NOTE: Majority of the information in this blog was created by the Doctors and Information Technologists under the guidance of the Medical Services Department of the Makati Medical Center. To them, I owe much.
One of the most heart-rending stories I hear are the cries of patients, unaffected by COVID-19, but still needing care for their conditions (the diabetics, the hypertensives, the fatty liver, the acid reflux…). The clinics have CLOSED. The community is under quarantine. They CANNOT get in touch with their doctors.
Doctors NEED to go online. NOW. This is your patient’s lifeline. Let me show you one way to get it done, and get it done FAST.
- Laptop – check that the camera and microphone works
- Phone with Data or Wifi access
- Reliable internet access
- Paymaya (download on appstore or playstore)
- Zoom for cloud meetings (download on PC/Mac/appstore/playstore)
Paymaya and Zoom were chosen because these are free to download while offering the services that are sufficient for our purpose. I have NO disclosures or interests in these apps/companies. There are other options out there (i.e. GCash, BPI QR, BDO fund transfer, among others). Explore them and compare. The more payment options you are aware of and are available to you, the easier it is for patients to pay your consultation fee.
What is Telemedicine?
Telemedicine is the remote delivery of healthcare services, such as health assessments or consultations, over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose, and treat patients using common technology, such as video conferencing and smartphones, without the need for an in-person visit.
What is Teleconsultation?
Teleconsultation is a subset of telemedicine which focus on providing remote consultation services without the need for specialized assessment and diagnostic equipment.
Qualifications for Teleconsultation
My hospital leaves to the doctors the discretion to decide whether their patients are qualified for teleconsultations, but here are some of the recommendations:
- The doctor should have existing doctor-patient relationship and that they have seen the patient in person prior to the teleconsultation
- The patient’s condition is not an emergency nor requires urgent medical intervention or procedure
- The patient does not require any assessment and/or diagnostic procedures which can only be performed by the physician at the point-of-care
- The patient can communicate effectively through the communication medium chosen by the physician (Viber, Skype, Zoom, etc.)
Setting up Zoom for Cloud Meetings
Download and sign up for a free (basic) Zoom account. If you have an active google account, signing up is as easy as clicking “join using google account.”
The following steps detail setting up a Zoom meeting on a phone. The laptop version is similar and I enjoin you to explore its features (and differences) from the phone app.
Scheduling a Consultation
Select the Schedule button and set the Date, Time, and Duration of your meeting (hereafter, we will call it a consultation). The time zone should be the same as the meeting host (hereafter, referred to as doctor). Attendees (hereafter, referred to as patients) join time will vary by time zone. Duration allows for easy time-blocking on calendars and does not limit your actual consultation time. We usually set a duration of 30 minutes.
Deselect the Personal Meeting ID (PMI). We don’t want the next patient to enter the “room” while a consultation is ongoing (just like in real-life).
In the meeting field, enter “Consultation: Patient Name”
Some options to consider:
- Video – Choose if you want the doctor’s or the patients’ webcams on or off when joining the consultation. I suggest you choose ‘off’ for the doctor and patient. The doctor and patient will have the option to start their video in the meeting
- Audio – We prefer to select ‘Both’ to allow patients to use any computer devices or telephone to listen and talk on the meeting. Most of your consultations would use the computer device.
- Enable join before host (doctor)– Allow patients to join the consultation
without you or before you join.
- Mute participants upon entry – This will mute the patient as they join the consultation. The patient will have the option to un-mute their microphone in the consultation.
- NO NEED to enable waiting room
The scheduled calls will appear in the “Meetings” tab.
Invite Your Patients
Select a scheduled meeting from your list.
Click on “Add Invitees”
Click on “Messages”
Alternatively, you can paste this invitation as a message sent to your patient’s email, messenger, or copy to clipboard and paste in viber.
As the consultation time approaches, click “Start” to begin your interaction.
(((( Your consultation proper starts here ))))
To end the consultation, click “End” or “Leave”.
Setting up Paymaya
Start by downloading the Paymaya and creating an account. The steps are:
- Download the PayMaya app from the App Store (Apple) or Play Store (Android)
- Fill out the online form. Once done, tap the Continue button.
- Tap the View Card button.
- Enter your address and birthday.
- Enter the required information under the Online Payment Card Number page.
- You’ll receive a confirmation of your PayMaya account activation.
Next, upgrade your account by following these steps:
- Log in to your PayMaya account. Once in the app, access the menu then select UPGRADE YOUR ACCOUNT.
- Fill out the required information and make sure you have at least one  valid primary ID. Please ensure that the Name and Birthday you entered in the Upgrade Application form matches the Name and Birthday reflected in the Valid ID that you will be uploading.
- Record and submit a 4 to 5-second video selfie
- When taking the video selfie, you must follow the instructions onscreen and take note of the required gestures.
- Make sure not to cover any part of your face and remember to position your head / face properly in the video capture frame.
- After recording your video selfie, review your application and click on SUBMIT.
- You may monitor the status of your application by clicking on CHECK MY UPGRADE STATUS in the app menu.
- Once your upgrade application is approved, you will receive an SMS confirmation within 24 hours and can then start enjoying the features of your upgraded PayMaya account.
NOTE: Upgrading your Paymaya at this time is OPTIONAL, but would be necessary later on if you decide to transfer funds to and from your bank account.
After your consultation is finished, let’s talk about getting paid.
- Open your PayMaya app and click on “Request Money” option.
- Click on the “Send Request Money Link”
Patients will receive an SMS notification about the payment request indicating the amount, the name of the doctor, and instructions to click on a link to proceed with the money transfer.
Once payment has been made, the doctor will receive an SMS notification that the amount was received through PayMaya.
If your patient does NOT have PayMaya installed, refer to the instructions above and teach them.
Patients must acknowledge that an online medical consultation is not an adequate substitute for a regular or face-to-face consultation at the out-patient clinic due to its inherent limitations, like inadequacy of physical examinations, and/or lack of access to medical tools, among others.
Patients must also acknowledge that the initial management may be limited to a verbal and/or written advisory and medical prescription. It is incumbent upon the patient to keep his/her follow-up appointments. Further, the patient must acknowledge that he/she must immediately inform the doctor via an agreed upon method of communication if symptoms are not relieved as expected, or if deterioration occurs.
In such events, patients would also need to make the necessary arrangements to be seen in the clinic and/or hospital.
There are times even before this COVID-19 crisis that I don’t charge patients. The money has always been secondary to the service. This solution gives the patient and physician the chance or option to avoid having money contaminate the relationship. If you don’t want or need to get paid (or maybe you want to set a lower or higher fee), that’s your CHOICE.
Setting up FREE consultations sound nice and noble. A few issues become apparent here.
One, doctors (and their families) will eventually need to eat too. Since majority of your consultations would involve OLD patients who usually pay for their consultations, why should online consultations be treated differently?
Two, the doctor-patient relationship exists once you engage your patient. It cannot unilaterally be terminated by the doctor (abandonment), but a patient may choose to drop you at any time. If during the course of your consultation and the patient experiences an adverse outcome, you can be liable. You didn’t get paid, you’re still liable! Get paid because you will need this for your liabilities in the future.
Three, have you ever had patients refuse to consult you again because you didn’t charge them at all? They’re upset because you gave something of yourself and they have no opportunity to reciprocate. So they give a chicken, or eggs, or even a whole cow. You eventually learn that they had to go out of their way to give something to you. Nothing is completely free (except our unconditional love to the ones we love).
My personal experience is that if you have a good relationship with your patient, they will find a way to pay you. It may not always be with money.
I still have emails from patients saying that they wish the clinics would open soon (That’s ok, it’s my wish too). Overall, you get the sense that what they really need is CONNECTION – a way to communicate. Most people are built that way.
This online thing is our NEW normal, we must go to where our OLD patients are, whether we like it or not… whether we are ready or not. Go, or go the way of the dinosaur.
Us doctors NEED to be ready.