Attitude to telemedicine in the times of COVID‐19 pandemic: Opinion of medical practitioners from India

The COVID‐19 pandemic has brought forth a renewed focus on the role and relevance of telemedicine services. ¹ , ² , ³ With lockdown putting constraints on travel, and emphasis on social distancing to prevent the spread of the virus, telemedicine seems to be an appealing option for patients and care providers for medical consultations. ⁴ , ⁵ , ⁶ While telemedicine has already made headway among the more developed nations, it is probably yet to find a firm footing in resource‐constrained countries. ⁷ , ⁸ Yet, the pandemic has provided an opportunity and a need to rapidly expand telemedicine services in developing countries. We conducted an online survey of medical professionals from India (with a sizeable proportion of psychiatrists) to understand their perspectives about telemedicine and its future in the country.

An online survey was created on Google Forms and circulated via snowball sampling through social media. The questionnaire comprised of agreement to consent, information about limited demographic information, work profile, whether participants had used telemedicine in the past, and their opinions about various facets related to telemedicine. A total of 221 responses were logged in between 12 and 21 April 2020, out of which five participants did not consent. Eight more participants were excluded as they were not practicing doctors, leading to a total figure of 208 analyzed responses. Analysis was done using spss Version 21 (IBM, Armonk, NY, USA).

The responses are presented in Table 1. The sample comprised largely of resident doctors, and almost half were postgraduates. The results reveal that most of the participants had used telemedicine in some form, but had not confirmed the patient's identity or documented the consultation. Such respondents also tended towards considering it easy to understand the patient's problems, having had a good experience with digital consultation, and were likely to recommend it to colleagues. Respondents largely agreed that telemedicine would help quality health care reach remote areas of the country, and reduce budgets and waiting times for the patient; however, they also cautioned that telemedicine could: (i) be a hindrance to direct clinical decision‐making and treatment; (ii) be a hindrance to patient–doctor relationships and trust; and (iii) result in vulnerability of digitally recorded personal information. Respondents were largely skeptical about the possibility of telemedicine significantly replacing the current patient‐care system over the next 5 years.

Table 1.

Responses of participants

Variable	n (%) or mean (±SD)
Age (years)	29.2 (±3.4)
Sex
Male	117 (56.3%)
Female	89 (42.8%)
Prefer not to say	2 (1.0%)
Qualification
Medical graduate	111 (53.3%)
Postgraduate	97 (46.7%)
Job profile
Resident doctor	162 (77.9%)
Consultant/faculty	25 (12.0%)
General physician	19 (9.1%)
Medical officer	2 (1.0%)
Location
Delhi	98 (47.1%)
Other states	110 (52.9%)
Psychiatry specialist	46 (22.1%)
Have you ever consulted patients over digital mode?	165 (69.3%)
Did you confirm patient identity?	98 (59.4%)
Did you keep a record of the consultation?	55 (33.3%)
How ‘easy’ was it to understand your patient's problems? (1 = not at all easy, 5 = very easy)	3.13 (±0.89)
How would you rate your own experience with digital consultation? (1 = worst experience, 5 = best experience)	3.14 (±0.76)
How likely, based on your experience, would you suggest teleconsultation to your colleague? (1 = very likely, 5 = very unlikely)	3.10 (±1.03)
Telemedicine platforms will help quality health care to reach remote areas. †	3.61 (±1.17)
Telemedicine will cut the budgetary need in public health by reducing the cost of health‐care delivery. †	3.50 (±1.15)
Telemedicine will reduce the waiting times for patients. †	3.97 (±1.00)
Telemedicine will help with keeping patients’ digital medical records safely, easily, and accurately. †	3.59 (±1.21)
Patient follow‐up and refilling of medications will be much easier with the telemedicine approach. †	3.60 (±1.20)
Indians will quickly accept the concept and telemedicine will replace the current pattern of the patient‐care system in the next 5 years. †	2.41 (±1.23)
Lack of in‐person contact between patient and the doctor will hinder the relationship and trust. †	3.81 (±1.09)
The digital record‐keeping will make patients’ personal information more vulnerable to being stolen, pirated, or hacked. †	3.53 (±1.13)
The absence of general and systemic examination would hinder direct clinical decision‐making and treatment. †	4.28 (±0.98)
The Indian population is yet to accept and utilize the concept and telemedicine will not replace the current pattern of patient‐care system in the next 5 years. †	3.88 (±1.09)

^† Strongly disagree (1) to strongly agree (5).

Exploratory analyses revealed that male participants and psychiatry specialists tended to believe that telemedicine would help to provide better care in remote areas (P = 0.015 and P = 0.003, respectively). Psychiatry specialists also more commonly endorsed that telemedicine would reduce budgetary needs (P = 0.006). None of the questions had moderate or high degrees of correlation with age. Among those who had used telemedicine, psychiatrists were more likely to find it easy to understand the patient's problems (P = 0.005) and to suggest telemedicine to a colleague (P = 0.001).

The present findings suggest that telemedicine in some form is becoming a reality, though there is a cautious enthusiasm about telemedicine in general from the medical fraternity. The most significant concern highlighted by the doctors was the potential hindrance to clinical decision‐making and treatment. The advantages offered by telemedicine are many, but it is unlikely to become a well‐accepted and robust replacement for in‐person medical care. In fact, most respondents, irrespective of age, did not feel that telemedicine would replace usual care over the span of the next 5 years.

An interesting observation was that among users of telemedicine, psychiatrists were more likely to find telemedicine easy to work with in terms of acknowledging the presenting complaints of the patient and to recommend telemedicine to colleagues. This suggests that uptake of telemedicine may be better with psychiatrists as compared to other professionals, who may value the need for the manual physical examination and closer observation that are vital for their practice. Results from a large insurance database also suggest that telemental health services accounted for about half of the telemedicine visits, with such telemental health visits increasing most rapidly for those areas that did not have a psychiatrist. ⁹ Also, though a considerable proportion of the participants had used telemedicine in the past, many seemed unlikely to recommend teleconsultation to a colleague. This is a worrisome consideration as it may lead to limited general uptake of telemedicine in India's medical community.

The present findings should be interpreted in regards to the following caveats: (i) sampling constraints with possibility of referral and selection biases; (ii) one‐third of the respondents had never had an actual teleconsultation experience; (iii) opinion being sought on selected aspects (there could be many more issues pertaining to telemedicine, including ‘willingness to practice’); and (iv) data deriving from a single country. Despite the limitations, the findings carry forward the discussion of use of telemedicine, possibly differentially by different specialties based upon their clinical needs, ⁹ , ¹⁰ and possible justifiable resistance to radically changing ways of practicing medicine with the use of telemedicine. However, psychiatry as a specialty may be able to embrace telemedicine faster than other fields of medical practice.

Institutional ethical clearance was not required as this was an online survey. Informed consent was obtained from each participant. This study fulfills the ethical provisions of the Declaration of Helsinki.

Disclosure statement

The authors do not have any conflicts of interest.