I am a neurologist treating disorders of brain, spinal cord and nerves. I like educating public and doctors about various aspects of neurological illnesses. This blog is an attempt towards the same. I work at Apollo Hospitals, (Jubilee Hills and Kukatpally branches), Hyderabad (phone-0091-40-23607777/60601066/9618204512; firstname.lastname@example.org)
For ONLINE CONSULTATION, please click on the icon on the right hand side for details.
TELEMEDICINE CONSULTATION IS AS GOOD AS TRADITIONAL CONSULTATION FOR NONACUTE HEADACHES
The traditional method of consultation involves a patient visiting a doctor's clinic. The doctor takes history, performs clinical examination, orders investigations (as necessary) and prescribes medicines. This is the "gold standard" when it comes to accurate diagnosis and correct treatment.
However, there are a number of limitations for the traditional method of consultation:
1. Lack of time on the patient's side due to his/her work/family assignments;
2. Lack of a specialist in his native place;
3. Limited number of choices of specialists in his native place;
4. Higher costs (travel costs, need to skip work, etc).
In this digital era, telemedicine consultations are feasible. This could include email chatting, audio or video consultation. By this method, a patient can choose a doctor in any part of the world, timing of consultation can be flexible and the costs are lower.
However, the major concern is the accuracy of telemedicine consultation. This issue was addressed in a recent research in patients with nonacute headaches. About 200 patients were treated on the basis of telemedicine consultation and another 200 patients with traditional method of consultation. At the end of one year, there was no difference in the outcomes in either group.
There is a fear of missing secondary causes of headache such as brain tumor, bleeding in brain, infection of brain, etc. One would need to provide 20,200 consultations by telemedicine to miss one such case. That is an extremely low risk.
In conclusion, telemedicine consultation seems to be an ideal alternative to traditional consultation for patients with nonacute headaches.
This study was published in recent issue of Neurology Journal (July 14, 2017 issue) and can be accessed at the below link:
Almost all doctors
see patients in OPD and it is the most important aspect of patient care for a
physician. For a surgeon, OPD consultation is important to counsel patients
regarding surgery after discussing the pros and cons of the procedure.
What factors determine the success of OPD
There are several
aspects of OPD consultation that determine whether it was successful or not.
These include: 1. Whether doctor carefully listened to patient’s problems or
not? 2. Whether the doctor was pleasant or not? 3. Whether adequate time was
allotted for the consultation or not? 4. Whether adequate information was given
regarding diagnosis, investigations, medications, treatment, prognosis, etc or not?
Of all of these, the duration is consultation is probably one of the most
How long should an ideal OPD consultation last?
There is no
uniform guideline regarding the optimum duration for an OPD consultation.
Doctors complete an OPD consultation in as little as 3-4 minutes, and some
doctors spend almost an hour per patient in the OPDs. Spending more time would
increase patient’s satisfaction, however, that is not the only criteria ensuring
Longer duration of
OPD consultation would limit the number of patients a doctor can see per day.
This would lead to long waiting periods. Is it advisable, when there are so few
doctors seeing so many patients?
Duration of OPD
consultation can increase without necessarily increasing the efficiency of
diagnosis and treatment. For example, patient may try to discuss in detail
certain irrelevant history (symptoms or past treatment) or he may bring volumes
of old documents, which may not be relevant. He may discuss certain facts that
he “half-learned” from the Internet, which may not be relevant to the case.
Some patients are very talkative and it is difficult to stop them.
What is the best strategy?
doctors know the relevant factors in history taking and examination. Doctors
should guide the discussion in OPD, and politely point out if the patients are
drifting away. Most important points can be discussed in 8-10 minutes. In any
case, patients on average remember only three points from an outpatient
consultation. So, there is no real point in overloading patients with too much
information in a single consultation. Also, not all patients require the same
amount of time. For example, a regular patient coming for diabetes or
hypertension medications may not take more than 3 minutes, if sugar and BP are
normal. On the other hand, an elderly patient with multiple comorbidities on
multiple medications may take 15 minutes. So, the duration can be tailored as
per the needs of the patient. On an average, 8-10 minutes per consultation
This article was first published in www.docplexus.in Can be accessed at the following link-