Since I'm personally active in the quite specific field of cardiovascular radiology, I have problems to communicate with radiology technicians to get exactly the technical parameters I want, and a resident is on site. For more standardized examinations like oncology follow-up, things are easier to manage from a distance, however teaching is virtually absent when not in direct contact with the team.

Great Hazem, I look forward to seeing your work soon

I have experienced difficulty in outpatient ENT clinic when I have wanted to see an ear skin lesion. The patient did not have the resources or know-how of setting up a video consultation. The telephone consultation alone was inadequate in this case.

In my ophthalmology experience, patients are absent from clinic for all kinds of investigations, like visual field test, perimeter, optical coherence tomography, tonometry, acuity testing, ganglion cell analysis, ...

In fact, the widespread use of telemedicine could be an option under the situation of COVID-19 pandemic.

However, not all the countries are ready for the widespread use of tele-medicine. Furthermore, in some specialties such as surgery, it is far more complicated.

In Greece, the tele-medecine has not been adopted yet by the National Health System, although there are relevant reflections and considerations.

Due to restriction measures, people cannot have their outpatient consultations apart from emergent situations.

In the outpatient setting, privates doctors have teleplone consultations with their patients without being payed.

People in Greece are reluctant to adopt tele-medicine. They do not feel safe if they do not have the chance of face to face consultation.

Furthermore, old people are not that used with the use of technology.

However, undoubtedly, some changes will be adopted by all the countries. In Greece, tele-prescription of medicines has been adopted since the beginning of April.

Some patients aren’t as tech savvy as others. The over 65 yr old age group tends to have more difficulty

agree with the difficulties faced by geriatric patients

I look forward to the following article on European Journal of Geriatrics and Gerontology

Revisiting the role of telemedicine under the 2019 novel coronavirus outbreak

DOI : 10.4274/ejgg.galenos.2020.282

Pregnant mothers have to be looked after in person to ensure the pregnancy progresses satisfactorily. Associating illnesses such hypertension, diabetes etc. should be looked after.

Further, the growing anxiety about the corona virus infection in mothers need to be addressed, thereby restrictions on their open clinic visits to be limited and the care at the field level, home visits to be encouraged.

Eur J Geriatric Gerontol 2020;2(1):26-27

http://www.ejgg.org/archives/archive-detail/article-preview/revisiting-the-role-of-telemedicine-under-the-2019/37312

https://doi.org/10.4274/ejgg.galenos.2020.282

I agree with your comment that "Different specialties have different practicing needs" .

For consultations that are 'clinical history' centered, there will probably be major changes where tele-health becomes the predominant service model for people with access to digital media.

For 'spot diagnoses' , and clinical examination involving 'inspection' and some dermatology, psychiatry, etc, this is probably true.

In response to your question- "Will tele-medicine totally uproot the usual face-to-face room consultation of medical practitioners?"

There are many areas where the 'physical examination' is crucial in the clinical assessment, and tele-health cannot provide a good alternative for the clinical basics of 'palpation, percussion and auscultation'.

In these areas , tele-health, as currently available, will fall far short.

This would apply to many specialties, especially in the diagnostic stage.

However, in the follow up stages, tele-health may well suffice in many instances.

Agree to you, Trevor!

And I found that many telemedicine tools apply to screening, instead of treatment

The American Medical Association (AMA) has created a new resource for this purpose at https://innovationmatch.ama-assn.org/groups/ama-physician-innovation-network-public-area/discussions/Telemedicine-amid-COVID-19/pages/resources-23

There are also concise guidelines and practical tools at https://telehealthtoolbox.netlify.com/ aimed at helping practice transition to telemedicine during the COVID-19 pandemic.

Lastly, these two papers should be of interest: Covid-19: a remote assessment in primary care, available at https://www.bmj.com/content/368/bmj.m1182 and Virtual health care in the era of COVID-19, available at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30818-7/fulltext

In the Philadelphia area, we are experiencing a lack of enthusiasm from patients to schedule telemedicine appointments when they are offered. So, there are many openings that are unfilled. However, we are hearing that both physicians and patients are satisfied during their appointments for follow-up care.

An unexpected benefit that has surfaced is that family members that often don't make it to the office with the patient are able to participate if they are all together at home (during the Covid-19 pandemic).

Why are patients turning away from teleconsultation under the COVID pandemic when they can go no where?

Thank you Maged N Kamel Boulos for the excellent links and references provided.

These references also refer to the limitations of telehealth in certain 'clinical' areas.

The American Medical Association (AMA) resource comments on selection of appropriate patients and selection of appropriate conditions for telehealth, and the role of triage.

It also refers to its usefulness in 1. follow-up care of already diagnosed conditions, 2. and chronic conditions; 3. behavioural health; 4. and overcoming transportation barriers for patients. As well as its limitations.

The BMJ and Lancet references also mention the enormous limitation of telehealth in the area of physical examination.

" There are no validated tests for the remote assessment of breathlessness in an acute primary care setting " ( https://www.bmj.com/content/368/bmj.m1182 )

" Like Topol, Agrawal warns that virtual health care comes with a trade-off in the quality of patient care. " ((https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30818-7/fulltext)

In my opinion, telemedicine has definitely some roles like

1)Entry of patient particulars, chief complaints, detailed history, investigation reports etc etc.

2) It will helpfull in diseases which can be diagnosed based on history or simple spot examination.

3) It will decrease the burden of carrying reports to chamber and also unnecessary visits.

But it has also some limitations like

1) Gaining patients trust and satisfaction, which I think can be made with proper mass communication.

2) Many a times we require detailed examination, for which patients have to visit chambers. Examination procedure/set-up needs to be modified for that.

Many seniors are unable to implement video consulting through digital tools

The Coronavirus Disease 2019 Crisis as Catalyst for Telemedicine for Chronic Neurological Disorders.

JAMA Neurol. Published online April 24, 2020.

https://doi.org/10.1001/jamaneurol.2020.1452

Great question Sunny Chi Lik Au

As a surgeon and ultrasound specialist, I have been limited in both areas. The idea of self-management strategies for endometriosis has emerged and that is important because regardless of COVID or not, self-management strategies are important to pain-causing problems.

Now, it would be great if we could remotely perform ultrasound!

Tele-medicine is not only pertinent in times of an outbreak, but is also generally related to the lowering number of physicians/ other medical personnel vis-à-vis a growing population. It is, therefore, here to stay for the long-run. We should better start finding solutions to any issues at hand, rather than just stating them.

One possible solution is to employ (on a need base) the vet community. They are trained to use some of the machines (e.g. echographs, scanners) used in human medicine - to record data and send/ upload it electronically for use by the relevant, remotely located medical specialists in human medicine.

Usually, there is a vet - even in small communities. All of them are mobile - some of their machinery too (i.e. visiting animal patients on farms, not just at the clinic). Better sanitization (or using separate machines for humans) though is required.

Another solution would be to appeal to the army and the airlines sector. They are intertwined in terms of pilots, but there is no reason why the army cannot train physicians/ nurses for their own uses, as well as to serve both as security and flight attendants - to be working on a 3-year rotation with hospitals (for more work experience and better allocation of human resources).

This should also lower the amount of student debt for these professions (when coming through the army route).

Airline companies can give back by selling their old airplanes (instead of leaving them to rot somewhere) to the train engineering sector to recycle into high speed trains for developed, as well as developing countries. Once the wings and several other external parts get removed, the corpus is suitable for land travel. The railway lines are already there - some will need to be updated to allow for magnetic levitation.

Some of these trains can be subsequently outfitted with the proper machinery and personnel (medical, security) to be used as train hospitals - to reach remote communities, or areas in emergency need.

Transmitting basic health-related awarenes to the public (e.g. what is important to describe to a physician in a tele-medicine consultation to streamline the process) would be more difficult, but not impossible.

The system is new(ish). It is normal for people to distrust it (at the initial stages).

:)

https://www.futuremedicine.com/doi/10.2217/fon-2020-0324

An editorial on challenges and advantages of telemedicine

Hello, in Portugal, during Covid there was a huge increase of tele consultation. Still some barriers were found:

- older people have more difficulties in using digital tools.

- 3G and 4G coverage is still low in some rural areas.

- Lack of good tele consultation tools available to be used, some physicians then still want to do the face to face consultation.

There are some challenges that go beyond the features of the tool itself... factors such as the tool's fit in the overall clinical workflow, system integration and interoperability, the user's previous experience with technology in general and with telemedicine specifically...etc

Have a look here for more insights on social, organizational, and technological factors that may impact adoption Article Social, Organizational, and Technological Factors Impacting ...

Direct reflexes of my students on my lectures

Sunny Chi Lik Au I am giving this answer related to the patients admitted in the hospital recipients because I was deployed in the indoor patient department of COVID+VE patients.

Telemedicine is beneficial or not beneficial related to the service provider and receipients.

for service providers like Doctors, Nursing staff, and for other staff also it is personally beneficial because they didn't come in contact with COVID +ve patients directly.

for COVID +vepatients who are admitted in the ward, they need regular monitoring of their health status, which is not possible telephonically because educationally and intellectually all are not the same. health status of the patients can't be monitored telephonically.

Tele medicine was one of the best possible option we were left while this pandemic erupted.

But there were challenges associated to that.

It wasnt equivalent to the physical meeting.

Country like Pakistan in many areas the internet issues.

The time lag between the ppl using internet.

Multiple communication at the same time.

Things sometimes got confusing.

In Australia we have een using Tele Medicine for a number of years. It has proven it's value especially with the large areas that patients previously had to traverse for appointments. Since Covid it has continued to be exspande to allow access for more clinicuians.

The limiting factors are digital skills and familiaruty from clinicians and patients along with a relianble source of conectivity.

considero que es una buena alternativa, no solo en estos momentos de pandemia, sino para integrarlo en la práctica habitual. Si el paciente no requiere exploración o recogida de muestras se puede evitar el desplazamiento.

biggest difficulty is that if network is not proper we can not have visual view and have to rely only on the symptoms told by patient...many time vernacular terms also create problems...

Although telemedicine contributing a great but most patient prefer direct consultation.

Patient examination is not possible in telemedicine but information of per abdominal and pelvic examination is vital for treatment decision in gynecologic oncology patients .