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Tuesday, December 06, 2016

E-consults and Apps in India...Why they haven't worked yet!

There seem to be a whole host of new service providers on the internet targeting the medical community. The path breaking, ground shattering, myth busting, scenario changing medical e-consults or online consultations are here and pushing at us from all angles. Almost everywhere you look, there seems to be a new provider or an app that promises you the best clinical opinion online and the easiest consultation (most popular ad tag line is 'no waiting') you've ever had. 

The crux of the e-consult is this. You log on to a website or an app, put in your symptoms or queries and they connect you to a doctor of their choice to analyse what you have put it. When it just started off, it was a crude questionnaire you had to fill with a lot of basic questions sort of like the cue cards these call centre employees use when first on the job. This has become refined to a process wherein you can now upload reports and images and offer a better understanding of your illness.The Doctor choice still remains with the app or provider! In a nutshell, here is what the process is like.



Now, there is no doubt in my mind that this is where the future lies in terms of medicine and technology making it easier for the patient to connect with a doctor. However, I have a couple of reservations and most of them point out to the reason why this has not picked up at all in India.

1) There isn't one provider / app that has been able to correctly design their process to make it easy. Either getting on is too complicated or once your in, choosing the right options are confusing or lastly there are too many tedious things to do before actually getting what you want. Does this then really cut out the waiting time for your own doctor?


2) The age old objection of no physical examination being possible stays on. While this may be ok for the patients who would feel perhaps that they just have a simple illness that needs a few over the counter drugs, there are enough and more stories of serious illness being found out only on a physical exam done as a routine and not for presenting complaints. I can't begin to explain how many cancers and chronic illnesses have been caught out over a simple visit for a viral sore throat or fever.



3) The digital divide and generation gap. It's all too well to say we are living in a digital age and our population is one of the youngest in the world. The ground reality sadly is that most people are still unaware about using a smartphone / tablet to it's complete capabilities. The generation above us is still struggling to come to terms with online banking, e-commerce and online research. Getting them to trust a doctor online who doesn't see them is going to be a task. In the villages, the population is dependent on the one tech savvy person who would do this for them and make them sit in front of the webcam while they describe their most personal and intimate symptoms. Would you be open to talking about it in front of someone who may not be ethically sworn to confidentiality?  


4) It's no surprise that most of these providers that started off as medical care givers over the internet have now positioned themselves as Second Opinion providers. This makes good business sense in terms of at least getting things moving along. However, using the app for a second opinion usually leads to two outcomes: One, you're satisfied with the opinion and then look to meet this doctor (if possible) to continue treatment with him/her (has actually happened with me) and two, you're completely dissatisfied with the opinion which leaves you back to square one.

5) The main reason why I think this hasn't worked so far and still won't unless they change this main reason is this - Most Doctors on these platforms are doing this part-time. They aren't invested in it enough to provide the best possible care for the patient. The attitude is that I will see this patient once on the computer screen and that's the end of it. So, no details are taken, no real relationship is formed and the trust issue will always rear it's head at a point of conflict. 

Unless you have full time doctors invested completely in the platform, treating it's success as their success and it's failure as their own failure, the system will not take off. 

Unless, you have that consistency which is developed with the doctor seeing the patient over time and knowing the patient inside out, the accuracy will not be there. 

Unless you have developed enough trust with the users there will be no return users, no long term subscribers. The ones that do subscribe will be driven away if there are frequent doctor changes.

Unless you obtain the privacy required and tackle the ethical dilemmas involved it will not take off.



All of these are doable. Unfortunately, no one seems to be thinking in this direction. The idea of converting health records to digital formats seems to have blocked everyone's minds away from the actual ideas that can help them grow. I do hope this changes quickly because the potential is enormous, especially here in India. I see a future, how bright it turns out depends on how quickly we realize which way the light is!



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