Ethics and Decorum of Telemedicine in the phase of COVID-19

During this global crsis of COVID-19, telemedicine  has emerged as an effective and sustainable solution for precaution, prevention and treatment minimize  the   spread of COVID-19. Telehealth is an innovative and valuable mechanism which is mending gaps between people, doctors and health systems. It is cost effective and time saving service access for promoting patient wellness and population health.

History takes us back to the age of Alexander Graham Bell,when the world’s first telephone call made by him on March 10, 1876 was actually a request for medical help. “Watson, come here I want you,” he said after acid from a Leclanche cell fell on his hand. This platform of telemdicine is growing ever since and has advanced into modern technologies through not only audio aids but also video and  other social media groups. This virtual digital healthcare is the roadmap for improved medical care. However,there are unique challenges on this road of telehealthcare.

Telemedicine is demanding at both ends including patients and as well as clinician. The advisory suggest few tips to the professionals and patients to benefit equally from tele-consulatations

• It is advisable to have good internet speed minimum 3 mbps with good quality of webcam  for clarity of audio and video. Always  ensure microphones and softwares are tested before the appointment.
• It’s the duty of every new patient to keep the clinicain abreast of his past medical records and keep it ready before hand. A note pad with a pen  will ease the queries and can be easilly jotted down.
• A  doctor should also be equipped with digital health records of previous patients including chief complaints for follow up consults to conserve time  and making it productive while consultation.
• To be punctual goes for both. The virtual visit takes advantage over real.  The notification system, such as through email or text, that lets patients know when doctor is ready to see patient and viceversa.
• Setting up a professional space for e-consultations which is clean and free from background distractions adds comfort to patient privacy and patient feels secured.
• An eye contact while video consultation is important and its best  to sit on chair with table and to avoid couch or bed. This reflects professionalism and makes your patient feel heard and appreciated.
• Keeping a lag time in mind is important. It is suugested to wait about 2 seconds before speaking to allow patients words to come through clinicians end and viceversa.
• The outlook of doctor gains confidence in patient. The attire should simulate the same as in person consultations at the hospitals. It could be formals or scrubs or white aprons.

In the Hippocratic text titled Decorum, doctors are instructed to “dress decorous and simple, not over-elaborated, but aiming rather at good repute, and adapted for contemplation, introspection and walking”. The essence of decorum reflects the neatness, professional demeanor and vitality of the practioner. One thing that distinguishes the doctor from the patient in this encounter is appearance.

 

To maintain the decorum and ethics at telehealthcare is the need of an hour. On 12th May 2020, the Board of Governors, Medical Council of India with the previous sanction of the Central Government of India, passed new regulations called “Indian Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations, 2020”. These regulations and guidelines incorporate the practical framework and has tried to address the current need and significance of telemedicine during coronavirus.

There is a growing body of evidence suggestive of patient’s perception of a doctor’s character influences health outcomes. Patients are more likely to be satisfied and  honest with doctors on the basis of their outlook. Displays of empathy,  trust ,  good code of conduct have shown better outcomes in patients struggling with conditions including depression, obesity, diabetes, hypertension etc. Doctor’s consultations have a placebo effect on patients.

It is well said by  William Osler “ A good physician treats the disease; A great physician treats the patient with the disease”. In the current scenario, lets pump our syringes with compassion , empathy, decorum and ethics to deliver quality care to our patients through telemedicine.