Tele-Psychiatry: After Mars, Can we Reach the Unreached?

Abstract

Byline: Suresh. Math, Sydney. Moirangthem, Naveen. Kumar Mars Orbiter Mission, India's first interplanetary mission to planet Mars, was a grand success and placed India in the elite club of space explorers on 24 Sept 2014. [sup][1] However, medical care has not reached the unreached population despite such advancement in the field of information technology. In an effort to bridge this gap, the Indian Space Research Organization (ISRO) initiated an ambitious Telemedicine Pilot Project in the year 2001 which was implemented in several States across India. [sup][2] However, the following decade showed that telemedicine was not able to deliver the intended objectives and has not reached its full potential. This article focuses on the issues, challenges and suggestions for telemedicine in India. Telemedicine Technology: Telemedicine is defined as the delivery of health care services, where distance is a critical factor, by all health-care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of diseases, injuries, research and for continuing education of health care providers, all in the interests of advancing the health of individuals and their communities. [sup][2] In simple words, telemedicine can enable primary care doctors/para-clinical staff to perform the function of specialist doctor's tasks under the supervision of the specialist through telemedicine. When compared with conventional health care, telemedicine saves time, is economical and reduces the effort to the rural patients, as they are not required to travel long distances for obtaining specialist consultation and treatment. [sup][3] Patient acceptance, clinical outcome, safety and satisfaction has been found to be similar to the conventional face-to-face consultation and care, [sup][4],[5] In spite of the above advantages telemedicine in India is haunted with number of issues [sup][6] discussed below. Implementation factor: Telemedicine was implemented with the objective of reaching the unreached. However on analysis of the telemedicine network across India, it could be easily concluded that, telemedicine network are well-connected between tertiary care centre (medical colleges) and secondary care centres (district hospitals) only. Primary health care centres are not yet included in the telemedicine network, hence it falls short of reaching the goal of 'reaching the unreached'. Man power issues: Telemedicine was imposed on the existing, already over-burdened medical staff without providing additional man-power. In one of the study from Karnataka, 76% of the doctors reported they were already busy in their conventional work, 20% were not ready to wait for teleconsultation and 4% did not want to seek help from the nodal centres. [sup][6] Telemedicine should become part of the health system and needs to be considered as a separate department with dedicated medical staff, supporting and technical staff. Attitudinal issues: The biggest challenge continues to be the human mindset to keep the homeostasis as the norm and providing obstacles for the change. Doctors at the district hospitals have the mind-set of ' I am also a specialist, then why should I ask for opinion?' , ' It is not my business to ask for opinion' and ' What will patient think of me, if I ask for opinion from other doctor, they may think that I am not competent '. This issue needs to be addressed by educating the doctors and providing incentives in implementing telemedicine. [sup][6] Technical difficulties: Poor (satellite/broad band) connectivity, lack of uninterrupted power supply, faulty maintenance of equipments and absence of dedicated noise free space are some of the technical challenges faced in effective delivery of telemedicine services. Logistic Challenges: After tele-consultation, it was found that prescribed medicines were not available, well-equipped laboratories were not there and radio-diagnostic facilities were not there in the client (remote) centre, which hampered the quality of telemedicine services. …