The UP Medical Informatics Unit has released five chapters of the telemedicine guidance in the past month at bit.ly/upmiutelemed2020. Chapter 5 was on the ethical and legal issues arising from the practice of telemedicine in the Philippines. Despite the presence of telemedicine platforms prior to the CoVID-19 pandemic, telemedicine was not considered mainstream locally. When the community quarantine was declared, many patients were unable to see their physicians. What followed was a scramble to establish an online presence, with many physicians opting for Facebook.
My Facebook page, the Endocrine Witch is eight years old. When I started it years back, it was an advocacy for health literacy. I wrote Facebook posts in Filipino in an effort to educate the public about diabetes, thyroid and other endocrine disorders. At medical conventions where I was asked to talk about social media and healthcare, I was often asked by skeptics, what’s your return on investment (ROI)? One physician even told me quite bluntly that I was building an unrealistic expectation for the public, that all physicians should be putting up Facebook pages. He said, when I go home, I don’t want to have to go on Facebook to answer queries from my patients. At another meeting, I was subtly accused of putting up this Facebook page to advertise my clinic practice.
When I started this Facebook page, I didn’t have my name on it. Just Endocrine Witch (years later, I called myself Dok Bru). But I realized I needed to put my name on it when patients would ask their endocrinologists, “Do you know Dok Bru? Is she really an endocrinologist?” Thankfully, there are only a few hundred Filipino endocrinologists and most of them know me. Patients would show up at the Philippine General Hospital information desk asking for Dok Bru. On the page, I would get comments asking about my clinic hours and fees. I always just gave the clinic phone for this inquiries. Many of these inquiries were from those who could not even come to see me, as they lived outside of Manila or even abroad. I will not deny that some patients have found their way to my clinic via the Facebook page, but if we really talk about ROI, considering the effort I put in to write and post as regularly I can, it’s not worth it. And so I maintain, that this page is #ParaSaBayan.
And so I couldn’t help but be surprised that when the pandemic hit, many Filipino physicians began putting up Facebook pages for their clinic practice. Some accept appointments via these pages, and some conduct consultations via Messenger. I was getting requests to like their Facebook pages. I must admit I was annoyed when someone made a friend request, and within minutes after I accepted the friend request, this MD was already asking me to like a Facebook page of his clinic. I wanted to say that it should be the patients liking the page and not me.
I started accepting patients for follow up via teleconsultation in March. I decided not accept new patients via teleconsultation. Having decided that, I did not see the need to inform my page’s followers about my availability for teleconsultation. My patients schedule their followups directly with my secretary Mel as was my practice even before the pandemic. I accepted email consultations for followup. I quickly realized the limits of the text-based mode of telemedicine and subsequently shifted to a secure video/audio platform. Recently, I saw some posts of physicians bemoaning the blurring of boundaries with “unli-consult” via the messaging apps they were using. Some patients would leave messages at all hours. Many physicians felt pressured to answer and wondered if they would be liable, if messages were not promptly addressed or even left unanswered. I still use email to send my patients a summary of their teleconsultation visit, lab requests and e-prescriptions. I have however, turned on a “vacation responder” message:
Ang email address na ito ay ginagamit ni Dr. Isip Tan para magpadala ng reseta o lab request, at para tumanggap ng requirements para sa teleconsultation sa [telemedicine platform redacted] (informed consent, lab results, prescriptions, questions to be answered). Ipaalam kay Mel kung magpapadala ng email sa address na ito. Kung ang email ay hindi para sa ganitong mga layunin, maaaring walang kasagutang matatanggap. Hindi rin po puwedeng gamitin ang email address na ito kung may emergency na nais isangguni kay Dr. Isip Tan.
Not everyone can afford wifi access. I realize that means that not all of my patients can “see” me via telemedicine. Marion Renault wrote about this in a recent Wired article, When Health Care Moves Online, Many Patients are Left Behind.
Since Covid-19 upended his practice, he’s watched patients—in particular minority, low-income, and rural patients—struggle to download apps or loop interpreters onto phone consults. He’s canceled visits because of inadequate Wi-Fi; on some calls he spends as much time guiding families through the technology as he does helping with their medical concerns. “When I call my suburban families, it’s no problem. It’s a fun Zoom visit,” Bignall says. But for the others, tech issues consume appointment slots.https://www.wired.com/story/health-care-online-patients-left-behind/
Let’s discuss these further at the #HealthXPH tweet chat on 13 June 2020, 9 pm Manila time.
T1. What are the pros and cons of putting up clinic Facebook pages to inform the public of a physician’s availability for teleconsultation?
T2. What are the pros and cons of using messaging apps for telemedicine?
T3. What are your thoughts on social media, the digital divide and telemedicine?
Photo by NeONBRAND on Unsplash