Tele-Consultation: What and How Effective is it

Tele-Consultation: What and How Effective is it

(Article updated on 3rd October 2018)

We often have a mental image of a person walking into a clinic when someone says that they’re “visiting the doctor”. We’d imagine that the doctor will perform physical examination on the person, diagnose the illness, then prescribe medication if needed.

Now, try to picture the “visit” as a virtual one: a person heads to a website, enters a chat room, and starts chatting with a doctor. The doctor replies the texts with medical advice, and sends an attachment of a signed prescription for the medicine needed. Sounds futuristic, isn’t it?

Except that the future is actually now.

Malaysian Director General of Health, Datuk Dr Hisham commenting on Malaysian Healthcare Apps September 2018, “There is also the challenge of uberisation of healthcare where patients are linked to healthcare providers via a technology platform. This may range from a physical service to a complete online virtual healthcare services, even across the border. These require regulatory framework and practising guidelines to ensure patient safety, quality of care, confidentiality and accountability.”

You’ve probably heard of tele-consultation in its other names, such as tele-diagnostics or tele-medicine. The concept of getting medical advice and prescription from a doctor without being physically present in a clinic may still sound foreign for some Malaysians, but this method of obtaining diagnosis and medication is predicted to increase in popularity by the millions before we reach year 2020.

How is it done?

Image credit: Monash University

Tele-consultation is as simple as the example illustrated earlier. Go online, head to the website that provides online medical consultation, and chat with the doctor as you would in an actual clinic. In some cases, a video call could even be done so you’ll be talking to the doctor in person – minus the physical examination, of course. The doctor will then explain the illness to you, or provide advice on how to deal with it. You’ll be given a prescription, which you can use to obtain the proper medication from any pharmacy near you. Some platforms will even deliver it to your home or office.

In some cases when a physical examination is required due to the severity of the illness, or if certain symptoms need physical examination, an appointment can be fixed on the spot as well.

How effective is it?

Image credit: Healthcare Touch

A few studies have been conducted to find out if tele-consultation is as good as it sounds. One study tested its effectiveness in three different medical fields (cardiology, dermatology, and diabetology) and found that tele-consultation is rated as high as 95% in usefulness.

It has proved to be most useful in the field of cardiology as management of emergencies is much better than physical examinations. When it comes to dermatology, they’ve reported more accurate diagnosis as well.

With such high effectiveness in specialised fields like diabetology, it’s believed that tele-consultation will be proved even more useful when it comes to dealing with non-chronic illnesses, most of which will not require physical examinations.

What are the benefits?

Image credit: Astia Health

No more numbers and queues! That’s one of the major benefits of tele-consultation. As a patient, you’ll save lots of time as you’ll have direct access to doctors almost immediately. This is great news for patients with disabilities, or those who live in rural areas. As long as there’s a solid internet connection, you’ll be able to get medical attention really soon.

It also saves you a lot of money by reducing the unnecessary visits to the emergency rooms. Sometimes, people get admitted for mild symptoms that can be easily controlled by themselves without the need for medication. However, the emergency attention and consultation given often result in a hefty bill. Through tele-consultation, patients can have their symptoms checked immediately at a minimal cost without incurring travel expenses unnecessarily.

Of course, tele-consultation is not meant to totally eliminate physical examinations. Physical care and consultation is still required for chronic illnesses, or for symptoms that require face-to-face examinations. Tele-consultation exists with the aim to provide more people with the proper healthcare that they need. Real time care can be given to more patients – online and offline – as waiting rooms have shorter queues for emergency cases, and outpatient cases can be settled without the need for people to go through the hassle of traffic and queues.

As such, with an effective solution for tele-consultation, patients who tend to forget/miss their regular checkup and appointment can be reminded through this system and soon our healthcare sector will move towards preventive health services instead of treating a disease.

Reference: Malay Mail

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Hearing Loss in Your Child, What to Do Next?

Hearing Loss in Your Child, What to Do Next?

First series of hearing loss in your child: When parents are told that their child has hearing loss, many a times they are lost about what they should do next. What are the management steps that parents should take to help their child?

 

Knowledge is power

There is nothing more important than finding out every detail of the problem that your child has. Feel free to ask your audiologist or doctor, how they test your child and what is the purpose of each test done. Confirm how reliable were the tests done. Next ask the exact nature of the hearing loss as it would be crucial on deciding what the next step would be.

If it is a conductive hearing loss, whereby the problem is either on the outer ear or the middle ear, the problem might be cured by a medical doctor. If it is a sensorineural hearing loss, determine whether it is a permanent hearing loss or is there a chance of a cure.

The audiologist should be able to advice you on this. Remember, you have the right to have a second opinion. You can ask the audiologist to provide you a copy of all the results, a report for records and also reference if a second opinion is sought.

baby-child

Image Source: Singapore Motherhood

You should also find out the sounds that your child could still hear. Contrary to common perception, it is rare for us to find an individual who does not have any hearing at all. In fact, most children with hearing loss have a degree of residual hearing. Knowing the types of sounds your child can hear as well as the level of loudness is important to help him communicate. Even for temporary hearing loss, it is important to know the communication strategies that you would need in order to help your child through this trying period.

 

Hearing Aids

hearing-aid-child

Image Source: Pinterest

The Malaysian Association of Speech-Language and Hearing (MASH), the professional association for audiologists and speech language pathologists in it’s guideline states that all children with hearing loss of 25dBHL or more should be considered for hearing aid fitting. Various researches worldwide also indicate that a child who receives optimum amplification and rehabilitation early has the potential of developing speech and language that are similar to children with normal hearing levels.

In most cases of permanent hearing loss, your audiologist would recommend that your child should be fitted with hearing aids to help him/her hear. The first thing that we should know about hearing aids are that they help your child to hear by making sounds louder however they will not cure hearing loss. Your child needs to be trained to hear with the hearing aids as amplification alone is not sufficient to help your child understand sounds and language.

Technology in amplification has been improving tremendously. It is important that you know the difference between the various technologies available before deciding on which hearing aids are the best for your child. Most audiologists would recommend digital hearing aids compared to analogue hearing aids for your child. A complete discussion on the differences and benefits of these technologies would require an entire article. Your audiologist would be more than happy to explain to you about them.

 

ear-diagnosis-child

Image Source: Very Well

Another question that you would be asking yourself would be whether one hearing aid is enough or should you get a pair. For children with hearing loss in both ears, the best benefit would be amplification in both ears. This is to maximize their learning potential as well as to ensure that sounds are as natural as they can be. Wearing a single hearing aid when both ears have hearing loss is similar to using a monocle instead of your spectacles. An adult who has acquired speech and language might be able to cope but a child who is learning would struggle with a single hearing aid.

If your child has severe to profound hearing loss and gets insufficient amplification even from the most powerful hearing aids, then a cochlear implant might be beneficial. Again, please remember that a cochlear implant is a device that helps your child to hear and a lot of rehabilitation needs to be carried out before they could listen and understand speech as well as proceed to speak. This is true with both hearing aids and cochlear implants.

Next up on Health Tips by Teleme, the second series on Hearing Loss in Your Child: Communication and Assistive Listening Devices.

 

Source: The Malaysian Association of Speech-Language and Hearing

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Dr. Shailendra

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Mr. Saravanan Selanduray

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Your Child’s Vision: Refractive Errors (The Need To Wear Glasses)

Your Child’s Vision: Refractive Errors (The Need To Wear Glasses)

Here we have come to the last part of the series Your Child’s Vision. In this post, we’ll explain about Refractive Errors (the need to wear glasses).

In normal vision, light enters the eye and the image is focused clearly at a single point on the retina (the light sensitive area similar to the film of a camera) at the back of the eye.  Refractive errors result from abnormality of either the length of the eyeball or curvature of the front of the eye called the cornea.

When a refractive error exists, the image is not in focus and 3 situations can arise.

 

1. Myopia (short-sightedness)

Image source: Coolwinks

The image is focused in front of the retina because either the eyeball is too long or the cornea too curved.  The child can see near objects but distant objects appear blurred.  This is the commonest refractive error is Asians and usually manifests between the ages of 6 to 16 years of age.  There is a correlation between short-sightedness and high intelligence, excessive reading, excessive playing of computer or handheld games and not spending enough time outdoors to see distant objects.

 

2. Hyperopia (long-sightedness)

Image source: Coolwinks

The image is focused behind the retina because the eyeball is too short.  Both far and near objects appear blurred although the distant vision is slightly less blurred.

3. Astigmatism

Image source: Coavision

 

The image is focused at 2 points on the retina and objects at all distances appear blurred and distorted. Astigmatism is due to unevenness of the cornea.

A child who develops a refractive error will require spectacle correction to be able to see clearly. This is very important for the child visual development (especially if the child is below the age of 9 years) because not wearing spectacles can lead to amblyopia.

 

When and how often should a child have the eyes checked?

 

It is recommended that children should have their first eye examination at the age of 3 years and again just before the start of school (around 6-7 years old) by either the eye doctor, orthoptist or optomterist.

The eye test should include:

  • Measurement of any refractive errors (shortsighted, longsighted or astigmatism)
  • Eye movement assessment and detection of any squint
  • 3D vision (depth perception) assessment

Risk-free children can have the eyes checked every 2 years while children who wear spectacles should have their eyes checked every year by the optometrist as the prescription may change within this period.

 

 

Age No Symptoms & risk-free At risk children
Birth to age 6 years

One check by the age of 6 years. An eye check at age 3 years is optional

One eye check by the age of 1 year & as recommended thereafter

Ages 6 to 18 years Every 2 years Every year
Children who wear glasses Every year Every year

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Your Child’s Vision: Common Eye Problems In Children

Your Child’s Vision: Common Eye Problems In Children

If you’ve read about the 1st part of Your Child’s Vision Series (Your Child’s Visual Milestones). It’s understood that children from 2 years old onwards are the age group that usually manifest common eye problems which we are going to talk about in this post.

The following are common eye problems which can be found in children.

 

A. AMBLYOPIA  (also known as ‘lazy eye’)

Amblyopia occurs because the eye is not able to reach the full potential of its visual development as the eye is not used (in other words, neglected) by the child who prefers to use the other normal eye to see.  This is because the image seen with the affected eye is not as clear as the normal eye and the child prefers to see with the normal eye.

Any disease which blurs or blocks the vision during childhood will result in amblyopia.

Causes include:

  • Refractive errors which have not been corrected with spectacles
  • Squints (the eye which is squinting will be neglected and become amblyopic)
  • Congenital cataract (cataracts which have formed at birth although this is rare)
  • Cornea scarring due to infection or injury (also very rare)

 

In order to reduce the possibility of amblyopia, it is important to diagnose the condition and intervene early. A child with amblyopia may have no visual complaints because the child may be using the other good eye which has normal vision. For this reason, it is absolutely vital a child (who is at risk) must be assessed using appropriate testing techniques and examined by an eye doctor, optometrist or orthoptist to screen for amblyopia.

Amblyopia can be reversed if the situation is detected early during the visual development period (until the age of 9 years).  The earlier amblyopia is detected, the greater is the child’s chance of recovery.  Once a child is diagnosed to have amblyopia, the first plan of action is to treat the underlying cause (if any) such as shortsightedness using spectacles or congenital cataract using surgery before starting amblyopia therapy.

 Image source: huffingtonpost

The amblyopia therapy involves patching the good (i.e: normal) eye so that the amblyopic eye will be used by the child and hence stops it from being neglected.  The duration for patching the normal eye varies between 1 to 6 hours per day depending on the regime used and the severity of the amblyopia. It is important to use the lazy eye during the patching period by doing hand-eye exercises such as drawing, copying and colouring.

 

Compliance with therapy is the single most important factor determining a successful outcome.  It requires full cooperation of the child and parents as well as strict supervision of the eye doctor or orthoptist to ensure good results.  Visual improvement can sometimes be measured after only 1 month of therapy.  Patching can be stopped when the vision has improved to almost normal (the lazy eye can never reach 100% normal so at best 90% of normal can be considered excellent result), or when there is no further visual improvement especially when the child has reached 9 years of age.

 

B. SQUINTS (also known as ‘cock-eye)

Image source: Allaboutvision

Humans possess two eyes which give us binocular vision and hence the ability to judge depth and distance in 3-dimension. In the normal person, the 2 eyes are parallel to each other and move together when we look from one object to another.

Image source: SightMD

A squint is present when the 2 eyes are not aligned parallel to each other. When looking ahead, the squinting eye (or cock eye) is either deviated inwards or outwards and is known as a convergent or divergent squint respectively.

When a child has a squint, the vision in the squinting eye will be suppressed and the child will prefer to use the normal eye all the time. This will lead to amblyopia (lazy eye) in the squinting eye. Squints usually appear between the ages of 1-3 years.

Treatment of squints involves patching the normal eye to reverse the amblyopia (see treatment of lazy eye above) and then plan to perform squint surgery to align the eyes so that they become parallel again. Some squints do not need surgery and eye fusion exercises together with spectacles will be sufficient to treat the squint.

Successful treatment will allow the child to look normal (so that he/she will not be teased at school) and restore some degree of binocular vision for the child.

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Your Child’s Vision: Your Child’s Visual Milestones

Your Child’s Vision: Your Child’s Visual Milestones

At birth, the infant’s visual function is not fully developed but continues to develop in the first few years of life.  It is therefore important to monitor your child’s vision as he/she grows so that any abnormalities can be detected and treated early.

The visual milestones (see Table below) are a useful guide to monitor your child’s visual development. If the child does not appear to follow the milestones or if you have any concern, do consult an eye doctor, optometrist or orthoptist for a more thorough eye examination.

Children’s Visual Milestones

Age Visual ability
0-3 months At birth, the vision is poor (only in the range of hand movements or count fingers).  The newborn infant will initially choose to look at light sources such as a torch and only begin to develop eye contact with adults from around the age of 6-8 weeks.  The infant will soon be able to follow large objects which move slowly within his/her environment.
3-6 months The child will now begin to reach objects with his/her hands especially brightly coloured and larger objects.  The eyes will begin to move more widely and with less head movement.  The child will also be learning to grasp with his/her hands and also watch the parent’s face when being talked to.
6-12 months The child is now able to see smaller objects such as ‘100s and 1000s’, bread crumbs or sweets.  The child will try to pick them up and place them in his/her mouth!  The child can also interact with the parents as he/she will be interested in simple pictures in books or drawn for him/her.  He/she will be able to fixate and follow objects of interest such as his/her favourite toy.
12-18 months The child is able to recognize people’s faces and pictures. As the child begins to crawl, he/she is able to know the way around the house.  At this age, the child’s vision can be estimated by putting ‘100s and 1000s’ in your palm and watching the child reach for them.
18-24 months The child now becomes interested in picture or cartoon books, and may even recognize them as representations of real objects.  The child’s vision can be estimated by rolling STYCAR balls of decreasing sizes at around 3 m in front of the child and the child should be able to follow the balls movements.  The vision corresponds to the smallest ball that the child is able to see moving.  The child’s vision can also be assessed using Forced Preferential Teller Acuity Cards or Cardiff picture cards if the child is cooperative.
2 years onwards The child’s vision is almost at its peak development but continues to improve until the age of 7-9 years old. The vision can now be tested accurately using picture recognition and matching technique with Kay or Cardiff picture cards.  All children should be screened by the age of 3 years because squints and amblyopia (lazy eye) usually manifest by this age group.

Children at risk

In most cases, the child’s vision develops without any problems. However, in some children, there may be problems during the early development of their vision and this may affect the development of the child’s other milestones such as speech (as the child cannot see words to learn) or motor development (as the child does not have the confidence to see where he/she is crawling or walking).  The child may also have difficulty bonding with the mother as he/she may not be able to see the mother’s facial expressions.

Baby image created by Yanalya – Freepik.com

Children at risk include those:

  • Who have someone in the family with eye diseases such as congenital cataract, squints or high refractive errors which may be hereditary in nature
  • Born to mothers who were ill during pregnancy (especially during the 1st trimester) with infections such as rubella, cytomegalovirus or herpes virus
  • Born prematurely (especially less than 32 weeks gestation)
  • With low birth weight (especially less than 1.5kgs)
  • Who have Down’s syndrome or are educationally subnormal

Download Teleme App and consult a specialist today on your child’s vision care and treatment:

 

Ms. Melanie Yeoh

Ms. Melanie Yeoh

Orthoptist (lazy eye /squint)

 

Dr. Tsiang Ung

Dr. Tsiang Ung

Ophthalmologist (paediatric)

 

 Dr. Manoharan Shunmugam

Dr. Manoharan Shunmugam

Ophthalmologist (retina)

 

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