Tuesday, September 20, 2016

IMA View Point: Virtual Clinic viisitng the doctor in an online setting - Guest post Dr K K Agarwal

Dr K K Aggarwal 1. As per a Supreme Court judgment one should not prescribe medicine on a telephonic consult unless it is an emergency. But this does not apply to counselling and advice. Even government of India runs help lines on mental health, tobacco cessation, child sexual abuse etc 2. Today a new trend called virtual visits is available through video conferencing apps that download to a smartphone, tablet, or home computer. 3. Patients can experience a “virtual” visit with a qualified physician at any time, day or night. Its not just a fad. The benefits go beyond triage. It’s a step towards remote, affordable, convenient primary health care. 4. In the west the cost can be half of in-person visit, and most insurance companies are now covering them. In US Blue Cross policies, offer their own virtual doctor services free of charge. Medicare does not cover virtual visits. The cost of a virtual visit can be even less than the out-of-pocket co-payment that Medicare requires for an in-person doctor visit. 5. In US, the consulting doctors are licensed, vetted and are assigned to you based on where you live. They carry malpractice insurance and authorised to order tests and prescriptions. But without seeing in person, their ability to assess a patient is limited. 6. In a consult there are limitations. A physician can look at your rash, but can’t examine the back of your throat or listen to your lungs. In depression it may make no difference but in abdominal pain one needs a physical examination. 7. The care may be no different. People who go to a virtual visit are just as likely to have a follow-up appointment in the next few weeks, have similar antibiotic prescribing rate but one is most likely to end up with a broad-spectrum antibiotic and less specific drugs and specific tests like in strep throat. 8. In US Two of the most widely used are Teladoc (www.teladoc.com) and Doctor On Demand (www.doctorondemand.com). 9. Virtual visits aren’t meant to replace doctor’s office visits but may be a good option for minor, temporary problems (cold, flu, sinusitis, a non strep sore throat, rash, diarrhoea, vomiting, or conjunctivitis ― particularly in odd hours or for follow up visits. 10. It’s best to see your regular doctor as soon as possible.


Monday, September 19, 2016

Dear Patients, Please Dont Mess With Your Doctors Mind - Guest Blog Dr Aniruddha Malpani

Doctors do their best in order to take good care of their patients because they want their patients to get well. It's in his best interests to do so, because a happy patient will refer lots of others to the doctor, and thus help his practice to grow. However, in this day and age, unfortunately the trust which patients used to have in their doctor has taken a big beating. This is why patients spend a lot of time on Dr. Google, trying to get his second opinions. Now while I am a big believer in the Information Therapy which Dr. Google provides, patients need to understand that this is a double-edged sword , and they need to be sophisticated users to benefit from this. One of the worst things you can do to a doctor is to keep on challenging his authority or questioning his advice. He feels disrespected , and he's not going to take as good care of you as he would have if he had felt that you trusted and respected him. The doctor-patient relationship is a delicate one and you need to nurture it. Now this doesn't mean you that you leave your brains at home and do everything your doctor tells you to, just because he is the medical expert. However, you do need to respect the fact that he's a trained professional. The problem is that trust is intangible. It's not something which you should give away easily , and therefore it's quite reasonable to expect your doctor to work in order to earn your trust. But once he's done that , then you shouldn't keep on playing doctor yourself. You should allow him the autonomy to help you to make the right decisions. This becomes a positive virtuous cycle. If the doctor senses that you trust him, he respects you as well, and will go out of his way to make sure that you get the best care possible. This is why it's best to follow the middle path - after you've verified your doctor's advice, let him be the captain of the ship. This means that you should let him know that you accept him as  being the leader of the medical team, but that you are still an important part of the team. He will also reciprocate, and this will help the two of you to craft a win win partnership where everyone benefits.

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