Approach to a Patient in Telemedicine

Posted by Shivani Jain on Tue, Feb 28, 2023  
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As we have already landed in the world of telehealth and telemedicine, there are few important considerations which  needs to be focussed upon while taking history by us as Clinicians and to be understood by patients in the process of teleconsultation.

Focusing on history taking first which we in our medical curriculum during graduation were taught before we digged into to knowledge of diseases. A detailed history taking is the key in teleconsultation even today. It includes asking in detail about the chief complains, duration, aggravating and relieving factors, past medical and surgical history, Family history, menstrual and obstetric history, any addictions, any allergies. It should also include history on diet, sleep, exercise, stress.

Emphasizing on this as we know history taking is important before examination in our general practice, similar should be our approach in teleconsultation. Only after a detailed history should we be asking for images or examination parameters like pulse, blood pressure parameters, BMI etc. One needs to be patiently listening to the patient as even patients are learning to have a teleconsultation and are not in routine to such a kind of a practice. Patients should be made as comfortable as possible; to remove the anxiety in them related to a teleconsultation and build the trust in patient doctor relationship.

Patients also need to cooperate clinicians in detailed and systematic approach of history taking and examination. Sometimes patients get irritated or no longer want to give a detailed history and want a quick resolution, this should however never be encouraged and may  this be explained to the patient while taking consent before the consultation.

I also want to emphasize here that the history taking Performa in teleconsultation should be different for every age group of patients as we do in physical consultation for e.g., Vaccination history, comprehensive Geriatric assessment, etc.

Doctors should keep the etiquette of a clinician like wearing aprons, behaving in a manner a doctor does in her/ his OPD. A telemedicine doctor should be trained in referring the patients as and when needed and managing the patient in a multidisciplinary approach.

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