Getting used to telemedicine

Almost daily, my colleagues and I now receive requests for consultations through our institution’s Facebook page. To protect patient privacy and ensure personalized, appropriate care, such inquiries used to be deflected by encouraging the senders to consult directly with a physician. However now, in the time of COVID-19 when face-to-face consults can be both impractical and unsafe for clinicians and patients, there has been a paradigm shift in how we handle such inquiries, giving rise to an unprecedented need for an ethical and safe practice of telemedicine. Telemedicine isn’t new, but platforms and support for it have risen since the pandemic. Roadblocks to accessing health care, already a challenge for a vast number of Filipinos before the pandemic, have multiplied in the last few months. A paucity of options for public transport, dwindling incomes, and fear of venturing outdoors and contagion with the novel coronavirus have compounded previous difficulties in seeking face-to-face consults. Older physicians, who may continue to practice long after middle age, as well as those who are at risk of severe illness from COVID-19, likewise are reluctant to resume clinics or to do procedures back in the hospital hot zones. And yet patients continue to suffer from non-COVID-19 illness: consults must be made, follow-ups done, treatments prescribed, prescriptions given.

In the face of these difficulties, doctors who would never have dreamed of using social media for their practice have turned to telemedicine. The Department of Health as well as individual hospitals have endorsed their own televisit hotlines. Several platforms and websites can help patients look for providers. However, the most accessible and free application for most Filipinos is still Facebook, which is used both as directory and as a platform for appointments. The number of professional Facebook pages for doctors and group clinics has surged since the start of quarantine. It’s a boon for those in need of televisits, as well as for health practitioners whose practice has also been affected by the coronavirus.

Needless to say, telemedicine presents its own risks and limitations. Physical examination, a cornerstone of diagnosis, is severely limited in online consults. Many physicians continue to be uncomfortable with online visits and may also have difficulty building rapport or understanding patient concerns clearly. Privacy concerns exist both for vulnerable patients, and for physicians whose responses and consults can be recorded without their knowledge or consent. Payment schemes differ among platforms, which may cause inconvenience and embarrassment. Trouble is taken to look for encrypted connections and secure platforms (of which Facebook might not be one). Adequate consent forms are needed before formal consults. Questions about etiquette and ethics abound. In a profession for whom self-advertisement is famously limited, what is the role of Facebook pages, which are often curated, to have regular postings of lay-oriented medical content?

Given these limitations, televisits are clearly not ideal for some, and many still long for the ease of conventional consults. However, it may also be said that there has been a clamor for a safe, supported and consistent practice of telemedicine even before the onset of the pandemic. Those with limited mobility, those with poor access to transport, and those in more remote or underserved areas have long needed access to telemedicine consults and support for e-prescriptions. That a pandemic was needed before these options could be this widely recognized and supported shows that we have a long way to go in optimizing options for care for vulnerable and underserved groups. Hopefully, long after the pandemic is over, the willingness to use telemedicine when necessary will remain.

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