TELEMEDICINE CONSULTATION IS AS GOOD AS TRADITIONAL CONSULTATION FOR NONACUTE HEADACHES

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:

http://www.neurology.org/content/89/2/153.short

DR SUDHIR KUMAR MD DM
CONSULTANT NEUROLOGIST,
APOLLO HOSPITALS, HYDERABAD
drsudhirkumar@yahoo.com
04023607777/60601066

OPTIMUM DURATION OF OPD CONSULTATION

WHAT IS THE OPTIMUM DURATION OF OPD CONSULTATION?

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 consultation?

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 important factors.

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 patient’s satisfaction.

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?

Most experienced 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 would suffice.

This article was first published in www.docplexus.in Can be accessed at the following link-

https://www.docplexus.in/#/app/posts/5cdf6cab-03fe-4e12-934a-cd4d472fbc23

Image above is for representational purpose only

Dr SUDHIR KUMAR MD (Internal Medicine), DM (Neurology)

Senior Consultant Neurologist

Apollo Health City, Jubilee Hills, Hyderabad

Phone: 040-23607777/60601066

Email: drsudhirkumar@yahoo.com