient is willing to travel or requests an in-person consultation. Also, medical practitioners are not permitted to solicit patients for telemedicine through ads or other inducements.
Q: Can medical practitioners prescribe medicines through telemedicine? What type of medicines can they prescribe?
Yes. Registered practitioners can offer prescriptions through telemedicine consultation.
These are the medicines that can be prescribed:
List O: Medicines that are used for common conditions and are often available ‘over the counter’. For instance, paracetamol, ORS solutions, cough lozenges etc. Medicines that may be important during public health emergencies can also be prescribed.
List A & B: In case of follow-ups, medications that need to be continued for chronic illnesses like diabetes, hypertension and or additions to these may also be prescribed.
Prohibited List: Medicine that have a high potential of abuse, listed in Schedule X of Drug and Cosmetic Act and Rules or any Narcotic and Psychotropic substance listed in the Narcotic Drugs and Psychotropic Substances, Act, 1985.
Q: Will telemedicine be cheaper for a patient?
In respect of fees, telemedicine consultations will be treated on par with in-person consultations. The RMP may charge an appropriate fee for the telemedicine consultation, but this cannot exceed the fee charged for in-person consultation. An RMP should also give a receipt/invoice for the fee charged for telemedicine.
Q: When should telemedicine consultation be avoided?
Telemedicine services should be avoided for emergency care when alternative in-person care is available, and telemedicine consultation should be limited to first aid, life-saving measure, counseling and advice on referral.
Q: How useful is telemedicine during times of an epidemic like COVID-19?
Telemedicine will be very useful. A telemedicine visit can be conducted without exposing medical staff to viruses/infections in the times of such outbreaks, particularly when personal protective equipment are in short supply. Telemedicine also prevents patients the need to walk into clinics and hospitals where chances of contracting infections is higher. This however depends on the condition and discretion of the practitioner.
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