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by Mohammed I Abubakar MBBS, MSc

Applied technology has made it possible for doctors to view the most remote aspects of human body leading to new understanding as regards diagnosis and treatment of diseases. In the same manner advances in technology has lead to creation of access to healthcare services for individuals living at a distance from the care provider. Telemedicine is a healthcare delivery system where care is provided to patients remotely. Challenging clinical problems are being effectively managed through this ICT enabled system.

Though there is still a lack of understanding amongst a number of healthcare providers about the possibility of carrying out an effective physical examination (PE) of the patient through video interaction. However evidence has shown that conducting PE through video call is practical, easy and aids effective decision making. But first of all it is a known fact that 80% of the diagnosis can be made through history alone while history and PE together provide 95% diagnosis. Some scholars have even indicated that 95% of the diagnosis can be reached through history alone. Of course this is in no way undermining the value of PE in making a diagnosis.

Physical examination generally involves keen observation of the patient to seek signs of a disease. This observation can be done through video consultation with ease by the healthcare provider. Also with some guidance the patient or their relative can help in the PE by following the instructions of the doctor.

Through the video call the doctor can observe the skin tone, presence of rashes, changes in color and pallor. The patient’s gait, respiratory rate (is the patient not able to speak complete sentence due to difficulty in breathing?), challenges with speech as well as distress can all be noticed from the video. The physical state of the patient can also be observed: whether they are able to sit up or have to lie down during the telemedicine encounter.

The eyes of the patient can be observed by focusing the camera to assess jaundice, conjunctival injection, extra-ocular muscles movement and pupillary reaction to light. The patient can be asked to open their mouth so the doctor can view their pharynx for redness, swelling and exudates. Patients can also check their own pulse while the doctor observe and time them.

Also the patient can use monitoring devices such as blood pressure monitor, thermometer, pulse-oximeter and blood glucose machine to monitor their blood pressure, temperature, pulse rate, oxygen saturation as well as blood glucose level respectively.

Newer tools are now available for conducting physical exam and these are app enabled so can be connected to the mobile phone or tablet for real time assessment of patient.

Tytocare: is a handheld examination kit and app used with the patient at a distant. It is a digital stethoscope, otoscope, camera and thermometer that the patient can use to capture the image of the ear, pharynx and skin as well as audio of the heart sound, lung and abdomen and record temperature and heart rate then send to the doctor.

Video (https://www.tytocare.com/professionals/)


 

 

MedWand

Leveraging Technology in Healthcare Provision for Developing Countries
UNCTAD, Geneva, 7th November 2019

https://unctad.org/meetings/en/Presentation/CSTD2019_p03_FunmiAdewara_en.pdf

 

MedWand: is an easy-to-use handheld device containing multiple diagnostic tools through which a doctor can assess the patient remotely.

Link (https://medwand.com/index.html)

 

Phillips new stethoscope, ultrasound and colposcopes are all being used for PE.

 

A family member or relative could be guided to examine the patient’s abdomen while the doctor observes areas of tenderness elicited by the examiner.

In conclusion the strategy of physical examination in telemedicine encounter is practical, easy and aids the diagnostic process.

 

For more information go to the link below to access courses and materials on telemedicine:

Thomas Jefferson University – https://cme.jefferson.edu/content/telemedicine-providers-conducting-effective-telehealth-physical-exam

Telemedicine Magazine – https://telemedmag.com/article/telemedicine-physical-better-think/

 

References

Jameson, J. L. et al. eds. (2018) Harrison’s Principles of Internal Medicine. 19th ed. McGraw Hill. USA.

World Health Organization (2010) Telemedicine Opportunities and Developments in Member States: Report on the 2nd Global Survey on eHealth. Global Observatory for ehealth series. Vol 2

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