On the moment of 100th Pulmonology Teleconsultation

COVID19 has created unprecedented crisis and challenges particularly to the health care setting where it has given significant blow to the existing "Doctor-Patient" relationship.

Particularly in India, where we would have seen images of "No calls / No messages / No WhatsApp consultation" in OPD clinics of many doctors owing to the legal issues related to this type of "Teleconsultations", The Board of Governors (Medical Council of India) was very quick to formulate and publish the "Telemedicine Practice Guidelines"(TPG) dated March 25th, 2020 - on the first day of the nation wide lockdown.

The journey of Pulmonology teleconsultations at our institution began in the month of April, 2020 with the intention of providing “safe health care” to the chest symptomatics. As we all know, cough/fever/breathing difficulty are the principal symptoms one looks for Pulmonologist - and unfortunately the same symptoms also represent COVID19. Therefore, patient safety posed a significant challenge which remained the driving force to initiate the program.

And today, in very short time frame, we reached 100th Pulmonology teleconsultation. In my experience, patients & relatives appeared relatively happier and expressed less complaints then their earlier formal OPD consultations. I gained insights on their daily living, their practical limitations and ingenious solutions - elaboration of which is beyond the purpose of this blog.

Here I am writing this blog to share few practical points to smoothen the teleconsultation for betterment of patient care.

• Scheduling appointment is the very crucial first step. Ensure your dedicated quality time during entire teleconsultation
• Check your devise (Camera & Sound) and internet connection at least 5 minutes before beginning
• Do study the patient’s reports or previous consultation notes before beginning : so that the conversation is not interrupted. Take liberty to study them in mid of teleconsultation if needed and show curtesy to call back
• Keep the device at appropriate distance so that your face, hand movements & gestures are visible. Preferable to do teleconsultation from work place which adds professionalism
• Do not cover your face with the mask/cap/face-shield while doing teleconsultations. It is always good to have specific batch time of teleconsultations rather than seeing them in between routine OPD patients where one has to wear personal protection
• Greet the patient & accompanying relative: Just as it is done in formal visit. Always ask whether you are seen & heard properly and convey the same back. Use “Thumbs Up” sign to communicate if all is acceptable
• Always mention the patient's name, identification number as well as date & time of Audio-Visual teleconsultation for the purpose of accurate documentation
• It is of immense importance to document “First Time consultation or Follow Up consultation” - as it has bearing upon prescribing medications. Please refer to Telemedicine Practice Guidelines for further guidance
• Do mention the date of last consultation along with the mode : in-person or Audio-Visual Teleconsultation. Please keep a note of the date of last formal OPD consultation
• Make a list of patient’s complaints : also document minor complaints
• Document Pulse, SpO2, Blood pressure by getting assistance from patient’s relatives if possible. In absence of availability of instruments, mention level of consciousness, ability to perform triball exercises, ability to complete a sentence in one breathe etc. form which an impression of general status of patient can be structured
• Ascertain that a probable diagnosis can be achieved from the information gathered and a confident prescription can be generated. If slightest in doubt, must call patient for in-person consultation. A prescription must contain PROVISIONAL DIAGNOSIS
• Do mention, In-spite of consent taken, the limitations of teleconsultation : that is inability to examine with stethoscope/ auscultate. However, do reassure the patient that the condition can be managed over the said medium & not to hesitate from informing any of adverse events
• Always inform that the “E-prescription” will be available in one or two hours via e-mail/WhatsApp or the particular medium & it bears the same level of significance as formal OPD prescription, based on which any pharmacist can deliver medicine
• Doctor’s identity, registration number, hospital logo & official signatories has to be on the prescription generated
• Adhere to the specific lists of medications (Like list O, A & B) as described in TPG
• Do mention the date of next visit with particular emphasis on requirement of formal OPD consultation or not.

I would like to conclude from my experience that Teleconsultation has been proved to be a boon for patients by providing them care while keeping them safe.