Re: e-Medicine and Online Pharmacies Thank you for an interesting discussion. Being a physician, I would like to provide view from the other side on the “online consultation” debate. Let me forewarn you, this is a pretty long post.
On the topic of online pharmacies. The cost cuts do benefit the customer. The convenience of ordering stuff from the comfort of your home is genuine- the success of amazon, flipkart etc is testimony to that fact. However, current margins are unrealistic and sustaining them, in some ways, could be detrimental. Often, it is the smaller generic pharma companies that provide the largest margins, as against the larger more reputable ones. It would, hence, be logical to assume that online pharmacies would push these products as they get the best margins on these (that is even after providing a good rebate to the customer). However, often efficacy of drugs from these smaller companies are untested and if quality is poor- either active ingredient is in lower concentrations or there is less attention to quality control practices during manufacture, the patient taking the drug is not benefitted and at-times harmed. So, please insist on drugs from reputed well-known brands, even if you end up paying a bit more. Be VERY careful when going for generics from unheard of manufacturers- irrespective of whether you are buying online or in your neighborhood pharmacy.
Telemedicine, in various guises, has been around for over a decade and a half. However, the technology remains immature. I am sure that it holds great promise, though, what form and shape it will eventually evolve is unclear. Major developments in big data, AI etc. hold great promise – but any meaningful application is still a fair way away. Though, demonstrations of cross ocean robotic surgery have taken place- where is surgeon is sitting in one continent and controlling a robotic instrument operating on a patient in another continent- these are impractical, enormously expensive and fraught with risk. Even is there is one great surgeon in one city who is exceptionally good at a particular operation, there is no way he or she can provide that surgery to all that need it.
Current online consultation portals are basically first contact virtual meetings and, in most instances, will encourage you to visit a physician – often the portal itself referring you to one in your geographical location, and a charging the doctor a fee for the referral.. Virtual consultations with senior doctors, are like Rs.1 airline seats- more hype than substance, the portal using these to promote themselves.
Like any other person, doctors too value their personal time. It would be most unacceptable to most to be sitting by their phone all hours of day and night to reply to queries from unknown virtual clients, who they have never physically seen before and know next to nothing about. The physician giving advise virtually is liable in the real world too!
Therefore, you really are not going to get any reasonable advice. If you feel you or some close to you is sick, don’t seek reassurance in a virtual consult – go see a doctor – or visit a hospital emergency unit. Let me assure you, it will be far far more valuable to you.
The other issue I have is this. Access to specialists and doctors is easiest in India, at least in towns and cities. Most often consultations are available at short notice or as walk-ins. This is in sharp contrast to more “developed” medical systems such at that in the US, UK or Australia and Europe- where waiting periods to see a specialist can run into weeks and even months.So how is virtual consultation actually benefiting you? Issues in urban health provision is affordability and I do not think telemedicine is the answer.
The real problem lies in underserved rural areas. Telemedicine seems like a good option – at least theoretically. But, to expect these folk to be able to provide accurate data online and follow online instructions – in the absence of basic amenities and education is far fetched. A hybrid model with a general physician to screen and evaluate a rural patient locally and then communicate virtually with a specialist in a remote location is perhaps the way forward.
On a more philosophical note, medicine is a “human “ science. A lot of diagnostics and patient care involves nonverbal cues , non-data driven methods and soft skills. Telemedicine will never be able to replicate this. The recent fracas with EMR (electronic medical records) in the US is testament this. |