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Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 1-2

Adapt and adopt: Remote delivery of healthcare in neurosurgical practice

Department of Neurosurgery, National Neurosciences Mission, Adarsha Super-Specialty Hospital, Manipal-Udupi, Karnataka, India

Date of Submission24-Jul-2021
Date of Decision26-Jul-2021
Date of Acceptance30-Jul-2021
Date of Web Publication27-Aug-2021

Correspondence Address:
Dr. Jaspreet Singh Dil
Department of Neurosurgery, National Neurosciences Mission, Adarsha Super-Specialty Hospital, Manipal-Udupi, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcvs.jcvs_19_21

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How to cite this article:
Dil JS. Adapt and adopt: Remote delivery of healthcare in neurosurgical practice. J Cerebrovasc Sci 2021;9:1-2

How to cite this URL:
Dil JS. Adapt and adopt: Remote delivery of healthcare in neurosurgical practice. J Cerebrovasc Sci [serial online] 2021 [cited 2022 Dec 2];9:1-2. Available from: http://www.jcvs.com/text.asp?2021/9/1/1/324815

Almost two years into the pandemic, it would be foolhardy to deny that the outbreak of COVID-19 has become one of those events that has altered civilisation. Several events have occurred in the course of history that became a focal point of transition, but few in the area of health and healthcare. Much of the medical workforce directly dealing with the COVID-19 pandemic today were not even alive during the era of smallpox. There is no sense in assuming that the world will go back to a certain kind of normal after the pandemic, as it is a signal of change that must be recognised and medical people must take a leading role, especially when it comes to the issue of healthcare delivery.

If we are to identify what has most visibly changed in the world, it is the manner of interaction. Thanks to all developed facilities available to us today, technology has aided us by allowing us to be connected virtually even during lockdowns and curfews. This must stimulate the discussion on remote delivery of healthcare and its possibilities.

Telemedicine is a beneficial reality. Several advantages are apparent, such as it is a sound method of triage that can save the patient from an unrequired visit to the hospital, and prevent avoidable in-person consultations. This allows the care provider to attend to those patients who have an actual need to be physically present in the hospital.

It is possible for the neurosurgeon/neurologist to elicit a proper history via video consultations and also guide the patient through a physical examination to obtain enough information to infer on the condition of a patient, such as inspection of the attitude and gait of a patient; manoeuvres to test power; conduction of a straight-leg-raising test; assessment of affect and speech; observation of visual cues of paralysis; observation of chronic patients at home and follow-up for their rehabilitation, such as real-time observation of patients receiving nasogastric feeds, or on urinary catheters, or undergoing physiotherapy; and clarification of concerns related to medications. Patients can be counselled about the best next step and taught to observe for important warning signs and risk factors in time-sensitive diseases like strokes. They can be taught about pulse/blood pressure and blood sugar recordings, and advised to undergo required tests or imaging procedures prior to their visits if deemed necessary.

Surveys have been conducted to assess the perception of doctors as well as patients about telemedicine, and have shown that majority are in favour of the system.[1] One of the added benefits, specifically in the period of a pandemic, is safety and reduced exposure. In a way, it is a revamped version of the home call that the doctor of the yesteryears would undertake, but in a manner much more feasible.

Even professionally, doctors can attend virtual meetings and discussions and even complete career enhancement courses without being restricted by geography.[2]

There are of course disadvantages, such as providing efficient access to teleconsultations for people in rural areas in a large country like India, although, that is also an area for possible improvement, i.e. through creation of virtual outreach facilities for conducting virtual camps in coordination with the local primary healthcare setup and spread of awareness about healthy practices at home and self-monitoring of health.

Apart from this, there are concerns[3],[4] pertaining to issues such as remuneration, confidentiality and security, but these can also be addressed by logical regulations[5] encouraging creation and use of standardised platforms that clarify the personal responsibilities of the patient and the doctor, the electronic mode of payment, the duration of consultations, secure management of databases and electronic health records.

The development of artificial intelligence in medicine and the increasing role of the patient in the management of their health, is undeniable.

We must become aware of the things that can be achieved remotely, and recognise what we can do to strengthen this, in our respective fields of work, so as to optimally integrate technology and medicine. To adapt to the future by adopting practices that will make it sustainable, for the doctor and the patient in the post COVID-19 era, is the goal that the pandemic must make us continually work towards.

  References Top

Amol R, Niveditha M, Kanwaljeet G, Vivek T, Vivek G, Shashwat M, et al. Turning a new chapter in neurosurgery outpatient services: Telemedicine a “Savior” in this pandemic. Neurol India 2021;69:344-60.  Back to cited text no. 1
Ganapathy K. Telemedicine: An integral part of clinical neurosciences. Neurol India 2021;69:352-3.  Back to cited text no. 2
[PUBMED]  [Full text]  
Deora H, Mishra S, Tripathi M, Garg K, Tandon V, Borkar S, et al. Adapting neurosurgery practice during the COVID-19 pandemic in the Indian subcontinent. World Neurosurg 2020;142:e396-406.  Back to cited text no. 3
Iyengar K, Jain VK, Vaishya R. Pitfalls in telemedicine consultations in the era of COVID 19 and how to avoid them. Diabetes Metab Syndr 2020;14:797-9.  Back to cited text no. 4
Ministry of Health and Family Welfare, Government of India Telemedicine practice guidelines. Available from: https://www. mohfw.gov.in/pdf/telemedicine.pd. [Last accessed on 2021 Jul 24].  Back to cited text no. 5


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