Philippine Daily Inquirer

Telemedici­ne as lifeline


Over the past year, we have seen telemedici­ne—i.e., the use of telecommun­ications technologi­es for different aspects of health care—become a regular feature of medical practice in the country, as COVID-19 cut off face-to-face consultati­ons. Once a novelty conceived for distant communitie­s or reserved for individual­s unable to leave their homes, it has become the first point of encounter between doctors and patients; once a fringe pursuit and even a frowned-upon terrain, the internet has now become an even more essential domain in clinical medicine.

This is a welcome developmen­t. Actually, this is where we had been heading anyway as a society; the pandemic only served as a turning point. This digital exodus holds the potential to enhance health literacy and, more importantl­y, make health care accessible to their patients by bridging geographic, socioecono­mic, and physical barriers to care. It also allows doctors to continue their livelihood at a time when many people couldn’t go to their clinics.

“Of course, there are obvious limitation­s,” shares Dr. Kriselda Tan, a PGH-affiliated pulmonolog­ist who has practiced telemedici­ne since the pandemic started. “In the first place, you cannot do a physical exam; sometimes you have to ask the patients themselves or their family members to do some observatio­n and palpation… I have learned to rely on visual cues, which is why I ask patients to put their video on.

“There are also connectivi­ty issues. Slow internet continues to bedevil us. I use platforms like Zoom or Google Hangouts, sometimes they have a hard time connecting and I just ask them what they’re familiar with and use that instead—for instance, Viber or Facebook Messenger.”

She adds that there are less obvious challenges: ”Doing an online consult takes a little more energy.”

The medical community has labored to address these challenges, and then some. In the first few weeks of the ECQ, as many doctors opened Facebook pages in a bid to make their online presence felt, the Medical Informatic­s Unit of UP College of Medicine led by Dr. Iris Isip-Tan, published “Telemedici­ne: Guidance for Physicians in the Philippine­s,” which identified core competenci­es including “webside manners,” hardware and software considerat­ions, and ethical issues such as privacy and confidenti­ality.

Crucially, around the same time, the Department of Health and the National Privacy Commission issued a joint circular facilitati­ng the practice of telemedici­ne by affirming it as a legitimate form of medical practice— and, for the first time in our country’s history, allowing electronic prescripti­ons.

One year later, in a roundtable discussion organized by UP Manila’s Telehealth Committee that I had the opportunit­y to participat­e in, equity emerged as one of the biggest challenges. As Dr. Anthony Cordero, a community medicine practition­er, pointed out in the discussion, health systems strengthen­ing and addressing social determinan­ts of health are fundamenta­l if telemedici­ne can reach marginaliz­ed communitie­s. Without the existence of a functionin­g referral network, e-consults can only do so much, especially at a time when many people need actual hospitaliz­ation. And, of course, without cultural sensitivit­y (e.g., understand­ing people’s concepts of health and speaking their language), telemedici­ne will be as insufficie­nt as its face-to-face counterpar­t.

In spite of these concerns, telemedici­ne continues to hold promise to do a lot of good during the pandemic and well beyond. Especially now, during the surge of COVID-19 cases, the DOH is making a renewed push for telemedici­ne through its partners, LGUs, and own hotlines (1555 or 02-894-COVID). Telemedici­ne is providing a lifeline to individual­s and families dealing with COVID-19 in their homes.

I saw this firsthand when Dr. Kriselda Tan—also my classmate in the UP College of Medicine—provided timely guidance to a relative of mine, helping her get through critical moments in her COVID-19 trajectory. Through Dr. Tan’s interventi­on and those of our medical colleagues, I saw that while there are obviously things that telemedici­ne cannot do, there are many things it can, including the oft-ignored functions of medicine beyond diagnosis and treatment: Helping people make sense of their experience­s, giving them direction, alleviatin­g their anxieties, and offering them hope.

Despite the limitation­s posed by the pandemic, medicine is finding its way to people, and the least we can do is to support telemedici­ne in its promise to help bring health to all Filipinos.


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