Pediatrics was the worst hit of the specialties when the Covid-19 pandemic swept across the country. Eight months later, in mid-November, most OPDs have recovered to pre-pandemic levels, but footfalls in pediatrics continue to be low (1). This is because parents are still terrified of taking their children to hospitals and clinics. As a result telemedicine for pediatricians is gaining popularity.
But there are a few roadblocks. So, we bring to you some useful tips that could help you deliver better care remotely.
Regular care in Pediatrics
As a Pediatrician, you provide services to both healthy and sick children. These include vaccination, assessment of growth and development, diagnosis and treatment of diseases, and counseling about childhood and adolescent issues.
Many of these needs in-person visits, of course. Vaccinations must be done in the clinic. Acutely sick children are best physically seen at the clinic or emergency room.
Visits to the pediatrician are disruptive for the family. The child needs to miss school to see you and one parent, at least, needs to take time off from work.
Some children live in rural and remote places and find it difficult to access pediatric specialist care. Telemedicine can come to their rescue. But if you conduct medical exams on children remotely, you need to be aware of the challenges you will face and also how to overcome them.
What are the challenges of using telemedicine for pediatrics?
Telehealth advice for pediatricians
One of the foremost things that you should remember is that the parents must accompany the child during the video consultation, since most children might not be able to articulate their problems clearly. Having the parents explain things will make your diagnosis and treatment easier besides helping reduce the anxiety of the child.
A video consultation is pretty different from an in-person consultation. So, to ease things up for you and your patients, start by introducing yourself. Remember to look into the camera (rather than the screen) when talking. This has a similar impact as maintaining eye contact in an in-person conversation.
You must obtain and save the consent for a telehealth consultation.
As a physical examination is not possible, your diagnosis will be by history and inspection only. Therefore, get as much detail about the problem from the parent (and the child, if old enough).
After summarizing the treatment plan, give the patient and family some time for questions. Be friendly and patient. Avoid calls and other distractions during the consultation.
Ask if the family has a weighing machine, thermometer, spirometer, etc. These can provide objective data for your treatment decisions.
Electronic Health Records store the data from the patient and can be accessed just as easily in a video consult as in an in-person consult.
Is a certain diagnosis not possible? Does the child seem acutely ill? In such cases, you will, of course, recommend an in-person visit.
A tip about documentation – the higher likelihood of missed diagnoses requires careful documentation. You must also document the refusal by the family of a seriously ill child to go to a hospital or emergency room.
The clinic staff should be able to guide first-time patients and their parents. This will overcome their fears about virtual consultations.
Adequate hardware: High-definition (HD) video, good audio equipment, and a fast internet connection are needed. High definition video helps judge conditions like dehydration, cyanosis, breathlessness, and jaundice.
In addition to the hardware and internet connection, proper telehealth software is advisable.
During the pandemic, telemedicine for pediatricians has been of immense value. With more and more states and payors reimbursing e-visits (2), telehealth adoption among providers is also increasing. But, telehealth consultations can be a little difficult for pediatricians as they deal with children. However, implementing the above mentioned video consultation tips will help you to improve the quality of your online consultations as well as your diagnosis and treatment plan.
An online consultation is not the same as a regular face-to-face examination and the treating physician/provider may be limited by the written information and imaging provided by the patient or limited by the technology during the encounter. Accordingly, the diagnosis could be limited.
This article does not claim that an online consult is intended to replace a medical face-to-face evaluation fully or partially by a physician.
1. Ateev Mehrotra, Michael Chernew, David Linetsky, Hilary Hatch, David Cutler, and Eric C. Schneider. The Impact of the COVID-19 Pandemic on Outpatient Care: Visits Return to Prepandemic Levels, but Not for All Providers and Patients. https://www.commonwealthfund.org/publications/2020/oct/impact-covid-19-pandemic-outpatient-care-visits-return-prepandemic-levels.
2. Olson CA, McSwain SD, Curfman AL, Chuo J. The Current Pediatric Telehealth Landscape. Pediatrics. 2018 Mar;141(3):e20172334. doi: 10.1542/peds.2017-2334. PMID: 29487164.
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