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Consultation over telephone

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There should be some guidelines for The Telephone Consultation and Online Practice. There were some cases when doctors treated the patient on telephone & were involved in some litigations .

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Consultation over telephone

  1. 1. TELEPHONE & ONLINE CONSULTATION IN TODAY’S MEDICAL PRACTICE DR. AVINASH BHONDWE Family Physician
  2. 2. PROGRESS OF MEDICAL SCIENCES ALWAYS WITH SCIENCE & TECHNOLOGY • STETHOSCOPE, SPHYGMOMANNOMETER • X-RAY, CT, MRI, PET • MICROSCOPY, ELECTRON MICROSCOPY • PHARMAC- INORGANIC & ORGANIC CHEMISTRY • ENDOSCOPY • ROBOTIC SURGERY
  3. 3. TELEPHONE
  4. 4. TYPES OF TELEPHONE CONSULTATIONS • 1. DAY TO DAY REQUESTS • 2. FOLLO UP CALLS • 3. EMERGENCIES • 4. HOSPITAL ADMISSIONS • 5. POST DISCHARGE • 6. OUT OF STATION PATIENTS • 7. SENIOR CITIZENS • 8. WHATSAPP
  5. 5. DAY TO DAY CALLS MINOR AILMENTS SYMPTOMS NOT IMPROVED NEW SYMPTOMS ANXIETY DIET A KNOWN HEALTHY PATIENT WITH SIMPLE COMPLAINTS- SNEEZING, HEADACHE, HYPERACIDITY
  6. 6. FOLLOW UP CALLS 1. PATIENT WAS SEEN A DAY BEFORE AND A NEW SYMPTOM ARISES 2. PSYCHIATRY TREATMENT. 3. DIGNOSIS CONFIRMED & FIXED TREATMENT -FOR UPDATES- DENGUE, CHICKENPOX, DIABETES 4. PATIENT WITH TERMINAL LONG STANDING ILLNESS HAVING SOME SYMPTOMS
  7. 7. FOLLOW UP CALLS 5. UNTOWARD EFFECTS TO THE TREATMENT AND ANAPHYLAXIS- Abdominal Pain, Vomiting, Rashes, 6. PRESCRIBED MEDICINES NOT AVAILABLE IN MED STORES 7. ROUTINE PATIENT’S - ROUTINE COMPLAINTS -POST ALCOHOL, VOMITING, ABD PAIN
  8. 8. EMERGENCIES • ACCIDENTS • MIDNIGHT CALLS • UNWELL CHILD • SEVERE REACTION • ALARMING SYMPTOMS-  Chest Pain  Hypoglycemia  Unconsciousness  Abdominal Pain  Breathlessness
  9. 9. ADMISSIONS AND POST DISCHARGE
  10. 10. OUT OF STATION PATIENTS
  11. 11. SENIOR CITIZENS
  12. 12. WHATSAPP
  13. 13. ONLINE CONSULTATION • IDEA BEHIND • WEBSITES & APPS Docsapp (3/5) Easy to use Practo (2/5) A bit Expensive GetVisitApp (2/5) Works well for general consultation Lybrate (2/5) complicated as well as not free FreeDoctorHelpline (4/5) works well & Free Consultation too.  JustDoc, Healthians, InstaDoctor
  14. 14. ONLINE CONSULTATION • TRIAGE-Triage is the process of determining the priority of patients' treatments based on the severity of their condition. • This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. • The term comes from the French verb trier, meaning to separate, shift or select.
  15. 15. ONLINE CONSULTATION • FACEBOOK PAGE/ MESSANGER • WHATSAPP • QUESTIONS ON HEALTH AND DISEASES • CHAT WITH THE DOCTOR
  16. 16. TELEMEDICINE • PATIENT AWARENESS • REMOTE VILLAGES • GOVT APPROVED SERVICES • OWN SITES CONSULTATION
  17. 17. RISKS • HISTORY • MISLEADING INFORMATION • THE SYMPTOMS ASSESSMENT IMPROPER • CLINICAL EXAMINATION • CONSENT • DOCTOR PATIENT RELATIONSHIP • CONSEQUENSES
  18. 18. A DECISION OF HIGHCOURT
  19. 19. Can a Doctor Give A Telephonic Consultaion? • In Indian supreme court Judgment Martin F. D’Souza vs Mohd Ishfaq (3541 of 2002) dated 17.02.2009 • Justice Markandey Katzu and G S Singhvi enlisted precautions which doctor/ Hospitals/ Nursing Homes should take: • “54(b): No prescription should ordinarily be given without actual examination. The tendency to give prescription over the telephone, except in an acute emergency, should be avoided”. • If any mishap occurs, lower courts and or the state councils can give verdict against the doctor citing the above Supreme Court judgment.
  20. 20. BMJ • hat you need to know • Check that the patient can hear and understand you, and is in a suitable place to talk • In the absence of other cues, the tone and content of speech is important • Gain information from an indirect physical examination by asking the patient to describe signs such as breathing and vital signs and rashes • Provide strong safety-netting and remember that a face-to-face consultation or home visit may be needed
  21. 21. UK & US • Up to a quarter of patient-physician interactions occur via telephone in settings such as US internal medicine and UK primary care. • 1 Telephone consultations have the potential to improve access, convenience, and choice and are the most common alternative to face-to-face consultations. • 2 Comparative studies show that patient are equally satisfied with both forms of consultation • 3 However, randomised controlled trials and time series studies show that telephone consultations do not necessarily reduce workload for clinicians.
  22. 22. MESSAGE TO DOCTORS
  23. 23. TAKE HOME MESSAGE

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