Author: Dr. Vedavid Akash Manick
The dramatic impact of the COVID-19 Pandemic has not only disrupted social gatherings and interactions but has inadvertently influenced clinical practice. The expected surge of persons seeking care for this contagion led to most health services in Trinidad and Tobago entering “emergency mode.” Non-essential services, inclusive of elective surgeries and outpatient clinics were closed, and clients were encouraged to avoid coming into hospitals unless essential. Ensuring the welfare of patients, particularly those with chronic disease, during these difficult times resulted in clinicians seeking innovative methods of continuity of care in a time of social distancing.
Doctors have adjusted to this challenge by reviewing the clinical records of established clients in clinics and communicating with them via telephone. Clinically stable individuals had prescriptions re-written, with adjustments made, if necessary, and advised on the collection of these along with rescheduled appointments. Clinically labile persons received earlier rescheduled dates, and a few persons needed to keep their appointments. These adjustments highlight the need for re-evaluation of telemedicine in the health infrastructure of Trinidad and Tobago, in a time of social distancing.
Telemedicine uses communication technologies to allow for consultation between doctors and patients remotely.1 A logical product of the technological age, the concept has been around for a long time, with published papers discussing its use in reducing health office visits from as early as 1879.2 To some extent, it is already part of our modern medical practice as clinicians, be it a telephone call or text for advice from a specialist colleague, or a WhatsApp message to the radiologist to review a chest x-ray or a CT Scan. Formally, Trinidad and Tobago have already embraced the technology. The University of the West Indies Telehealth program established in 2004, enabled consultations for several paediatric cases with international specialists.3 The potential benefits of this tool as an adjuvant for traditional healthcare are significant. Despite these benefits, the potential of telemedicine is yet to be realized, both in developing and developed countries.1
To date, medical education continues in the traditional mould of history taking and physical examination in the intimate setting of a consultation room. The clinician relies on verbal and nonverbal cues to comfortably diagnose and treat a client. The use of voice media, like the telephone, removes the visual cues, and even in video conferencing, the element of touch goes as the patient cannot be examined physically. Despite careful discussion with many patients aiming to keep them at home, physicians were often dismayed as clients, especially older persons, still showed up, mere hours after called simply because the doctor called! Embracing telemedicine on a larger scale necessitates the need for further training by physicians in using the technology for assessment and communication.
While the technology itself can improve accessibility and cost of providing care, particularly to clients living in remote communities, in many developing countries, the infrastructure is not available.1 According to the Telecommunication Association of Trinidad and Tobago (TATT) Digital Divide Survey in 2013, only 44.6% of households had access to internet service.4 Older persons and disabled, who would more likely benefit from consultations, are less likely to be comfortable with technology, with many even being resistant to the concept altogether.5
Embracing telemedicine goes beyond the clinician and the patient. Many medical records are still kept in paper form. Locating and negotiating large files which often do not have updated contact information makes consultation both in conventional practice and over communication media extremely challenging. Additionally, for successful implementation on a broad scale, there needs to established policies and standards set out to govern, among other things, patient confidentiality, and the storage of data. Medicolegally, there remains an absence of a legal framework internationally to govern practice.1 Guidance on financial remuneration for clinicians using telemedical consults to augment their service is necessary.
With no end to the COVID-19 Pandemic on the horizon, the medical profession would need to find innovative methods to serve clients. Embracing technology through telemedicine may be the method by which we preserve the doctor-patient relationship while conforming to all social distancing guidelines.
- World Health Organization. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. Global Observatory for eHealth Series, 2, World Health Organization, 2009.
- Board on Health Care Services; Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington (DC): National Academies Press (US); 2012 Nov 20. 3, The Evolution of Telehealth: Where Have We Been and Where Are We Going? https://www.ncbi.nlm.nih.gov/books/NBK207141/
- The University of the West Indies. UWI telehealth. Sta.uwi.edu, 2020. https://sta.uwi.edu/telehealth/ (Accessed 25/04/2020).
- Digital Divide Survey Trinidad and Tobago 2013. Tatt.org.tt. 2013. https://tatt.org.tt/Portals/0/documents/Digital%20Divide%20Survey2013_FINAL%2017-01-2014-reduced.pdf. (Accessed 25/04/2020).
- Cimperman M, Brenčič MM, Trkman P et al. Older adults’ perceptions of home telehealth services. Telemed J E Health, 2013;19(10):786–790. doi:10.1089/tmj.2012.0272.