The busiest outpatient department in the country is shut due to the lockdown. The corridors are empty and only the emergency services are fully operational. However, Room No. 4076, on the fourth floor of the teaching block at AIIMS, is buzzing – with a difference.
While several doctors at the institute have been assigned COVID-19 duties, many senior faculty members at AIIMS from across departments are offering teleconsultation, from the teaching block, to ensure that the premier health facility remains available to patients who come to it from across the country.
One of the constant queries that Dr Uma Kumar, Professor and Head of the Department of Rheumatology, is fielding these days concerns hydroxychloroquine, the drug that has been suggested as a prophylactic for coronavirus, though its use remains contentious. With HCQ originally meant for patients suffering from autoimmune diseases like rheumatoid arthritis and lupus, which her department specialises in, many of her patients ask her for it.
To one such patient calling from Begusarai in Bihar, Dr Kumar assures, “I will connect you directly with the company. They will provide you a sufficient dose of HCQ. There is nothing you need to worry about.” Minutes later, there is a similar call from Ranchi.
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In normal times, Dr Kumar’s department’s OPD sees over 3,000 patients a month, among the most at AIIMS. Says the doctor, who has been with AIIMS for 23 years, “During the lockdown, I have started receiving multiple calls from patients, including on if they can use an alternative medicine to HCQ. We are trying our best to resolve the problem. These are challenging times, and we need to find unique solutions. In most cases, I provide patients contact numbers of those who can provide them the medicines.”
With three of her senior resident doctors assigned to COVID-19 at AIIMS, she says they realised their non-coronavirus cases could suffer. “Since every medical record is digitised at AIIMS, we decided to use this data to connect with patients.”
Those whose consultation is due based on the records are alerted by Dr Kumar’s team a day before someone from the department calls them. Messages are sent informing the patients about the time the doctor will call them.
Dr Kumar says they handle almost 30 patients daily between 10 am and 2 pm, when the teleconsultation services are wrapped up for the day. “Unlike a regular OPD, calls take longer as most of a patient’s queries are around the pandemic. Are they in danger, is the most common question. I need to offer them detailed explanation of the specific precautions they have to take.”
Before a treatment is prescribed, verbal consent of patients is taken. “We communicate the pros and cons,” Dr Kumar says.
As part of the follow-up, the doctors ask patients if they have carried out the routine investigations advised to them, and to either read out the reports or send the same over WhatsApp. “We watch out for new symptoms. And if we feel a patient requires in-person consultation, we recommend they go to a nearby hospital. We can’t call them here because hospitals are becoming hotspots,” Dr Kumar says.
The challenge, the doctor adds, is new cases. “My inbox is flooded. But we don’t have records of those.”
She gives the example of a 27-year-old from Guwahati, who has had an autoimmune disease for seven years, who called in complaining of low-grade fever for the past five weeks and of fatigue, swelling in her feet, and rashes in the sun. “The symptoms show her disease is getting active,” Dr Kumar says, adding that ideally, she would ask her to undergo a kidney biopsy. “But keeping the lockdown in mind. I asked her to get simple tests done: liver, kidney function test, and urine examination. Based on the reports, we started medication without kidney biopsy.”
The 27-year-old is now on Dr Kumar’s priority list. “This is a list of patients who will need to visit the OPD on priority when the lockdown is relaxed,” she says.
As she wraps up for the day, Dr Kumar’s face lights up seeing a message from a patient. It says, “I sincerely thank you. I am proud of AIIMS and feel safe under the surveillance of able doctors. God bless you and your team.”
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