Saturday, August 11, 2018

Telephonic Consultation - part 2

*Dr Arun Gupta
President , Delhi Medical Council*

I am glad a debate has been started in medical community regarding menace of telephonic consultation. Though the Mumbai high court  case which triggered this debate  is not entirely about telephonic consultation only,  it has other elements as well. Nevertheless let us try to understand it from practical point of view.

First let us  all agree that *telephonic consultation is legally and ethically wrong* .

Practically also,  the entire onus is on doctor if something goes wrong. Patient has all the benefits and doctor has all the risks.

Than why this issue is so important ?

To begin with , we doctors give our mobile number to patients . Can't we simply refuse and give only office number to be called during office hours only.

During office hours too if someone calls , first response  simply should be show at clinic or nearest hospital, if it's an emergency. If  it's not emergency that ask the patient to show at his convenient time. Meanwhile simple things like paracetamol or ORS may be suggested.

Write it clearly on your prescription and other conspicuous places in clinic  that in case of emergency please contact the casuality of nearby hospital, preferably the hospital you are attached to.
This  point is  important for your follow up patients specially Antenatal, Postnatal, Post Surgery , Post Vaccination  etc. Here you are  suppose to  provide follow up assistance in case of emergency. There have  been instances where doctors have been  pulled up by courts for not taking care of  booked antenatal or follow up patients during odd hours.  Develop a mechanism so that your follow up patients know where to go in case u are not available. Than onus is not on you .

And now why only phones , patients will harass you through other means too, specially What's App. Where they even click a picture and seek your opinion . Flatly refuse to give any opinion without physically examining the patient .

Remember in absence of clear laws, the personal discretion of judge matters a lot. Time and again we have seen the judgement being totally reversed in higher courts due to absence of clear laws. As medical science and technology is advancing  lots of ethical dilemmas and legal issues are cropping up daily. We need to be very careful as anyone can be a victim of judicial subjectivity and overenthusiasm.

And finally let us admit fear of loosing a patient is the major reason we entertain them telephonically. My take  on this is that  do not ever be under a pressure to hold on to patients . They will exploit you and make your life hell. It's better to loose 10-20 % of your patients since they are cause of 100 % headache . Rest 80 % still good enough to give us a decent life than why to compromise on our peace and happiness . *Remember the ultimate aim of working or doing anything for that matter, is peace and happiness .
Happy practising...

Dr Arun Gupta
President Delhi Medical Council.

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