Half of medical science goes wrong in 5 year, but nowadays that’s happening within days and hours, and information distributed via various channels with various biases and not appraised well are a risk to populations. The goal of care providers should be not only to do no harm but also to do better care for every patient.
The sudden giant leap of telemedicine enables the HCW (healthcare workers) to help patients while also keeping themself safe, preventing extreme risk of possible troubles, one of highest beneficial areas for that in current scenario are triage and counselling. While triage helps in identifying and helping patients who don’t necessarily need hospitalization and hence helping in breaking the chain of transmission, the counselling approach will be very helpful for many feeling anxious or depressed under effect of lockdown and also for correct information sharing and empowering to make better decisions and it will surely keep increasing as the curve grows. While it takes time to flatten or crush the curve, the HCW efforts and their empowerment with telemedicine will be a strong force in battle against Covid-19.
With this sudden boost in telemedicine and rising of various formal and informal networks providing teleconsult following are the challenges that should be ensured to the best possible level while keeping patient care as the first priority.
1) Data security and prevention from data breach.
2) Informed patient consent.
3) Verification of tele-consult providing doctors.
As providing the best possible care to the patient is the most important goal and reason to adopt technologies, these are a few important points I wish to bring notice to telemedicine providers for better clinical care.
- Take detailed patient history and record it. The SOAP notes (Subjective, Objective, Assessment, Plan) enables the documentation in a standard and organised way, other alternatives maybe using Narrative history by help of a volunteer or patient/care-take themself. The Detailed information is important to understand the condition of a patient, and make informed decisions to provide best possible care and also the record is available and shared in any format so it helps in continuity of care for the patient.
- Update yourself and follow standard guidelines. As research is happening at tremendous speed to fight the war against covid from every domain and social media enabling the fast paced knowledge transfer, false information or non critically appraised information have become a bigger risk. Research papers uploaded to preprints are interpreted in various ways and distributed via various media to the public in an exaggerated way, which is causing harm and even making their way even to guidelines which are not well appraised and not made by a good standard committee. In such scenarios it is better to follow standard guidelines, and keep track of national guidelines and updates as the changes are also happening fast. A learning network can help with that.
- Guideline based medicine is not enough. Firstly as most of Covid-19 cases are asymptomatic and total number of reported cases is around 6000, it is expected that most cases now will be of non-Covid-19 problems and providing only symptomatic treatment, or depending only on guidelines for the diagnosis may not be enough, rather it may be a bad practise. It’s important to understand the detailed history, and patient needs and then utilize the knowledge available and even help from doctors/specialists in the network whenever needed to make the best decisions. It is good to pause and reflect, use references and CDSS (clinical decision support system) and so critical appraisal of available research whenever needed. There is risk of exploding the curve and in that case Covid-19 patients will increase and telemedicine can be extremely helpful in caring for mild cases and asymptomatic positive cases who may need counselling and education. For Covid -19 various evidence based resources and even online courses are available online and free to excess and it will be good to learn from them early and be prepared to help maximum in the best possible way.
- Context specific decision making is important. For a patient from sealed hotspot area it may not be possible to go for walking to relieve their anxiety attack, or for a rural patient in area under lockdown it may not possible to find the medicine if prescribed the brand name rather than the generic name, so while advising a patient, it is important to discuss and understand the details for making right choices.
- Empathy and good communication is important especially when tele-consultations have no geographical boundaries in the country and patients connect from various different locations, languages, literacy level, etc. Every tele-consultation is a chance to educate people and hence strengthen our nation’s preparedness against the Covid-19 disaster and so it should be utilized well.
- Ministry of Health and Family Welfare (Resources & Training material) https://www.mohfw.gov.in/
- National Center for Disease Control – https://ncdc.gov.in/index4.php?lang=1&level=0&linkid=127&lid=432
- ICMR – https://icmr.nic.in/content/covid-19
- AIIMS Delhi – https://www.youtube.com/channel/UClhIpqB1ENbKtsWsVk0P_vg/videos
- Healthcare Workers Preparedness : COVID 19 by PGIMER Chandigarh https://www.youtube.com/watch?v=CPMEJuBLHOM
- Introductory Online TSI Telemedicine Webinar for Medical Doctors Registered and Practicing in India https://bit.ly/2yiKASd
- COVID-19 – A clinical update https://www.coursera.org/learn/covid19clinicalupdate
- OpenWHO – https://openwho.org/courses/
Database of publications
- WHO https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov
- BMJ https://www.bmj.com/coronavirus
- Cambridge University Press https://www.cambridge.org/core/browse-subjects/medicine/coronavirus-free-access-collection
- Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/index.html
- Chinese Medical Association http://medjournals.cn/COVID-19/index.do
- Cochrane https://www.cochrane.org/coronavirus-covid-19-cochrane-resources-and-news
- Elsevier https://www.elsevier.com/connect/coronavirus-information-center
- European Centre for Disease Prevention and Control (ECDC) https://www.ecdc.europa.eu/en
- JAMA Network https://jamanetwork.com/journals/jama/pages/coronavirus-alert
- The Lancet https://www.thelancet.com/coronavirus
- LITCOVID: US National Library of Medicine https://www.ncbi.nlm.nih.gov/research/coronavirus/docsum?filters=topics.General%20Info
- New England Journal of Medicine https://www.nejm.org/coronavirus
- Oxford University Press https://global.oup.com/academic/category/medicine-and-health/coronavirus/?cc=us&lang=en
- PLOS https://blogs.plos.org/plos/2020/01/novel-coronavirus-2019-ncov-outbreak/
- Science https://www.sciencemag.org/coronavirus-research-commentary-and-news
- Springer Nature https://www.springernature.com/gp/researchers/campaigns/coronavirus
- SSRN (Preprints) https://www.ssrn.com/index.cfm/en/coronavirus/
- Wiley https://novel-coronavirus.onlinelibrary.wiley.com/
1- SOAP Notes – https://www.ncbi.nlm.nih.gov/books/NBK482263/
2- WHO Coronavirus disease (COVID-19) Pandemic https://www.who.int/emergencies/diseases/novel-coronavirus-2019
3- Advice from Dave Sackett, the father of evidence based medicine – “Half of what you’ll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half—so the most important thing to learn is how to learn on your own.” – Smith R. Thoughts for new medical students at a new medical school. BMJ. 2003 Dec 20;327(7429):1430-3. doi: 10.1136/bmj.327.7429.1430. PMID: 14684637; PMCID: PMC300793.
AVINASH KUMAR GUPTA
Student Member DHIndia
Avinash Kumar is MBBS student, he self-taught IT and now learning Health Informatics while exploring the implementation process in User-Driven Healthcare Network (UDHC). He is an Ashoka changemakers Scholar, won 3 national hackathons, have delivered Android, Hybrid, Web, and VR projects.
Avinash is actively involved in patient-centred research and focuses on solving clinical and non-clinical patient problems using technologies available or innovate solutions feasible for patient needs. He also explores Improving Medical Education, Partnering with Public and Patients in Medical Research, Transhumanism, and Biohacking.