Dr. Walke, Past Chairman, Ethics and Medicolegal Committee FOGSI, provides some medicolegal clarity on telephonic and WhatsApp consultations.

With the onset of the mobile revolution, accessibility to services on phones has become an universal and often expected norm in the world. This expectation extends to all domains, healthcare included.For doctors to stay competitive and retain patients, they need to adopt new technology and match patient expectations. Traditionally, for remote medical consultations, a patient would reach out to their doctor or specialist over a  phone call. With the popularity of WhatsApp; the social media channel has very quickly become an accepted medium for connecting doctors and their patients for follow-up queries or minor health concerns.

The need for remote consultations

A typical doctor patient interaction undergoes four phases; history-taking, physical examination, investigation and finally treatment procedure or surgery. However, it is also true that every time a patient physically consults the doctor, history-taking and physical examination may not always be conducted; particularly for follow-up visits. At times the consultation may simply involve a verbal discussion about minor complaints; queries regarding drug dosages; appointments for procedures or surgery; minor post-operative issues or opinions on investigation reports.

Nowadays, doctors have gradually accepted and adopted WhatsApp and phone calls as a medium of communication for interactions that do not specifically require a physical examination. This is not only convenient for doctors, but also saves the patient significant time and money that is spent on physically visiting the doctor’s clinic. Avoiding travel in the busy traffic of metro cities further reduces stress and increases patient satisfaction. Patients get immediate and authentic answers to their queries and the pressure on the waiting rooms of the doctor’s clinics is relieved to some extent.

What are the challenges of remote consultations?

While remote consultations are commonly adopted, doctors are under constant fear about the medicolegal liability associated with them. The MCI code of ethics does not dictate any specific guidelines on telephonic consultation, but there is an underlying, often needless fear amongst doctors led by an assumption that that MCI does not recommend it. In the “Martin D’ Souza vs Mohd Ishfaq” case, the Supreme Court basically addresses telephonic prescriptions; however, doctors have misinterpreted the judgement and created reservations in their minds even about telephonic opinions and interactions. Media hype about a particular case in recent history that led to the criminal implication of the doctors involved in telephonic consultation, has only added to this fear. In this particular case, criminal liability was basically due to other grossly negligent acts of the doctors, but unfortunately media focused only on the telephonic consultation portion.

Another issue with communication on social channels and phone is that the doctor is expected to correctly identify the patient and then match the information shared with his/her recollection of the patient’s past history and diagnosis. Expecting the doctor to remember past medications, health parameters, allergy indications etc. of all patients is unrealistic and error-prone. Inaccessibility of this vital information may lead to incorrect assessment and more often a symptomatic rather than wholistic treatment call.

Also, this interchange often involves a patient sharing personal and private health data with their doctor over these social channels. These communications over calls or WhatsApp do not provide adequate privacy and safety to both parties.

What are the proposed solutions?

By no stretch of imagination can the practice of telephonic consultation be entirely evaded by most doctors. Instead of individually accepting that this routinely used practice is illegal and prone to risks, it would be better if doctors collectively seek help of associations like ‘IMA’ to issue statements that will impress upon courts that telephonic consultation is a “standard practice”. Unless this is done, doctors will continue to be vulnerable to the possibility of medicolegal hassles.

A mobile communication application to solve the problem?

This problem essentially poses an opportunity to create an organized and leak-proof channel in the form of an app. The app should essentially have the following features:

This problem essentially poses an opportunity to create an organized and leak proof channel in the form of a mobile app. The app should essentially have following features:

• Structured and organized channel for facilitating communication between doctors and their patients while maintaining complete privacy. Communication facilities would include audio and video calls, chat messages and document (health record) exchange.
• App should provide easy identification of patient with safe, secure and private storage of patient health details and records.
• App should guarantee medico-legal safety for doctors by securing joint accountability from patients with clear disclaimers and consents.
• This app will save time, effort and money for patients by enabling easy remote follow-ups for chronic conditions, dosage adjustments, sharing of diagnostic reports etc. when an in-person visit is not possible or warranted.
• A secure payment gateway that will allow doctors to charge for the consultation and ensure that the doctor’s time and efforts are adequately compensated.
• Prescriptions for simple medications drafted as a readymade template as per MMC and Drugs and Cosmetic Act guidelines (with provision for the doctor signature and stamp) with only a single print option

Conclusion

Doctors, remote consultations on phone for minor medical queries are unavoidable. Ensure that you are medico-legally safe and adequately compensated when you provide this invaluable service to your patients that is often taken for granted.