Telemedicine as lifeline

Over the past year, we have seen telemedicine—i.e., the use of telecommunications technologies for different aspects of health care—become a regular feature of medical practice in the country, as COVID-19 cut off face-to-face consultations. Once a novelty conceived for distant communities or reserved for individuals unable to leave their homes, it has become the first point of encounter between doctors and patients; once a fringe pursuit and even a frowned-upon terrain, the internet has now become an even more essential domain in clinical medicine.

This is a welcome development. Actually, this is where we had been heading anyway as a society; the pandemic only served as a turning point. This digital exodus holds the potential to enhance health literacy and, more importantly, make health care accessible to their patients by bridging geographic, socioeconomic, and physical barriers to care. It also allows doctors to continue their livelihood at a time when many people couldn’t go to their clinics.

“Of course, there are obvious limitations,” shares Dr. Kriselda Tan, a PGH-affiliated pulmonologist who has practiced telemedicine since the pandemic started. “In the first place, you cannot do a physical exam; sometimes you have to ask the patients themselves or their family members to do some observation and palpation… I have learned to rely on visual cues, which is why I ask patients to put their video on.

“There are also connectivity issues. Slow internet continues to bedevil us. I use platforms like Zoom or Google Hangouts, sometimes they have a hard time connecting and I just ask them what they’re familiar with and use that instead—for instance, Viber or Facebook Messenger.”

She adds that there are less obvious challenges: ”Doing an online consult takes a little more energy.”

The medical community has labored to address these challenges, and then some. In the first few weeks of the ECQ, as many doctors opened Facebook pages in a bid to make their online presence felt, the Medical Informatics Unit of UP College of Medicine led by Dr. Iris Isip-Tan, published “Telemedicine: Guidance for Physicians in the Philippines,” which identified core competencies including “webside manners,” hardware and software considerations, and ethical issues such as privacy and confidentiality.

Crucially, around the same time, the Department of Health and the National Privacy Commission issued a joint circular facilitating the practice of telemedicine by affirming it as a legitimate form of medical practice—and, for the first time in our country’s history, allowing electronic prescriptions.

One year later, in a roundtable discussion organized by UP Manila’s Telehealth Committee that I had the opportunity to participate in, equity emerged as one of the biggest challenges. As Dr. Anthony Cordero, a community medicine practitioner, pointed out in the discussion, health systems strengthening and addressing social determinants of health are fundamental if telemedicine can reach marginalized communities. Without the existence of a functioning referral network, e-consults can only do so much, especially at a time when many people need actual hospitalization. And, of course, without cultural sensitivity (e.g., understanding people’s concepts of health and speaking their language), telemedicine will be as insufficient as its face-to-face counterpart.

In spite of these concerns, telemedicine continues to hold promise to do a lot of good during the pandemic and well beyond. Especially now, during the surge of COVID-19 cases, the DOH is making a renewed push for telemedicine through its partners, LGUs, and own hotlines (1555 or 02-894-COVID). Telemedicine is providing a lifeline to individuals and families dealing with COVID-19 in their homes.

I saw this firsthand when Dr. Kriselda Tan—also my classmate in the UP College of Medicine—provided timely guidance to a relative of mine, helping her get through critical moments in her COVID-19 trajectory. Through Dr. Tan’s intervention and those of our medical colleagues, I saw that while there are obviously things that telemedicine cannot do, there are many things it can, including the oft-ignored functions of medicine beyond diagnosis and treatment: Helping people make sense of their experiences, giving them direction, alleviating their anxieties, and offering them hope.

Despite the limitations posed by the pandemic, medicine is finding its way to people, and the least we can do is to support telemedicine in its promise to help bring health to all Filipinos.

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