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Doctor online and Ethics

Doctor online and Ethics

Today India is moving rapidly towards Digital India. A few doctors especially in small nursing homes and solo practitioners or in rural set ups are still not upgrading to keeping records on a Computer and issuing printed prescriptions. Computerized Receipt of fees is another essential. This may become mandatory post demonetization.  It is now a high time for all to shift towards computerized record keeping. Today many patients are seeking advice online from doctors they have never met. It may have some advantages viz no location boundaries, cost effective, privacy, convenience, better than self treatment, 24/7 support etc.  However, many are still out there who strongly believe that doctors’ clinical examination and history taking are important. The technology or putting computer screen between the patient and doctor denies healthy relationships and better health outcome.  So, the questions arise:

  • Are these online consultation services worth your time and money?

  • Are these doctors providing helpful advice?

  • Should one wind up the physical clinics altogether and give online advice?

  • Should one buy medicine online? Can it be abused?

The Tamil Nadu Medical Council has issued letters to doctors, saying that they’re not allowed to list their names on online doctor listing platforms because they believe that this tantamount to advertising. It also means giving medical advice without personally examining the patient, which looks unethical.  Doctors have always been considered to be trusted professionals, and one of the jobs of the medical council is to make sure that medicine is practiced ethically. Lots of senior doctors believe that listing names on directories cheapens the medical profession, because then doctors will be treated as business men rather than professionals. ‘By not allowing doctors to reach out to patients digitally, the medical council is actually doing a disservice, not only to doctors but to patients as well’, say some other doctors. Protagonists of online medical consultation on the other hand say ‘it bridges the gap between doctor and patient, and it allows patients access to far more information about their medical options than they could get in the past. This is a great way of creating trust, because when a doctor says something on his website or email, it is a written information which can be monitored, and the council can make sure that the information which is being provided is accurate’. Why are senior medical doctors, upset about doctors going online? It may be resistance against change!
With more than 100,000 registered users across 160 countries, iCliniq boasts more than 1,000 doctors available for online consultations. Sehat’s founder says with more than 10,000 doctors, the portal is visited by 12,000 to 15,000 users every day. Where should a doctor draw the line in prescribing medicine online without an examination? Is it possible for a doctor to know what’s wrong with a patient with so little evidence? Who will bear the legal liability if the treatment goes wrong: the technology platform or the doctor? A virtual consultation cannot replace an in-person visit. “A very important aspect of the medical field is to see and touch the patient. You would look at the eyes, nails and tongue. A loss of appetite and dizziness could be anything from simple gastritis to brain tumor. The complaints of loss of appetite and dizziness are common and an online advice for this symptom may bring casual prescription on cursory thought by the doctor, where the underlying cause may be overlooked. It could be related to the brain, joint pain, thyroid, inner ear, spinal cord, eye problem, epilepsy, migraine. How reliable such a consultation may be?
Computer use during clinical examination

Patients want their physicians to look at them — not their computer screens — while in the exam room, a study has shown. Fewer than half (48%) of the patients of physicians with heavy computer use during clinical encounters rated the care they received as excellent on patient experience surveys, whereas the majority (83%) of patients whose physicians were less engaged with their computers during the encounter felt the care they received was excellent. High computer use was also associated with observable communication differences. “Although social rapport building can build trust and satisfaction, concurrent computer use may inhibit authentic engagement, and multitasking clinicians may miss openings for deeper connection with their patients. Negative rapport building may be an unintentional consequence of the electronic health record.”

Because the implementation of electronic health records appears to influence communication between healthcare providers and patients, particularly those serving populations with limited health literacy, educational and cultural improvement efforts should be undertaken to “support clinicians’ use of the electronic health record in ways that enhance their capacity to communicate with and care for diverse patients”. “Our challenge is to find the best ways to incorporate computers in the examination room without losing the heart and soul of medicine: the physician-patient relationship.” For example, physicians can preserve face-to-face time with patients by revisiting “the time-honored habit of reviewing the patient’s medical record before entering the examination room”. They also recommend spending the first couple of minutes of the visit engaged in dialogue with the patient without the computer. “Using the computer during information-gathering segments of the visit is both appropriate and expected by patients,” they explain. Routinely turning the screen to the patient so he or she can see what is being typed helps patients feel like partners in the care process, and it can also help with patient education, serve as a launching pad for discussions about health habits, and reinforce post visit instructions.

History taking and examination of the patient cannot be sacrificed in the garb of modernization or computerization!


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