Speaking with PUNCH HealthWise, Director/National Coordinator, Neglected Tropical Diseases Elimination Programme at the Federal Ministry of Health, Dr. Chukwuma Anyaike, says face-to-face consultation is still better in the management of diseases associated with stigma.

Anyaike, a consultant public health physician, explained, “Medical consultation has a lot to do with psychological permutations and interpretations. For instance, if a patient comes to you, there are certain things he may not want to tell you. But by the time you look at the patient and ask some questions, you will be able to get the right information from him or her.

“Eye-to-eye contact is very important in medical care delivery. It helps in extracting the truth from a patient. There are a lot of impediments in virtual healthcare delivery as a result of poor network and patients hiding some vital information from the physician.

“So, face-to-face consultation is very important, especially when it has to do with diseases that are associated with stigma such as HIV and other sexually transmitted infections.

“Patients with this type of ailments prefer one-on-one interaction. Some patients feel safer having face-to-face interaction with the physician. Privacy is very important and they also have time to talk to the doctor.”

Commenting on online consultation, Anyaike said, “The person you are talking to on the phone, you do not know who is there. You don’t know what the person is doing with the discussion or whether he is recording you. But if you are talking to a patient in the consulting room face-to-face, you are sure of what you are seeing.”

He noted that COVID-19 does not stop face-to-face consultation, “only that people should keep a distance.”

A former president of the Nigerian Medical Association, Dr. Francis Faduyile, said that face-to-face consultation is very important because doctors have to touch patients and that touching is an integral part of health management.

Faduyile said, “Advancement in any technology follows a stepwise movement. The technology in Nigeria has been laidback and when we are talking about telemedicine, we have to move from one level to the other for us to be able to attain the level that we can say, ‘Yes, we can use technology to see patients, to plan patients and to examine patients.’

“And because of that, we cannot jump from purely manual to digital; you have to pass through some stages.

“In Nigeria, the management of patients has been largely face-to-face, even from medical school. Many of the doctors that we have were trained having one-on-one interaction with patients.

“And, again, you cannot see a patient without touching. Touching is an integral part of management or the process of making diagnosis for doctors.

“You have to palpate. Palpate means you have to touch some parts of the body to see how they are working. You also want to percuss — to see the consistency; and finally, you have to auscultate, that is, using the stethoscope to hear some sounds.

“All these ones have not been improved or undergone the technological know-how for us to able to say, ‘Yes, we have advanced to that stage.'”

According to Faduyile, a lot of interactions between patients and doctors are still one-on-one in the country in spite of COVID-19.

He noted that the awareness of patients in the use of technology in accessing healthcare in Nigeria is still limited, coupled with the challenge of poor network.

For patients to take part in an online consultation, experts say, they need access to a smartphone, tablet or computer with a working camera.

They raised concerns about accessibility for those who don’t have good internet connection, as well as any potential decline in the quality of regular check-ups.

However, an infectious disease expert with the Infectious Diseases Unit at the Lagos University Teaching Hospital, Idi-Araba, Dr. Oluwafemi Akinpeloye, says considering the risk of infection at the hospital during the ongoing COVID-19 pandemic, patients should look for other means of consulting with doctors rather than face-to-face if it is not an emergency.

“Let us leave hospitals for emergency cases for now. In this advent of technology and the direction at which the world is going at the moment, I believe it is not advisable for patients to come to the hospital at the moment because of the present pandemic.

“COVID-19 still remains a pandemic. We have found out that when patients are in an enclosed environment, it makes it easy for infection to spread from patient to patients, from doctors to patients and from patients to doctors.

“Initially, there are other infections in the hospital environment that when a patient comes to the hospital, the patient can contract and now there is COVID-19, which is still ravaging the world.

“With technology, you can talk to your doctor online without visiting the hospital. For the sake of infection prevention control, you need to keep at bay by observing social distancing,” Akinpeloye explained.

In an article published in BMJ Open access journal, the authors say there is a growing need to extend feasible options for patients beyond the traditional consultation model.

BMJ Open is an open access journal dedicated to publishing medical research.

“Online consulting may provide an effective and convenient alternative for some groups of patients (such as those in employment) with non-urgent problems, who do not require face-to-face contact with the practice.

“It may also offer an acceptable means by which patients can consult their clinicians about sensitive topics, which may otherwise remain unarticulated,” the authors said.

source: Punch