The Indian Medical Association (IMA) on August 8 sought clear-cut guidelines from the Medical Council of India (MCI) on the issue of telemedication, while observing that the practice is illegal and unethical.

Apart from managing medical emergencies and situations involving adjustment of insulin levels in regular patients, analgesics for acute exacerbation of chronic pain under regular treatment etc., telephonic consultation will lead to medical negligence, the IMA said in a statement released on August 8. "Judicious use of telemedication in certain circumstances can be justified, but as the code of ethics is silent on these emerging areas, judicial over activism can prove to be detrimental to this noble profession. 

"Online consultations, online prescriptions and telemedicine are all topics which have posed ethical dilemmas. But at the same time, advancing technology can be harnessed for augmenting healthcare in remote areas, especially telemedicine and mobile health. The MCI must come out with clear-cut guidelines on these important issues, which many developed countries have," Dr Ravi Wankhedkar, National President of the IMA said.

Following a high court verdict to proceed with criminal prosecution in an incident which involved telephonic consultation, the issue came to the attention of the public and was widely discussed. Although the particular stand by the high court was not to find negligence in the telephonic consultation but for other reasons. Subsequently the arrest of the doctors in the case was stayed by the Supreme Court, the IMA said in the statement.

In this situation, judicial law comes into force and thereby the Bombay High Court verdict gains importance. Secretary General of IMA, Dr R N Tandon, said the common practice involved in treating a patient was eliciting history, physical examination, going through investigations and arriving at a diagnosis. Treatment was instituted after the diagnosis, he added. 

"In telephonic consultations, all or part of the above may not be undertaken. Hence there is always a possibility of alleging and finding negligence on the part of the doctor by the legal fora," Tandon said. A history of the ailment, clinical examination is needed to prescribe any medication. And ethically, a doctor can only prescribe medicine or advice on treatment upon physically seeing a patient and hence, telephonic consultations without seeing the patient is unethical and legally invalid, he said. A regular patient, seeking consultation over the phone, maybe due to change in symptoms or signs, need to be examined physically before altering medication to avoid negligence, Tandon added.