Editorial Team
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Those with the greatest need for health care have the greatest difficulty in accessing health services.
'As and when need arises' has been the healthcare attitude for most Indians. Be it the cost, the logistics of travel, the loss of working hours or any such reason; most of us do not relish the thought of 'getting a specialist opinion'. This is more obvious in the rural scenario where specialists are available far and few. In most medical situations, specialist opinions are a need, not an option - and specialist care is most effective when it is accessed at the right time and from the relevant specialist. Primary health care is the start and end point of the healthcare pathway of the society and specialist care is the most important healthcare delivery tool of this pathway; together they help to maintain the health status of the society.
70% of the Indian population resides in rural areas but almost 70% - 90% of the medical specialists are located in the major cities. Nearly 75% of dispensaries, 60% of hospitals, and 80% of doctors are located in urban areas, where only 23% of the population resides. Those with the greatest need for health care have the greatest difficulty in accessing health services. Despite a significant attempt at providing primary care to the rural population, there is poor accessibility of specialist and super-specialist doctors in non-metros areas.
Telehealth has been touted as the 'bridge' that can fill the gap and take specialist care to the villages of India. Let us take a multidimensional look at this scenario. As of 2020, there are 761.29 million internet users in India with 34% users using a smartphone. Given these statistics, the 'doctor on the phone' concept sounds like a perfect solution but it has some serious drawbacks:
Only if these drawbacks can be addressed, can teleconsultation become a relevant medium for health care delivery.
Whenever a solution is being designed to bridge the healthcare inequity between rural and urban India and to address the gap in availability of specialist care in rural India; we have to keep in mind that digitizing a sensitive area like healthcare involves a complete change in knowledge, skill and awareness of the healthcare providers and a change of perception and expectation of the patient.
And this 'healthcare need' definitely needs to be addressed. In the state of Maharashtra itself with a population of 123 million wherein there are 40 million in the paediatric age group, we have 2766 paediatricians localized in 6 urbanized districts while 1978 paediatricians serve the remaining 30 majorly rural districts.
The ease of accessing specialty opinion would encourage more timely opinions and that would again contribute to improved health at a lesser cost. Analytics on aggregated and anonymized data will allow population-wide correlation between clinician advice and health outcomes. Over time, the aggregated data will also help in standardizing clinical protocols and improving care quality. Digitization of health records will also help better data availability, track disease epidemiology, and rationalize treatment strategies.
A teleconsultation platform based on the Pyramidal Model of Healthcare, wherein the primary treating physician chooses a relevant specialist for his/her patient and then conducts a joint-video consultation to maintain the continuity of care is the answer to this healthcare dilemma.
'Human body is a complex mix of many systems which intricately interplay with each other. The understanding of these systems has advanced significantly in recent years with the exponential mushrooming of medical knowledge in the last few decades. The ability to gather this vast knowledge and decipher its use for the benefit of healthcare has led to the development of many specialty programmes. This dedicated learning has however divided the body into silos. The primary doctor treating a patient has the historic knowledge of an individual patient and identifies the specific need of gathering the information from a specific specialist for the benefit of his patient. The holistic care of the patient by the primary doctor with focussed inputs from relevant specialists forms the basis of the pyramidal model of healthcare.
In the pyramidal model of health care which is prevalent in most medically advanced models of healthcare, the primary doctor functions to integrate the inputs from the various specialists of a patient for providing holistic care to the patient.
Every specialist and super-specialist doctor is trained to identify, diagnose and treat specific health conditions. The patients need to be guided through the process of making a choice to see a specialist - the relevant specialist at the right time.
The specialist needs to receive all relevant information like reports and scans etc. so that he/she is familiar with the case. During the tele-consultation, since the specialist is not physically present with the patient, it is necessary for the primary doctor or healthcare provider who is with the patient to help the specialist by providing the relevant details of the physical examination to the specialist. Ideally, the primary doctor also needs to be a part of the discussion with the specialist to ensure a holistic continuity of care.
At the end of the specialist consultation, it is important that the patient has a consultation report as to what was advised by the specialist.
Basically, the health-seeking attitude of the people is what will define the health status of any society and we need to generate awareness amongst the Indian patients and encourage them to make healthcare access a first-response and not-just a last resort. This is possible only when healthcare is genuinely accessible, affordable and accountable (reliable). Telehealth and especially teleconsulting can play a big role in this.
If the patient is given the right specialist opinion at the right time and has a pre-admission or pre-procedure rapport with the specialist along with the assurance that his/her primary doctor is not only involved in the healthcare decisions but is available for after-care, then the patient is definitely not going to shirk getting a specialist opinion, from a relevant specialist at the right time.
Accessible, affordable and accountable specialty care is a definite need and not just an option and an effective and easy-to-use pyramidal tele-healthcare delivery model is an essential solution.
The article is contributed by Dr Ketan Parikh, a renowned paediatric surgeon and Founder, PyraMed, Telemedicine. PyraMed is a unique joint video consultation platform for doctors. This application aims to empower all doctors with specialist/super-specialist medical advice, and thus help provide quality medical opinion even in the remotest parts of India at an affordable cost.