Tuesday, September 06, 2011

Why online consultations are often more efficient than face-to-face consultations

The traditional mode of communication between doctor-patient has always been face-to-face. This has always been the gold standard, and it is believed that the best way of enhancing the doctor-patient relationship is to allow the doctor to see the patient , talk to him and touch him. While there is no doubt that talking to a doctor can be extremely reassuring for the patient, it's also true that it's becoming increasingly hard to do face-to-face consultations. Commuting to visit the doctor is no longer a trivial exercise in many cities; and given the fact that there are very few doctors and too many patients , results in patients having to wait for hours on end to see the doctor . This is often a complete waste of time and causes patients a lot of angst and anxiety.
However , my point is that often the quality of medical care provided is better as a result of an e-mail consultation , rather than a real life consultation ! This may seem a little counterintuitive , but let me explain.

There are often problems with communicating information during the traditional clinic visit. Patients are often stressed-out , and may forget to provide some important information in their medical history. They may also forget to ask the doctor some key questions, resulting in the dreaded “doorknob syndrome” ( Oh, by the way , doctor…). Many considerate patients are so worried that the doctor is extremely busy and has lots of other patients to see, that they often end up becoming victims of the “don't ask , don't tell syndrome”. This is why so many patients are often dissatisfied at the end of the consultation, and kick themselves for not asking key questions.

However , the problem is not just with patients – it’s with doctors as well ! For one thing , not all doctors are experts in the particular problem which the patient may have. They may not know enough about how to treat the problem - or they may just not be very interested in handling patients with those kinds of medical issues.

Often , doctors are very starved for time and they need to ensure that they see patients quickly so that they can continue performing their clinical duties efficiently . This is why they will try to expedite patient flow . Sadly, this often means that they can only provide 7 to 9 min. to talk to the patient . In this compressed time frame, it's extremely difficult both to get information from the patient; or to communicate in such a way that the patient will remember the doctor’s advise. This pressure of time creates a lot of stress both for the doctor and the patient.
Finally , doctors are human beings too. They have bad days . They may be distracted or they may be stressed out , as a result of which they may not be on their best behavior during each and every consultation.

One solution to this problem is to encourage e-mail consultations. Rather than being a second-class alternative, often the signal-to-noise ratio as regards the exchange of medical information between patient and doctor can be much higher as compared to a real life consultation !

If the doctor provides the patient with a structured form to fill , the patient can take as much time as is required in order to make sure that he provides all the important details . In case he forgets or is confused , he can refer to his old records in order to make sure that the information he provides is accurate and up-to-date . Since this puts the burden of providing the information on the patient , and since the patient has a lot more time and because he's putting it down in writing , he is likely to be much more careful and diligent in making sure the information he provides is complete. Since most diagnoses can be made with the help of a complete medical history, this will help to improve clinical care.

Since the information is being provided in a format which is been structured by the doctor, he is also comfortable that he has not overlooked any important medical information.
Since the doctor is writing down his advice, this is likely to be much more careful , comprehensive and complete . Since a lot of the patient's questions are going to be questions which an expert doctor has encountered before , it's often possible for him to provide links to reliable online sites which have a lot of details, as a result of which the patient can absorb the information at his own pace.

Is there is a risk the doctor may come to the wrong diagnosis ? Yes, this is possible, but the chances are low, because an expert doctor can tell the patient when email is not the right format – and when he needs to go to the ER or his family physician for further attention. Expert doctors in leading hospitals have always provided second opinions by reviewing a patient’s medical records – the use of email now makes it possible for many more doctor to provide a similar service to their patients !

The risk of mis-diagnosis has become less today, because so much of the diagnosis in medicine is based on lab reports, scans and investigations. Since the patient can email these to the doctor, the doctor has a chance to review these and provide a careful and thoughtful opinion.
Finally , because the information is in writing, it can be reviewed later on , and in case there is something which the patient has not understood , he can ask additional questions for clarification. Even more importantly , this information can be shared with other family members , caregivers and doctors , so it's possible to make sure that the information can be put to good use by the patient.
E-mail is a much more efficient way of providing information therapy to patients. However , the missing link so far has been that doctors have found it hard to charge patients for providing e-mail consultations. Once this becomes a reimbursable service , I think we'll see a lot more of these consultations, since it will allow expert doctors to reach out to many more patients !
As with every other tool , e-mail consultations have limitations as well , and it's important to be aware of these. It's obviously not very good in case the patient needs emergency care, but in most elective situations , using clever technology , the quality of care which can be provided with electronic consultations can be as good, if not better.
How important is it for the patient to see the doctor face-to-face ? This is going to vary from patient to patient. If the goal is to get high-quality information from an expert, many will be objective enough to accept the fact that it doesn't really matter whether they see the face of the person providing it . Others will still require more handholding and reassurance , and they can use additional tools such as videoconferencing to get this.

While e-mail is an efficient channel for new patients , it is even better for existing patients. Since the doctor has an established relationship , he can often provide reassurance or advise very efficiently by e-mail without having to call the patient in to the clinic. Patients appreciate this service, because it saves them time , money and energy ! Today many doctors will still call patients for a follow-up , not so much because they feel the patient needs the additional care, but simply because they can charge the patient for this visit ! I think it would be interesting to do an audit to see how many physician visits are unnecessary !

What do you think ? If your doctor were willing to provide you advise by email, would you be willing to pay for this ?

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  1. Interesting perspective. Completely agree that it will save time and energy. But not sure if it can be effectively implemented, so that the patient feels assured.

  2. Dear Mukta,

    Why won't patients feel assured ? They are smart and can always check and counter-check the doctor's advise ! Since everything is in writing, it's easier to trust the advise - and to verify it as well !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

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    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

  3. I think it is a good idea. It makes it easy for doctor too, specially if she/he does not want to work at fixed time from clinic. When patients are comfortable doing telephone consultation (without paying),e consultation should not be a problem. Dr.Jyoti

  4. Definitely to save time and energy this idea is great to consider also online doctors are reliable enough to meet patient's needs and give them enough as doctors in real life can do.


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