IMA View Point: Virtual Clinic viisitng the doctor in an online setting - Guest post Dr K K Agarwal

Dr K K Aggarwal 1. As per a Supreme Court judgment one should not prescribe medicine on a telephonic consult unless it is an emergency. But this does not apply to counselling and advice. Even government of India runs help lines on mental health, tobacco cessation, child sexual abuse etc 2. Today a new trend called virtual visits is available through video conferencing apps that download to a smartphone, tablet, or home computer. 3. Patients can experience a “virtual” visit with a qualified physician at any time, day or night. Its not just a fad. The benefits go beyond triage. It’s a step towards remote, affordable, convenient primary health care. 4. In the west the cost can be half of in-person visit, and most insurance companies are now covering them. In US Blue Cross policies, offer their own virtual doctor services free of charge. Medicare does not cover virtual visits. The cost of a virtual visit can be even less than the out-of-pocket co-payment that Medicare requires for an in-person doctor visit. 5. In US, the consulting doctors are licensed, vetted and are assigned to you based on where you live. They carry malpractice insurance and authorised to order tests and prescriptions. But without seeing in person, their ability to assess a patient is limited. 6. In a consult there are limitations. A physician can look at your rash, but can’t examine the back of your throat or listen to your lungs. In depression it may make no difference but in abdominal pain one needs a physical examination. 7. The care may be no different. People who go to a virtual visit are just as likely to have a follow-up appointment in the next few weeks, have similar antibiotic prescribing rate but one is most likely to end up with a broad-spectrum antibiotic and less specific drugs and specific tests like in strep throat. 8. In US Two of the most widely used are Teladoc (www.teladoc.com) and Doctor On Demand (www.doctorondemand.com). 9. Virtual visits aren’t meant to replace doctor’s office visits but may be a good option for minor, temporary problems (cold, flu, sinusitis, a non strep sore throat, rash, diarrhoea, vomiting, or conjunctivitis ― particularly in odd hours or for follow up visits. 10. It’s best to see your regular doctor as soon as possible.

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