There should be some guidelines for The Telephone Consultation and Online Practice. There were some cases when doctors treated the patient on telephone & were involved in some litigations .

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