more-in The Indian Medical Association (IMA) has asked doctors to completely avoid telephonic consultations stating that ethically a doctor can only prescribe medicines or advice on treatment to be followed only after seeing a patient. The IMA said in a release, “A history of ailments and clinical examination is needed to prescribe any medication. Hence, telephonic consultation without seeing a patient is not ethically or legally valid.” IMA president Ravi Wankhedkar said a regular patient seeking advice on phone is also invalid as the call will be on any change in symptoms or signs, which have to be examined before the medication is altered or further advice is given. “Instructions given by the consultant to a patient to inform via telephone the results of investigations and followed by the advice may be held valid as the consultant is responsible for the patient’s actions,” Dr. Wankhedkar said. On the issue of telemedicine, the IMA noted that it is between a doctor and a paramedic, or between a doctor and a super specialist. Hence, it said, both are responsible for any negligence. The IMA said deficiency of service occurs when there is deviation from common practice and lack of reasonable care causing damage to the patient. “The common practice involved in treating a patient is eliciting history, physical examination, going through investigations and arriving at a diagnosis. Treatment is instituted after diagnosis. In a telephonic consultation, all or part of the above may not be undertaken. Hence, there is always a possibility of alleging and finding negligence on the part of the doctor in such cases by the legal fora,” said the association. The IMA noted that in situations where physical examination is not required — like adjusting insulin according to blood sugar levels in a regular patient, analgesics for acute exacerbation of chronic pain under regular treatment, etc. — telephonic consultation will not amount to negligence. “Also in situations of managing emergencies till the doctor arrives, telephonic consultation can be undertaken in a judicious manner. Also in this type of consultation, there is an element of contributory negligence on the part of the patient or relatives if they by themselves opt for telephonic consultation,” said IMA honorary secretary general R. N. Tandon. If a patient is in distress, Dr. Tandon said, the treatment suggested by the practitioner in whom he/ she has confidence is appropriate and ethically correct. It is ethically incorrect if the method is used by the practitioner to avoid seeing a patient directly. “Information explosion and advancing technology can be harnessed to augment healthcare in remote areas, especially telemedicine and mobile health,” he said. The IMA has requested the MCI to come out with clear guidelines on the issue.

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