To Editor,
We have gone through an article titled “Telemedicine: Future of the Healthcare System and its Impact on Patient Satisfaction: A Literature Review,” recently published in your esteemed journal. The authors have done enough research and found out the important literature in the field of “satisfaction of patients in telemedicine.” They have pointed out that telemedicine is a cost-effective and time-saving method for patient consultation and that the satisfaction of patients with such medical consultation is not inferior to the physical consultation.[1] Telemedicine has saved the day during the COVID-19 pandemic period from 2019 to 2022 across the world. Clinicians also received the well-deserved appreciation for their work through telemedicine during such a difficult time.[2] However, we would like to point out certain points regarding the above-mentioned article.
Although telemedicine prevents the patients’ hassle and costs to reach the clinician, it can increase the dependency of patients and clinicians on unnecessary investigations. Ideally, the clinician can make a diagnosis based on physical examination with correlated history, rather than just hearing about the symptoms, which in most cases is important and enough for the diagnosis and treatment of the disease. In telemedicine practice, dependency on investigations in trivial cases may increase the time of intervention and lead to increased disease severity along with complications. It will also increase the population exposure to the blood-borne diseases. Unnecessary investigations will also increase the economic burden that the patient will have to bear, which can be more than the cost of traveling.[3] Follow-ups will also become costly and time-consuming as clinicians will have to repeat the investigations every time for follow-up, which can be done by a mere physical examination.
Another issue we would like to raise is that patients can use the same prescription for a similar kind of illness for his/her selves as well as for their family members. For infectious diseases, due to the development of various multidrug resistant organisms, it is necessary to do microbiological investigations like culture and sensitivity, every time, even for the similar clinical signs and symptoms. Gram-negative bacteria may develop resistance to antimicrobial agents quickly due to their inappropriate use, within few days of therapy.[4] Patients, unaware of the fact, use same antimicrobial agents prescribed by the clinician online for another infection and another patient. In telemedicine, follow-up of the patient is not feasible, unless the patient contacts clinician which they do not do following recovery.
Antimicrobial resistance (AMR) has been on the rise for a few decades across the globe. It has been established for decades now that over-the-counter antibiotic use and reluctance to do antimicrobial susceptibility testing have landed mankind at risk of developing a pre-antibiotic era. Due to the telemedicine, digital prescription is accepted for antimicrobial drugs. Preparing or modifying digital prescriptions has become easy due to artificial intelligence, and the authenticity of that prescription is not done at every pharmaceutical outlet. Also, the frequency of antimicrobial testing may decrease, and over-the-counter use of antimicrobial agents can increase. Thus, the unjudicial use of antibiotics may lead to increased AMR.[5] This can fasten the pace of “us” landing in the pre-antibiotic era.
To conclude, with telemedicine, there can be a rise in the cost and time for the diagnosis of diseases due to unnecessary investigations, which may also lead to complications. Follow-up will become difficult, time-consuming, and costly for the patients. There is a high risk of increasing AMR and very soon ending up in the pre-antibiotic era. Although the patients are perceiving telemedicine to be a BOON, while looking at the future, it may end up being a CURSE!
Comments on: Telemedicine: Future of the healthcare system and its impact on patient satisfaction: A literature review
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
References
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