Summary:

The COVID19 pandemic has secured a permanent place for online endocrinologist consultation in our patient care armamentarium. In this article, I highlight my own online consultation journey and tell you what to expect from it, what conditions are amenable to online consultation with your endocrinologist and how to prepare for it. I also share some happy stories from my journey!

Introduction:

The advent of online consultations with endocrinologist in keeping with the emergence of the COVID 19 pandemic has been a blessing for people trying to access healthcare during the lockdown. It is a way of practising medicine that is here to stay and it is time to embrace it, using it judiciously in appropriate settings. It can be a way of saving costs, a boon for people unable to access specialists in their area, a way to continue care with your trusted doctor when you move to a different city or get a valuable second opinion when you are in another country or continent! 

Many people feel that “It’s not the same” as a “REAL” consultation. That, however, in my opinion, is a matter of perspective – in this article, I will explain that at least in Endocrinology, an online consultation can be AS GOOD AS an in-person consult.

Of course, there will be obstacles/stops like any other new technology. Older people living alone probably have had the most difficulties like poor internet connectivity and making online payments. Older doctors struggled like their patients with learning new technology, setting up systems for electronic medical records, setting up payment pathways and sending electronic prescriptions. There has been a rapid rise in the number of companies working on solutions to overcome these issues and the situation will only get better.

My Online consultation journey – 

Often, children bring visiting parents to me for an opinion as they are not satisfied with the quality of care their parents are receiving in their area of residence. Sometimes, young professionals who move to another city for a job or after marriage express their desire to continue to consult with me but cannot do so due to distance. In August 2019, I was in the process of making a website for my practice and thought of having an integrated chat/consult service where my patients could upload their reports and problems and I could continue to consult them, wherever they were.

There was no way I knew of the looming pandemic but when it hit us, the website was a boon for me to continue to provide care for my patients who could not come to see me due to the lockdown. Through the pandemic, I conducted almost 1000 online consultations, taking more than a hundred women through their entire pregnancies managing their Diabetes without having ever seen thein

This cemented my long-held belief in the unique place of online consultations in our care spectrum. All specialities are not conducive to online consultation format but Endocrinology is uniquely suited to this care model. I went on to build a new website with integrated software that allows patients to choose the date and time of consultation, upload reports and prescriptions prior to the consult, make online payment seamlessly and securely, enable good quality video consultation and electronic prescription delivery as well. 

Why do I LOVE online consultations?

It is so rewarding when you consult 3 generations of a family together seamlessly in one consultation in spite of each generation being in a completely different state (Maharashtra, West Bengal and Jharkhand). I have consulted Indians living abroad (Australia, New Zealand, US, Qatar, London, Dubai and Singapore) when they need the comfort of a familiar Indian face to confirm the treatment is appropriate. 

I especially love online consultations as I am a strong supporter of women’s health. Women’s health often takes a backseat and the health and wellbeing of children, spouses and parents take precedence. Women can just plug in from the office for a brief 20 minutes, discuss their problems and jump right back into work! Often, consultations are easier virtually from home than in-person as the woman does not need to arrange childcare, does not need a spouse to accompany them, doesn’t have to struggle with a screaming child in the waiting room or worry about an ailing family member back home. We can ensure our women get the care they deserve through the medium of online consultation.

  1. What is an Online Endocrinologist Consultation? Is it as good as an in-person consultation? 
  2. What should I expect in an Online Consultation? What all conditions can be treated via an Online Consultation? 
  3. Is the Online Consultation interface easy to use? 
  4. How do I pay for the online doctor consultation service? How will the doctor prescribe prescriptions when it’s an online consultation? Is my consultation private and secure? 
  5. Do I need special equipment to use this service? (Laptop, Mobile, glucometer etc…) 
  6. How long does a session of an Online Consultation last?
  7. How do I prepare for an online consultation? Tips To have smooth & effective Online consultation

FAQ

1.What is an Online Endocrinologist Consultation? Is it as good as an in-person consultation? 

Endocrinology
 the science of hormones is a branch of medicine that is uniquely suited to an online consultation. Here is why

Thyroid | Dr Tejal Lathia

  • Most people visiting Endocrinologists have a chronic condition which needs regular follow up
 so most times the doctor has already done a detailed evaluation in the first consult, made the diagnosis and generated a treatment plan. Now, all that the person needs to do is follow the plan and touch base with the doctor every few months.
  • Most Endocrinology consultations are not urgent nor are physical signs needed to gauge treatment effects. So, an online endocrinologist consultation can be almost identical to a physical/in-person consultation. 
  • Lastly, treatment adjustment in Endocrinology is largely based on test results (TSH values) or how the person feels on treatment (less acne and hair loss) again allowing an online consultation with an endocrinologist to serve just as well as an in-person consultation.

So yes, in carefully selected endocrine conditions – an online endocrinologist consultation can be as good as a “REAL”  in-person consultation.

2.What should I expect in an Online Consultation? What all conditions can be treated via an Online Consultation? 

In an online endocrinologist consultation, you can confirm with your doctor whether you can continue the same medical management safely, stay connected with your doctor during pregnancy for blood glucose management, get your thyroid doses adjusted by a specialist without long wait times and continue avail her / his services even if you are not in the country. 

Here are the conditions in Endocrinology that can easily be managed with online consultations.

  • Well managed Type 2 Diabetes meeting treatment goals or with mild elevations of blood glucose
  • Diabetes in pregnancy needing frequent contact with a doctor
  • Hypothyroidism on treatment needing dose adjustments
  • Hypothyroidism in pregnancy needing frequent contact with the doctor
  • Hyperthyroidism on treatment needing dose adjustments
  • Polycystic Ovary Syndrome (PCOS) on regular treatment 
  • Post-surgery – thyroid/parathyroid 
  • Second opinion on treatment – radioiodine therapy for hyperthyroidism or surgery for hyperthyroidism 
  • Osteoporosis on treatment 
  • Perimenopausal transition 
  • Hypogonadism in males on hormone replacement 
  • Premature menopause/ primary ovarian failure on regular hormone replacement
  • Hyperprolactinemia / raised prolactin on long term treatment 
  • Hypopituitarism on regular treatment 

Please do not avail an online consultation for serious symptoms like :

  • Fever
  • Active infection 
  • Breathlessness or swelling over face/feet
  • Very high or low blood sugars
  • Excessive bleeding or severe pain

So basically in any urgent or emergent condition which requires a comprehensive physical consultation or emergency treatment, online consultations are not sufficient and you must see your doctor at the earliest.

3.Is the Online Consultation interface easy to use? 

Most doctors now use dedicated telemedicine platforms for their own consultations. Many doctors also use their own software or apps  to support online consultations. These are extremely easy to navigate and use.

  • Click on the link – you will be redirected to the online appointment page
  • Fill in basic details ( Name / age / gender / phone number or email ID)
  • Choose date and time of consultation 
  • Upload relevant reports/prescriptions / write a brief summary of the reason for consult 
  • Make a payment online by any convenient option ( debit card/credit card / NEFT )
  • Once payment is credited, you will receive a confirmatory email / SMS with date/time and  video link to connect
  • On the day of consult, click on the link and meet the doctor ( your family members from other cities/states or even other countries can join the consult)
  • After the consult, you receive an electronic prescription by mail/by SMS ( separate invoice can also be generated if needed for reimbursement ) with the date /tests needed for the next appointment.

 

Online Consultation | Dr Tejal Lathia

 

Information to the patient | Dr Tejal Lathia

 

4.How do I pay for the online doctor consultation service? How will the doctor prescribe prescriptions when it’s an online consultation? Is my consultation private and secure? 

As explained above, most online consultations can be paid for by debit/credit card or even google pay.  The payment link is usually integrated with the telemedicine platform or can be sent as a direct link as well from the payment portal. Furthermore, refunds are easy with online consults should you need one and invoices can be generated to submit for reimbursement or insurance purposes. 

Prescriptions can either be electronically generated if the doctor uses a specific software or can be handwritten and a picture shared in a pdf format by mail / SMS /WhatsApp. You need not sit for hours in the waiting room or spend long hours travelling to and from the doctor’s office for a routine follow up visit where the same meds are continued.

In individual doctor telemedicine platforms, your information is 100% private and secure and will not be shared with any third party. The payment gateways are legally liable if any payment information is leaked and a reputable gateway will NOT risk their reputation. 

5.Do I need special equipment to use this service? (Laptop, Mobile, glucometer etc…) 

So most people are afraid that they won’t be able to do an online consultation without a desktop computer or laptop. But this is not true! Most online consultation interfaces function just as well with a mobile phone. On my website, I often get requests for whats app video calls for consultation as sometimes there is limited internet access or limited technological know-how to use links/apps. This works just as well and I usually write out a prescription, click a picture of the prescription with scanning software and send it as a pdf which they can print or send to chemist or online purchase of medications.

6.How long does a session of an Online Consultation last?

For most endocrinology consultations, a session of approximately 20 minutes is usually enough. Of course, it helps if the person has already uploaded reports/prescriptions prior to consulting so that the doctor has time to see them in the context of your problem. This helps the doctor understand your problem, decide pertinent questions and formulate a tentative diagnosis or treatment plan well in advance. 

In my online consultation process, with my nutritionist/diabetes educator, we go through all appointments a day in advance. We identify people who need a nutritionist consultation online and arrange the same before the online consultation with the endocrinologist. This is invaluable as I already know the lifestyle of the person, his/her food and exercise habits in advance. 

This saves a lot of time in the actual consult – finding out food/exercise habits, answering queries like “Which fruit can I eat?”. This is also extremely helpful to make the best treatment choices for the person.

 For e.g – if someone has mildly elevated blood sugars and there is room for considerable improvement in food and exercise habits, we may be able to avoid medications for diabetes completely. 

7.How do I prepare for an online consultation? Tips To have smooth & effective Online consultation

  1. Please upload relevant current reports at the time of booking ( eg TSH for thyroid, FBS / PPBS / Hba1c for diabetes)
  2. Please upload current medications you are taking for the condition you are consulting for as well as those which are interrelated ( medications for diabetes as well as high blood pressure and high cholesterol )
  3. If you have any home blood glucose monitoring values, write them out, click a pic and upload this as well ( with clear date/time/relation with meals for clarity)
  4. If you are on insulin, please update the name and current dose of insulin
  5. State the current problem you are facing 

For eg routine consultation for diabetes OR

Diabetes of 6 years duration but am losing weight / have tingling in hands and feet OR Polycystic Ovary Syndrome (PCOS) with the recent increase in weight

  1. Check the link for video call a day in advance, join the link 5-10 minutes early
  2. Sit in an area with good lighting / good internet connectivity
  3. Use headphones if ambient noise is high or there is a lack of privacy
  4. Dress appropriately (we have had consults where someone is lying down on a bed and is scantily clad 😊)
  5. Have a list of questions ready for the doctor to ensure you don’t forget to clear your doubts

Don’t let your fear of technology stop you from accessing healthcare in a timely manner

 

Tips To have an effective Consultation | Dr Tejal Lathia

 

Summary:

Considering the need of the hour, it’s important to stay safe and practice social distancing. To avoid frequent visits to medical facilities, I am committed to serving you online. Please Book your appointments for online consultations on https://bit.ly/3mXEPPj