Is the pandemic limiting patients’ access to a doctor?

Is the pandemic limiting patients’ access to a doctor? The answer to this question seems obvious. During a pandemic, we have a home warrant and doctors’ offices are partially closed. So what to do when we need medical attention?

Let’s start from the beginning: as banal as it sounds – access to a doctor has never been easy.

Getting for a consultation with a specialist under the National Health Fund or a private visit to a recognized authority has never been easy. There were long queues for visits to most of them and for specialist examinations. How is it today, in the age of a pandemic?

It sure is not better. You can’t even sign up for most specialists, because you don’t know when their offices will be open. All the forces of the medical sector are focused on fighting the virus … and meanwhile, other diseases still exist – people still have to heal their existing and emerging health problems.

Patients diagnosed with chronic conditions require prescription medications and may need to change medications to worsen or improve symptoms that they cannot accurately assess. There are also accidents and emergencies that require urgent diagnosis.

So we are faced with a dilemma: how to get medical help and solve our health problems, since most offices are closed?

A blessing from Dr. Google – but are you sure?

We all use Dr. Google’s advice, and not from yesterday. However, it takes a lot of knowledge or luck to extract what can really help us from the enormous amount of information on the Internet. Most studies are general or incomplete, and we can often find contradicting information on a given topic. Exactly, on a given topic … but what? How do we know that the symptom entered in the search engine is related to the pathology that affects me? Who is to make this diagnosis for me? How do I assign my specific symptoms to a diagnosis? And here Dr. Google does not have a simple recipe anymore.

How helpful are newsgroups?

There are and more and more new discussion groups exist on the Internet, the members of which are usually the patients themselves and each other advise what is best to do with specific symptoms. Quite simple in theory: search for a Facebook newsgroup discussing topics in a given area, enter your symptoms, and we get good advice from kind people on the spot. Should we not, however, reflect on the responsibility of the person who will share our advice? Even if he does so in good faith, we are not sure that this concern will not be counterproductive. And then what?

When my car breaks down, I don’t go to the hairdresser …

Referring also to the advice of random people on the basis of whom we want to diagnose, it is worth asking a broader question: whom do I want to entrust with the care of my health? Many years of medical studies are not only a pleasure, but a period spent on acquiring the knowledge necessary to provide help to patients. Can we believe that a reliable diagnosis can only be based on internet searches and questions on forums? It is certainly worth reading, but failure to visit a specialist may prove fatal for us. So we know: direction – doctor! But how, if the offices do not work?

Or maybe teleporting, i.e. remote consultation?

All in all, it’s worth considering. Certainly, the greatest value is that we talk to a specialist. Is it legal at all?

What are the advantages of teleportation?

The undoubted advantage of teleportation is no limitation by the distance between the patient and the doctor. There is no regionalization here. Both a patient from a small, remote town and a large city can benefit from the help of the same doctors, the best in a given specialty or recommended by friends. It goes without saying that you don’t have to travel saving costs and time. Moreover, teleportation prices are usually lower than traditional visits. It can therefore be an ideal solution in the case of a visit whose sole purpose is to issue a document – e.g. e-prescription, in the case of chronic diseases.

Another advantage is what happens today, in the age of epidemics. it is of utmost importance: we can get help no risk of contact with other people on the way to the doctor and with other patients and staff at the facility.

The last thing is ease of registration: usually the appointment and payment are made on-line, without the need to agree and confirm the dates by phone, or to check whether the transfer, which is the payment for the consultation, has already been booked.

There is no rose without thorns ..

Teleporting is not without imperfections or flaws, however.

First of all, without having direct contact with a doctor, it can be difficulties in conducting a clinical trial. There are specializations where the related problem may be smaller (when it is enough to send a photo of the skin in the case of a dermatological consultation), while a reliable assessment of the stability of the joint cannot be performed without a physical meeting of the patient with the orthopedist.

Effective medical consultation must assume the possibility assessment of imaging tests patient – that is, on the one hand, you should be able to send the test results, and then be able to explain your diagnosis based on them. In the office it is easy, because the patient can see the examination from the computer and can ask questions. This can be problematic during teleportation. Of course, it is also impossible to perform additional tests that could finally confirm the diagnosis, which may take place during traditional visits, especially in private clinics.

There is no teleportation the possibility of performing outpatient procedures – that is, dressing the wound, giving injections, which are often needed to help or reduce pain.

Another feature is securityin two aspects: First of all, in the office, we are sure that we only talk about our health problems with a doctor. How is it in remote connections? It can be the same if we make sure that the system provides an encrypted connection. If this is not the case, we take into account the risk that sensitive information may fall into the wrong hands. Second, teleporting is part of therapy and should be governed by the principles of medical information gathering and the protection of personal data.

A possible technological barrier, i.e. ownership, is a separate issue hardwareto teleport you. While rather everyone has a telephone, the use of a smartphone by older people is not a matter of course, as well as access to a good computer with a camera and Internet access, which will ensure uninterrupted communication between the patient and the doctor.

Check it out: Telemedicine – what is an e-visit?

Does teleportation always mean the same?

Of course not. Moreover, the type and manner of performing such remote consultation may significantly reduce or completely eliminate some of its disadvantages. Let’s take a closer look at it.

Some offices offer telephone consultation. This is probably the simplest form of contact and rather the most limited. We conduct an interview only by listening to what the patient has to say and by asking him questions, but we are not able to see him, examine him, or analyze possible tests that have already been performed. It will rather be helpful for patients who have already been treated previously by a given doctor or in a given facility, with a diagnosis, often to issue an e-prescription or extend the e-leave.

We can also get help by email. Here, during the consultation, the patient can attach the results of his tests, descriptions, images, photos, e.g. of his skin lesion.

The main problem with such a consultation is that it probably won’t end up with exchanging email once. The doctor, asking the patient about specific symptoms or clarifying the questions, writes subsequent e-mails and receives new answers. It is rather difficult to imagine the effective work of a doctor who diagnoses more patients in this way at the same time.

However, if the first two forms of contact were combined, the consultation would be quite good. The patient would initially describe his problem, send the available tests electronically and the doctor, after analyzing them, would call the patient and discuss what is needed and give further recommendations. Is that enough?

There are even better solutions: videoconsultation. So what additional gives us a video connection? First of all, it gives a much greater possibility of performing a clinical trial.

When it comes to, for example, orthopedics, which is rather associated with the traditional method of medical consultations, you can assess asymmetries, swelling, muscle atrophy this way, but also – if the patient cooperates properly and sees each other with the doctor – he can conduct a basic examination himself. clinical, which consists in touching and applying pressure to specific places. Assessment of soreness in a given site will help to differentiate orthopedic pathologies. In the same way, the doctor may recommend certain resistance movements or perform some tests, which further refine the initial diagnosis.

Let’s go a step further – is the rehabilitation of the patient possible in this form? Certainly, it is impossible to perform manual therapy, but it is possible to conduct rehabilitation after surgical procedures, reduce pain, establish an exercise program and supervise the correctness of their performance. Or maybe preventive medical training for those who want to stay fit safely? Absolutely. A physiotherapist can also advise the purchase or rental of rehabilitation aids – sensory pads, balls, tapes or electrostimulators, helping in a quick recovery or in the progress of training.

We have been observing recently a multitude of different systems and offers in the field of remote medicine. There are those that rely only on a telephone conversation, some provide connection using popular communicators. There are also systems designed solely for medical consultations.

Check: E-prescription during coronavirus. How does it work and how to use it?

What features should teleportation have?

What will be the most effective in terms of receiving medical attention?

1. The basic form of communication should be a secure, dedicated video call, as the form closest to direct consultation, enabling the best clinical examination of the patient. videoconsultation should be supported by e-mail communication (enabling the sending of research results and good preparation of both parties for the visit).
2. When arranging teleportation and sending test results, it is worth paying attention to whether the system provides data security and encryption. Sending data via ordinary e-mail and using popular messaging services does not have to be such. We should also make sure how our personal data and medical records will be stored.
3. Ideally, if the videoconsultation tool has split screen option the patient and the doctor, or the test results are visible on a second monitor at which the camera can be directed. In Vedas, the doctor can present his diagnosis by referring to the patient’s image pictures.
4. Theoretically, the doctor can connect with the patient from anywhere, including home – but on the other hand consultations conducted from the clinic’s office they ensure immediate availability of the necessary documentation and the certainty that nothing in the office will distract the doctor from the problem addressed by the patient. It is similar with physiotherapeutic teleportation – here you additionally need space to perform tests, exercises and access to the instruments necessary to give physiotherapeutic recommendations. Such conditions are difficult to achieve from home.
5. For the patient’s convenience, all of them elements of the teleportation process should be in one place: the patient should easily book an appointment with a specific specialist at a suitable time, having the current specialist’s schedule, pay for the visit while receiving a payment confirmation and receiving a link to the place where the doctor will be connected.

To sum up: it must be said that the epidemic has greatly accelerated the development of telemedicine. Many doctors, once expressing opinions about the low usefulness of such systems in health care, today implement them in their offices. There is little dispute that they are becoming and will be an important part of healthcare.

Then the physical meeting with the patient seems irreplaceable.

Back to the beginning of this article: Does the pandemic reduce access to a doctor? Theoretically yes, but in practice it also opens us up to new possibilities of using remote consultations.

Michał Drwięga

Orthopedic and Traumatologist specialist, Mirai Rehabilitation Institute

Also read:

1. Online medical advice at the National Health Fund. Where to call to consult a doctor?
2. How to become an e-patient? Take care of your health without leaving your home
3. GPs switch to telepaths. How will they work now?

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