Sep 14, 2010
When Alexander Graham Bell invented his telephone in 1876 none including Mark Twain (American humorist) who spurned his invention then, had realized how this instrument would revolutionize communication to the extent it now has, encompassing almost every facet of human activity. Though telephone has revolutionized the communication system the world over this ubiquitous instrument (mobile phone) has now become the most abused and misused instrument by everyone and everywhere. But let us see the brighter side of it. We have heard of the potential health hazards caused by mobile phones. But the same mobiles are now being used as diagnostic tools and help save the lives of patients.
Yes. Telephonic medicine or providing clinical service through telephones has now become a reality the world over, though our country is just warming up to this idea. For, Indians who loathe group care or who are not able to appreciate or accept the concept of group care, telemedicine may not be something they willingly grab at the first opportunity. Dr G G Laxman Prabhu, eminent Urologist says that telemedicine can work wonderfully where hospitals or nursing care homes maintain up-to-date data on patients and in case when the patient is able to give necessary and timely feedback from his side.
Dr G G Laxman Prabhu got interested in this subject, thanks to a cancer patient and a nurse working in Indianapolis hospital. Having got interested, he has prepared a power point presentation on this topic which is dedicated to these two who were responsible for getting him interested in this subject. It this incident an Indian cancer patient who on his visit to India developed complications and tried to reach out to his hospital which helped save his life and the incident really touched his heart on realizing how telephone could be a portent weapon in saving lives. Of course telemedicine involves two people and a telephone call or even a SMS to be effective. Nonetheless, the entire gamut of telemedicine is not as easy as we generally envisage or believe it to be.
Boon or Bane?
It is certainly a boon says Dr GG as it is a portent weapon which may come in handy in the medical field. “Be it the landline or the mobile, telephone is the quickest to reach to the service provider i. e the hospital, nursing care or the doctor. With effective communication majority of the cases can be treated by giving proper advice even in emergency cases”, he states. But the danger stems from the fact that when not used effectively sometimes wrong advice may go across due to poor comprehension from both sides or the patient may end up calling someone who will not be able to help him/her. The mobile may be very distracting to the doctor if he is driving, examining a patient or while operating. It is also a tricky situation considering that there is very little time to give proper guidance and in the absence of body language it is slightly difficult to assimilate the gravity of the situation. Also, it offers no opportunity for second thoughts.
There is also the risk of lack of confidentiality in telemedicine especially in instances when patients are sensitive about making their sickness known to a third person. There is possibility of some one else listening to the conversation and hence the privacy factor might be lost.
In developed countries there is a well organized telemedicine service because of maintenance of adequate records and prescription for simple forms of medicine can be obtained by the patient or his relatives or caretaker by calling the doctor. In certain universities abroad training in telephone medicine is a small part of the curriculum, which is not part of the medical curriculum in India.
Telephonic medicines works in emergency services also, as apart from prescribing medicines or giving advice ambulance or other emergency services can be arranged within a short period of time.
What patients should do?
Before calling the patient should not where to call and it is always ideal to call the hospital/nursing care home or clinic where there is data base. If the doctor the patient asks for is not on duty it is always better not to disturb him/her and trust the doctor on duty and give a brief medical history. In order to do this the patient should always have knowledge of the diagnosis before he leaves the clinic whenever he goes for treatment so that he can give a proper background of the diagnosis when the need arises. Apart from keeping a pen and paper ready to take down prescription the patient should keep the prescription in front of him and tell the doctor the medicine/drugs taken by him, which makes the job of the doctor easy to give prescription. It is always better to be descriptive, being to the point while talking over the phone.
Another advice is it is better to call the landline because mobile is a personal instrument and there is no obligation for doctors who have the liberty to switch it off when they do not want to be disturbed. Patients cannot hold a grudge with the doctor for switching off the mobile because it is very personal.
Dr G G also says that patient should call the doctors during business hours as much as possible unless it is an emergency case that too to the clinic as the most favourable answer comes when the doctor is in the clinic. Patients should realize that the doctor is a human being and needs rest and leisure like other normal people.
SMS to the rescue
Even SMS service can be used by the patients effectively to avoid mistakes committed due to phonetic errors. In English language there are 9 letters which sound phonetically similar such as d and b, t and p, which might prove to be a costly mistake unless somebody is very proficient in taking orders on the telephone. In such instances SMS comes to the rescue of patients who can show the SMS and get the medicine as prescribed by the doctor.
However, Dr G G cautions that there are chances of SMS being misused if patients buy medicine which are not meant for normal consumption saying it is prescribed by the doctors. SMS cannot be a legal document but is just a facility which can be beneficial to the patients.
Dr G G recalls a funny incident caused by a SMS sent by one of his patients. One of his patients was fitted with a catheter and he told his caretaker to SMS him as soon as the patient passed urine. After a few hours he got a SMS from this caretaker of the patient saying “your patient passes away”. That was a frightening moment says the doctor who then went to his house to pay tribute only to find him happily chatting.
Is it a paid service?
The question that may arise now is how the doctor getting paid for the services he renders through telephone? Dr G G says “it is a mutual gesture and doctors usually don’t feel bad about it. We are not trained to think in that line”. But he says there are heartening instances of patients sending cheques for the telemedicine service provided. Dr G G recalls “I remember a retired cancer patient who was consulting me and the next day a cheque would follow. I was even feeling guilty to encash it”. However, he does not rule out the possibility of it becoming a paid service in future. Because in developing countries telemedicine and ensuing conversation consumes nearly 30% of the doctors’ practice time and a sizeable chunk of this conversation is frivolous.
“If it is a paid service then people will certainly think twice before calling and indulging in long, unwanted and inane conversation because they will feel the pinch knowing that the money they shell out will be according to the duration of their conversation”, says DR G G with a chuckle.
Despite the fact that medical care is just a telephone call away there is a flipside to it especially with regard to patients who make a big fuss for small issues and cry wolf every now and then. So when they are actually in need of advice or emergency service, help may not be forthcoming with the urgency it calls for, thinking it to be an instance of the boy who cried wolf. There is also a possibility of people calling the doctor frequently but unnecessarily which is even more irritable.
Tele Hand Shake
Dr G G says tale conversation has to begin with a tele-handshake which actually welcomes the caller to the conversation by extending the hand literally through voice modulation. The receiver has to greet the person and assure him with some kind of follow up action. The telephone receiver should be a good listener which helps the patients to realize that there is someone to listen to them. Many hospitals in the west prefer ladies preferably those who have raised children as it is realized that such women are better equipped to empathize and provide help to the patients. Moreover ladies can handle both men and women and will be very practical.
However, using telephone is an art which needs to be cultivated by providing proper training which is being done in western countries.
Mobile telephones use ads to the background radiation. Extensive and long usage of mobile is said to cause deafness, hearing impairment, headaches, sleep disturbance, memory lapse. Mobile radiation is particularly harmful to children.
Dr GG also advices mobile telephone users not to keep their mobiles under their pillow or near them during night time. The background radiation one receives from continuous use of mobile phone is said to be equal to 140 chest x-rays. His sincere advice therefore, is to keep away from mobile phones as much as possible and make use of this useful instrument judiciously.
Telephone no doubt is a multi-use instrument but it is left for us to use it prudently rather than get hooked to it or misuse it with playful levity.
Meet the Doctor...