Global Health Asia-Pacific September 2020 September 2020 | Page 73

Telemedicine able to penetrate hidden and
overlooked patient segments
I’ve been doing online healthcare consultations (OHC)
for three years now. I’ve helped many patients who
are confused about their symptoms. Some were lifethreatening.
To share an example, I had a patient with
diabetes who was experiencing a sudden onset of
sweating and headaches. His sugar test was within
normal range. He came to my OHC to get answers.
The first thing I told him was to go to the emergency
department to rule out a heart attack. Half of our
population is unaware of atypical chest pain. They do
not know that the sudden onset of neck pain, jaw pain,
left arm pain, or epigastric pain can be symptoms of a
heart attack.
Another example: the most common cases I
get during my OHC are menstrual problems. I had
a patient, a young Malay girl who was not married
and not sexually active (I believed her), who thought
she was pregnant just because she skipped her
menstrual cycle. She came to the OHC asking for oral
contraceptive pills. After obtaining more of her medical
history, I found that she was attempting to take a
traditional medicine for an “abortion” even though she
never did a simple urine pregnancy test! It sounds silly,
but some people panic and never think straight about
simple solutions. Some of them come from orthodox
families and are too shy to seek help from their family
or friends. Therefore, they need proper guidance
without fear.
Most of the time, it’s not about the treatment
itself but how you guide the patient to get the right
treatment.
Limitations of teleconsultations
During OHC, I depend on the patient’s words and
what I see during the video call to make a diagnosis.
It’s not the same as a physical examination. Therefore,
I’m always cautious and spend extra time to get a
good history. About 80 percent of diagnoses are made
by good history taking alone, a further 5-10 percent on
examination, and the remainder on investigation.
If I’m suspicious or not confident enough to come
to a conclusion, I always advise them to go to the
nearest clinic or hospital. I give them an e-referral
explaining my concerns. It’s better to be safe than say
sorry later. Most of the time, the patient understands
and is happy that I can guide them.
Telemedicine is not just for COVID-19
Telemedicine should not be seen as a quick solution
just for the current COVID-19 pandemic crisis. Instead,
we need to start using telemedicine to penetrate
populations that are not possible to tap into using
traditional face-to-face methods, such as rural
populations and underserved chronic and sensitive
cases within urban communities. n
Dr Rashid Khan is an emergency medical officer at
Cardio Vascular Sentral Kuala Lumpur (CVSKL).
THE VIEWS AND OPINIONS EXPRESSED IN THIS COLUMN ARE THOSE OF THE AUTHOR AND DO
NOT NECESSARILY REFLECT THE VIEWS OF GLOBAL HEALTH ASIA-PACIFIC OR ITS EMPLOYEES.
GlobalHealthAsiaPacific.com
SEPTEMBER-OCTOBER 2020
71