Your doctor will see you now - online
Published on
02 Aug 2020
Published by
The Straits Times
Telemedicine being used more widely amid pandemic as patients are more receptive to it
Ms Greta Susan d'Rozario is 86 and she recently completed two video-call consultations with her doctors last month.
Her verdict? She said there was "not much" difference between seeing her doctor in person and online.
Ms d'Rozario, who has mild cognitive impairment, diabetes, high cholesterol, hypertension and gout, met her doctor online for her regular follow-up sessions.
Her niece-in-law, Mrs Audrey Wee, 71, who had helped her attend the online session with Dr Alexander Yip at Alexandra Hospital (AH), said: "Dr Alex wanted to see how her gout is and she... showed him her knees and he was satisfied that there's no flare-up.
"I think it works somehow... It also depends on the type of illness you have."
And now, Ms d'Rozario is happy to continue with the online sessions, as it allows her to avoid going to the hospital in this Covid-19 pandemic. The medication that she needs is sent straight to her home.
The convenience is also what Mrs Wee appreciates. It used to take her a whole day to accompany her aunt-in-law, who lives alone, to the hospital as she had to travel from her place in the east to Ms d'Rozario's place in the south-west of Singapore.
Telemedicine has taken off in a big way here - and around the world - thanks to the Covid-19 pandemic, as more patients are willing to consult their doctors over video calls instead of in person.
Home-grown telemedicine apps like Doctor Anywhere and WhiteCoat have reported spikes in usage.
These apps were mostly started in the past few years. It was mainly the general practitioners who were using them to see patients who may have minor ailments such as the common cold and acute gastroenteritis.
Now, with Covid-19 in the picture, more doctors, including specialists, are using telemedicine to see a growing group of patients - and it can be a patient with anxiety, or a chronic condition like hypertension.
The Singapore National Eye Centre also started using it for its stable glaucoma patients during the circuit breaker period.
Those doing rehabilitation work may also use telemedicine or tele-rehabilitation at hospitals like AH and Changi General Hospital (CGH).
In June, CGH launched this for services like geriatric occupational therapy, speech therapy and physiotherapy, while Khoo Teck Puat Hospital, for instance, now offers tele-rehabilitation for speech therapy and physiotherapy.
Dr Lee Chun Tsu, AH's co-lead in vCare and associate consultant of AH's chronic programme, said that the hospital started planning for telemedicine, targeted at patients with complex chronic medical conditions, at the end of last year.
AH's vCare programme piloted on Feb 20 with just five patients trying out video consultations for the first time, but by June, the number of new cases had shot up to 133.
"The mindset of patients changed with Covid-19, so the take-up of telemedicine actually accelerated. The second thing is that hospital administrators are now more receptive to telemedicine," Dr Lee said.
Professor Lee Chien Earn, SingHealth's deputy group chief executive (regional health system), said that the health cluster's institutions have been ramping up existing telemedicine services and introducing new ones to ensure patients continue to receive the necessary care without having to make frequent trips to the hospital during the pandemic.
Earlier this month, social service agency Lions Befrienders Service Association started working with various public hospitals in an effort to help 6,000 seniors in rental flats access telemedicine services from next month, said Ms Karen Wee, the agency's deputy executive director.
These can be follow-up consultations for chronic conditions and allied health services such as physiotherapy, for instance.
The telemedicine push here received a boost when, in early April, the Government allowed patients to tap their Community Health Assist Scheme or Chas cards and Medisave savings to pay for video consultations for seven chronic conditions, including diabetes, hypertension and lipid disorder, and four mental health conditions, like schizophrenia and anxiety.
This will allow patients whose conditions are stable to avoid a physical visit to the clinic during this period of heightened alert due to Covid-19.
"It's essentially a changing of the times, right? The greatest criticism of telemedicine has always been the de-personalisation of the patient-provider experience.
"But this attribute in this current Covid situation is its greatest asset," said Dr Yip, who is also the clinical director of healthcare technology at AH.
Dr Lee said telemedicine is used only for later consultations.
"In the first clinical consultation, we meet the patient and their family in person and to build rapport. Also, as part of the medical assessment, we perform a full physical examination, which we can't do if this is a video consultation," he said.
Telemedicine, however, does have its detractors, whose various concerns include those relating to privacy and data security, and also that a severe condition can be easily missed.
In a May letter to the Straits Times Forum page, Dr Sitoh Yih Yiow, a geriatrician, cautioned against the unbridled promotion of telemedicine in the care of older people, who are vulnerable to precipitous declines in their health, require close monitoring, and often have atypical features when sick.
He said patients often assume that technologies such as telemedicine may safely substitute for in-person consultations, but a person reporting symptoms suggestive of a "simple" urinary tract infection via a video call may in fact be cold and clammy and in danger of impending septic shock.
He also said there is a need for the authorities to clarify the medico-legal responsibility of doctors who choose to diagnose and treat patients through telemedicine.
Dr Tan Yung Khan, a urologist in private practice, who prefers to use telemedicine for follow-up consultations and not to see new patients, said: "Doctors diagnose with all the senses. We need a good history, hear the patients' lungs and heart, touch them to assess pain and movement. Smell comes in too."
A physical examination helps doctors to order appropriate tests. In the absence of one, doctors will have to rely on more imaging tests.
"This may inadvertently lead to a higher cost for patients. Doctors may want to practise more defensive medicine, especially since the new sentencing guidelines for doctors seem a bit harsh," said Dr Tan.
A committee set up last year to improve the disciplinary process of the Singapore Medical Council on July 15 issued sentencing guidelines for errant doctors.
Also, patients will need to be fairly comfortable with technology - plus have an Internet connection - to embrace telemedicine.
The pandemic has clearly hastened the adoption of telemedicine as an acceptable mode of care. While treating patients from a distance has its challenges and needs to be handled with care, it appears to point to the way forward.
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
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