The document discusses the role of telephone and online consultations in modern medical practice, highlighting various types of consultations such as day-to-day requests, follow-up calls, emergencies, and services for senior citizens. It also addresses the risks associated with telemedicine, emphasizing the importance of actual examinations and outlining necessary precautions based on legal precedents. Finally, the document notes that while telephone consultations can enhance access and patient satisfaction, they may not effectively reduce clinician workload.

1. TELEPHONE & ONLINE
CONSULTATION
IN
TODAY’S MEDICAL PRACTICE
DR. AVINASH BHONDWE
Family Physician

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. TELEPHONE

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. DAY TO DAY CALLS
MINOR AILMENTS
SYMPTOMS NOT IMPROVED
NEW SYMPTOMS
ANXIETY
DIET
A KNOWN HEALTHY PATIENT WITH SIMPLE
COMPLAINTS- SNEEZING, HEADACHE,
HYPERACIDITY

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. 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. EMERGENCIES
• ACCIDENTS
• MIDNIGHT CALLS
• UNWELL CHILD
• SEVERE REACTION
• ALARMING
SYMPTOMS-
 Chest Pain
 Hypoglycemia
 Unconsciousness
 Abdominal Pain
 Breathlessness

9. ADMISSIONS AND POST DISCHARGE

10. OUT OF STATION PATIENTS

11. SENIOR CITIZENS

12. WHATSAPP

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

15. 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.

16. ONLINE CONSULTATION
• FACEBOOK PAGE/ MESSANGER
• WHATSAPP
• QUESTIONS ON HEALTH AND DISEASES
• CHAT WITH THE DOCTOR

17. TELEMEDICINE
• PATIENT AWARENESS
• REMOTE VILLAGES
• GOVT APPROVED SERVICES
• OWN SITES CONSULTATION

18. RISKS
• HISTORY
• MISLEADING INFORMATION
• THE SYMPTOMS ASSESSMENT IMPROPER
• CLINICAL EXAMINATION
• CONSENT
• DOCTOR PATIENT RELATIONSHIP
• CONSEQUENSES

19. A DECISION OF HIGHCOURT

20. 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.

21. 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

22. 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.

23. MESSAGE TO DOCTORS

24. TAKE HOME MESSAGE