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Doctors in Japan expand online appointment capacity, but limitations cause headaches

A doctor at Iseikai Hospital in Osaka's Higashiyodogawa Ward is seen doing an online examination in this partially modified image taken on May 1, 2020. (Mainichi/Yoshiyuki Hirakawa)

OSAKA -- Since April, more and more doctors in Japan have been offering their patients smartphone- and computer-based video chat consultations, including initial ones under special circumstances, as part of efforts to stem the spread of the novel coronavirus.

An increasing number of medical institutions are also introducing the measures because checks of patients suspected of being infected with the novel coronavirus are easy to do using such devices, and the possibility of the practice suddenly becoming commonplace has emerged.

But the amount of information doctors can glean from the checks is still small when compared to face-to-face consultations, and some professionals have voiced their concerns over instances in which it has been difficult for them to carry out diagnoses using the new measures.

During an initial outpatient consultation at Iseikai Hospital in the western Japan city of Osaka's Higashiyodogawa Ward, Dr. Dokusun Yan speaks to a patient from a computer in his examination room. The man on the screen describes being told at a routine health check that his blood pressure is high, and relays that he's been feeling lightheaded. Dr. Yan instructs him to keep checking his blood pressure levels at home, and to come for a check-up at the hospital if it persists. The appointment is wrapped up in around 20 minutes.

With the exception of certain specialties, none of the hospital's consultations were online before. Now, six doctors ordinarily in charge of comprehensive medical checkups, which are currently suspended due to the spread of the novel coronavirus, have from April 27 been doing online examinations including first-time ones.

So far only some patients have been checked with the service, but Dr. Yan said, "Both doctors and patients don't have to worry about infection, so both sides can feel secure. Even once infections from the novel coronavirus have been stopped, this way of doing consultations might continue to become more widely used." In the event that a prescription needs to be given after an appointment, the details can be faxed to a pharmacy close to the patient to reduce the burden on the patient.

But because doctors cannot physically check patients, there's a limit to the amount of information medical professionals can take from the appointments. There have also been cases where a patient's camera has been of a lower quality, making it difficult to do visual checks of people's throats and other places, and primarily the appointments take the form of medical interviews.

Precautions are also taken to ensure people aren't pretending to be patients; thorough checks are done, with photographs taken of patients' health insurance certification at the time an appointment is made, and some form of identification including a photograph being required at the beginning of the first meeting.

Haruo Kuroki, the head of the Japanese Telemedicine and Telecare Association's online consultation subcommittee, told the Mainichi Shimbun, "For patients with a fever or other symptoms that mean they can't rule out being infected with the novel coronavirus, and people who are avoiding going to hospital over fears of contracting it, this is a highly appropriate way to examine them."

He continued, "Both patients and doctors have yet to fully work out just how much they can do using a screen. Both sides should be prepared to recognize that they may find there is only so far they can go with some of it."

(Japanese original by Satoshi Kondo, Osaka Science & Environment News Department)

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