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| Governments and private firms have set up telemedicine clinics for patients who suspect they have the new coronavirus (AFP Photo/Alexander NEMENOV) |
Will
visiting the doctor ever be the same again?
In a matter
of weeks, the coronavirus pandemic sparked a technological revolution in
healthcare systems across the world that might otherwise have taken years.
Spurred on
by fears of contagion in wards and waiting rooms, many health practitioners are
replacing the face-to-face meetings that have always underpinned general
practice, with patient consultations by telephone and online video apps.
Some of the
most radical changes have been in primary healthcare, where doctors have often
faced shortages of protective equipment, but specialists in everything from
mental health to eye care have also turned to technology to treat patients at a
distance.
"General
practice has undergone significant changes in the way GPs and our teams have
delivered patient care during the pandemic -- and the speed in which these
changes were implemented has been remarkable," Professor Martin Marshall,
Chair of Britain's Royal College of GPs told AFP.
As the
virus spread, health authorities in the UK, Europe and elsewhere updated
guidance on everything from data protection to how to build trust remotely.
The United
States rolled back restrictions on access to telemedicine, and eased privacy
regulations to allow people to use platforms like Skype and FaceTime.
"People
are now seeing this model, which we thought would take years and years to
develop. And it's probably been accelerated by a decade," Chris Jennings,
US policy consultant and former White House health care adviser told STAT news
recently.
Globally,
58 percent of surveyed countries are now using telemedicine, the World Health
Organization said Monday, adding the figure was 42 percent among low income
nations.
Layla
McCay, a director at the NHS Confederation representing British healthcare
services, told AFP that most of the UK's 1.2 million daily face-to-face primary
care consultations were done remotely "in the space of weeks".
But there
were challenges.
"My
first video consultation was a mess. Builders were drilling, the microphone
failed, a colleague walked in, and lockdown was imminent," Camille Gajria,
a doctor and clinical teaching fellow at Imperial College London, told the
British Medical Journal.
She said
teleconsultations can be efficient but warned of "cognitive bias" --
a doctor, for example, might assume that a child playing in the background is
the one being discussed.
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Hospitals
like this one in Mexico have used online video platforms to let COVID-19
patients communicate remotely with their families (AFP Photo/ULISES RUIZ)
|
There are
also concerns that vulnerable patients might find it difficult to talk about
mistreatment at home, while elderly people could struggle to navigate
unfamiliar technology.
Remote
medicine
Telemedicine
may seem like a product of the internet age, but it has been around for
decades, developing alongside communication technology.
One big
leap came during the space race of the 1960s, when scientists worried about the
effect of zero gravity on the human body. Would it impede blood circulation or
breathing?
To find
out, both the US and Soviet Union conducted test flights with animals hooked up
to medical monitoring systems that transmitted biometric data back to
scientists on Earth. Later, longer missions meant astronauts needed systems
that could diagnose and help treat medical emergencies.
NASA went
on to develop terrestrial telemedicine, including a project to provide
healthcare to the isolated Tohono O'odham reservation in Arizona, as well as
disaster response in the 1985 Mexico City and 1988 Armenia earthquakes.
While the
coronavirus pandemic has driven sweeping changes in the way many people see
their local doctor, it has also highlighted the role telemedicine can play in
connecting clinicians with remote communities.
In India,
which has just 8.6 medical workers per 10,000 people according to 2018 WHO
figures, the majority of doctors are concentrated in urban centres, while some
70 percent of people live in rural areas.
Ayush
Mishra, founder of the telehealth provider Tattvan, said this means people
outside bigger towns are often forced to seek medical advice from overstretched
or ill-qualified practitioners.
His
business, one of a growing number of telehealth providers in India, operates 18
clinics, mostly ATM-style booths that are manned by a medical assistant who can
take vital measurements and linked with doctors in private hospitals in larger
towns.
The firm
languished in a legal grey zone for years until the coronavirus crisis spurred
the government into broadening regulatory approval for virtual consultations.
Now he hopes to open hundreds of clinics around the country.
Mishra
traces his enthusiasm for telemedicine to a horrific motorbike accident when he
was a biomedical engineering student in the northern city of Jaipur.
 |
Governments
and private firms have set up telemedicine clinics for patients
who suspect
they have the new coronavirus (AFP Photo/Alexander NEMENOV)
|
Severely
injured, he was driven ten hours to his hometown in Uttar Pradesh, before
falling into a coma as a local doctor performed surgery.
His family
was overwhelmed by "panic" until his father spoke by telephone to a
surgeon at a hospital in Delhi, enabling them to arrange treatment in the city.
Mishra lost
his leg, but told AFP the experience inspired him to want to equalise medical
access for people in smaller towns.
"You
need to be able to offer this access -- it's a human right," he said.
Not going
back?
Internet-connected
thermometers, pulse oximeters to measure oxygen levels, and smart devices that
monitor vital signs are all widening the scope of what is possible in remote
medicine.
In an April
article for JAMA Neurology, experts from the Netherlands and US said
telemedicine could be a useful tool for in-home training, such as activities
for survivors of stroke. Patients, they noted, could be monitored via sensors
in watches or phones.
"We
hope that this current COVID-19 crisis will soon be resolved. However, it is as
the old saying goes: 'never waste a good crisis'," they said.
"Telemedicine
for chronic neurological disorders should become part of the new normal rather
than the exception."
Marshall
said there are still many routine procedures -- vaccinations, blood tests and
physical examinations -- that cannot be done remotely.
"Those
living with multiple conditions and other complex health needs really benefit
from seeing their doctor in person -- and this is helpful for the GP, as
well," he said.
But he
added that research supports the use of remote consultations for patients with
simple conditions, or who have "transactional" needs like a repeat
prescription.
Many say
they want at least some of the changes to stay.
"It
has certainly turbocharged the digital transition nationally," said McCay
of the NHS Confederation.
"Lots
of feedback from our members shows the culture has fundamentally changed, and
clinicians who were perhaps previously resistant to digitisation are now
realising its benefits."
"We
can't go backwards," she added.
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