Seeing patients via VoIP – a way of building practice?
Increasingly I notice that more and more homeopaths are offering to see patients at a distance; that is, using VoIP services, without actually meeting face-to-face. While I think that Skype and Co. are a fab way to communicate, connect and be in touch I often wonder if this format is one that does justice to the patient / practitioner interaction.
There are considerations that speak for such a service to patients-at-a-distance. For one, it helps the expansion of the clinic, aids at generating a client-base. Where the location of a clinic and the marketing efforts of the practitioner do not create a sufficiently great clientele, the homeopath may choose to seek clients that do not live within travelling distance of his or her clinic. In such a case, Skype offers a means of reaching out to that distant clientele, and at the same time makes the offered treatments accessible to those patients that want the service, but wish not or cannot travel the distance.
Yet there is some controversy generally and specifically speaking. Generally speaking there are countries in which legislation vehemently criticizes the practice of prescribing for patients without having first seen them face-to-face. As such, in Germany for example, legislation specifies that conventional medical online portals such as ‘Dr.Ed’, where patients are exclusively being consulted and prescribed via the online medium are prohibited. Where at least one consultation has been done face to face, follow up consultations, however, may be conducted via online portals [1]. This is likely to apply for the alternative medical practices too.
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More specifically, for us homeopaths, there is some controversy where it comes to the application of homeopathic principles. We have been taught, during our studies, that observation is paramount in the homeopathic case-taking. Hahnemann states in the Organon [2], in Aphorism 90, many aspects of comportment and expression that the practitioner should be attentive to in the case-taking. While visual expressions may still be noticeable in VoIP systems, like Skype, that allow video imaging, in systems with just vocal/auditory connections, many potentially valuable hints such as gestures, posture, appearance, and mimicry go unnoticed.
This raises a couple of questions for me: Can we, in our practice, do without the element of observation that Hahnemann emphasized in Aph. 90? What role / value does observation hold in the case-taking of today? I mean, we are also losing other sensory elements, such as touch that may be valuable and are applicable in the face-to-face consultation. While we are not a discipline of a hands-on approach, these senses can deliver important indicators for a thorough case-taking.
We may of course argue that ‘a treatment’ is better than ‘no treatment’ for a patient in need. This may alone justify the consultation-at-a-distance, yet, I often ask myself how accurate such prescription, derived without the inclusion of my own observations and perceptions, are. I find frequently that there are subtle hints in body language, for example, that support my case-taking, if not have a marked impact on the eventual prescription.
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I think Skype and other such VoIP forums will eventually end up being part of our practices, the more extensive our use of the Internet is, and the more it expands to permit us to connect when-ever and where-ever with our patients.
Offering to see patients-at-a-distance is a service to grow our practice and a way of building our client base.
Yet we must be aware that in practice, we need to somewhat compensate for the element of observation and perception. We may have to adapt our case-taking methodology, may have to enhance our interrogation, and have to learn to extrapolate more and correct information to make up for the loss of these elements. Let’s hope our cases via VoIP are straight forward and have little that should or could be missed at the distance!
References:
[1] Bundesärztekammer (2015) Hinweise und Erläuterungen zu § 7 Absatz 4 MBO-Ä (Fernbehandlung), Berlin: Bundesärztekammer. Available online: http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/Recht/2015-12-11_Hinweise_und_Erlaeuterungen_zur_Fernbehandlung.pdf
[2] Hahnemann, S. (1974) Organon der Heilkunst (2. Auflage) 6B Heidelberg: Karl F. Haug Verlag.
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