COVID-19 has proven itself to be an indiscriminate infector, wreaking havoc on the health of millions across the world. Its arrival on Jamaica's shores has resulted in the closure of many privately owned medical practices, a response triggered by an attempt to curtail the spread of the virus. This has left at least two groups that most often seek care at these facilities — women and children — without physical access to their health care providers.
This has given rise to an increasing number of medical professionals and patients alike exploring an alternative to the face-to-face doctor's visit — telemedicine. This is being facilitated via platforms such as MD Link, which was started by Dr Che Bowen to help with the management of non-emergency medical conditions.
“Since the outbreak of the coronavirus disease, our platform has seen a large uptake of both medical personnel and patients registering to use the platform. People don't want to be on the road, the Government is advising them to stay off the road, and we realise that they are trying to avoid their doctors' offices and the hospitals where other sick patients are because of the outbreak,” Dr Bowen told All Woman.
He explained that for doctors, their decision is not only because they have realised that people are not coming out anymore, but they want to remain accessible to their patients while helping to reduce the risk of in-country transmissions and slowing the spread of the disease since social distancing is difficult to achieve in waiting rooms.
“Telemedicine is the diagnosis and treatment of patients using telecommunication and online services. So MD Link allows a person to see a doctor online on their phones, computer and other smart gadgets and have their prescriptions delivered to a pharmacy, lab requests delivered to the respective labs, and radiology requests sent to the respective radiology centre. So this allows you to skip the waiting room and see the doctor on your time and your doctor's,” Dr Bowen explained.
The platform carries a variety of medical experts including general practitioners, gynaecologists, psychiatrists, dermatologists, paediatricians, internists and recently the platform welcomed a neurologist and a vascular surgeon.
One gynaecologist, who is now accessible via MD Link, is consultant obstetrician-gynaecologist Dr Daryl Daley. Dr Daley said the platform may not be most effective for treating with most gynaecological conditions because most require a physical examination for a diagnosis to be made, but he says that it has its place.
“The majority of the patients that I see in my profession require examination — it could be anything from belly pain, breast pain or a pregnant patient. While a patient can provide me with some amount of information, I would need to take notes from the physical examination in order to make a diagnosis,” Dr Daley explained.
He said that medical conditions that the platform would be more suited to treat with include uncomplicated vaginal discharge (patients who present without a fever), yeast infections, women who have symptoms of urinary tract infections, discussions regarding infertility, contraception treatment, results from ultrasounds and labs, and the platform is also ideal for overseas patients who are interested in cosmetic surgery.
“Most of these conditions are either very straightforward to treat and/or manage, are therapy-based, and by that I mean it involves talking the patients through it, or have to do with a consultation — so basically the use of video and images. Counselling sessions with patients can also be very effective on this platform — it is easily one of the strongest elements of this platform,” Dr Daley reasoned.
Consultant Paediatrician at We 'R' Kids Paediatric Centre, Dr Lisa Franklin-Banton, shares similar praises for the programme; however, she says that virtual consultations, which she facilitates through her business website werkidsja.com, have proven very effective.
“Telemedicine can be a very effective platform for paediatricians to use. I recently started using the platform and it has worked very well. The advanced video and audio capabilities allow me to see my patients and allows me to interact with parents who will be able to provide me with the patient history especially for patients who cannot talk. In addition, at We 'R' Kids, since our medical records are digital, it's easier to manage a patient based on his or her history,” Dr Franklin-Banton said.
She acknowledges that there are limitations with the platform because ideally she would want to examine all patients, but since she cannot physically do this, she has to devise creative ways to ascertain as much information as possible about a patient before making a diagnosis.
“Since I can't physically touch my patients I usually ask parents to do things for me. So, for example, I would ask them to let me have a look at how they are breathing, open their mouths and let me have a look if they are complaining about a sore throat, and if that doesn't work well enough I ask them to follow-up the video with a picture via WhatsApp,” Dr Franklin-Banton underscored.
Similar to the challenge shared by Dr Daley, the paediatric expert said that there are some things that she cannot ask parents to do, like checking the child's ear if an ear infection is suspected, for example. Something like this, even when the symptoms indicate that it may be the issue, is difficult to diagnose via this platform.
“Because of the limitations presented by the platform, even after diagnosing a patient and they are on medication, I do a lot of follow-up. So, for example, if I see a patient via the platform and he or she has a high fever and/or a cough, I would follow them on a daily basis until I feel comfortable that they are better. So each morning using my list of patients I call or text patients for updates until patients are better,” Dr Franklin-Banton said.
There are instances in which the paediatrician says that she does not feel comfortable monitoring a patient via the platform — including when a patient is experiencing difficulty breathing, and excessive vomiting, for example.
Meanwhile, Dr Bowen said that female patients, who are the majority of psychology patients, can also benefit from telemedicine. He explained that in this time of crisis, patients tend to require more support than usual, and should consider taking advantage of the platform instead of risking in-person visits. He said various communication mediums available on the platform allow psychologists to effectively carry out their jobs since, unlike other speciality areas, it does not usually require a physical examination of patients.