Covid 19 has taken the entire world in its grip and normal life as we knew it till now, is in complete disarray. New vocabulary with words like Lockdown, Social distancing, respiratory hygiene, and PPE are becoming increasingly common in everyday life. However, normal is something that changes all the time; what was normal 10 years or even 50 years ago, is not normal today and this change is a continuous process. Just as we have had rapid changes in the last few decades, we will rapidly adapt to a new set of “normal” rules governing our lives. In fact, times and crises like these accelerate many changes.
As far as Ophthalmology or any other medical specialty is concerned, these are essential activities that will have to rapidly adapt sooner rather than later so that we can continue to function, providing essential services with a lot of caution, caution that might have been considered unnecessary or abnormal till now.
Some of the key changes that are sure to be seen in the near future include:
Digital technology has impacted our lives enormously in every field. However, the medical field has always been a ‘face to face’ specialty despite the growing influence of technology in hospital management and related fields. This pandemic has taught us that we will have to adapt to a greater role of technology to make consultations virtual and comfortable. For many conditions, it is indeed possible to evaluate the patient via video calls and advise treatment. There have been legal constraints to teleconsultation so far, but the various governments are now moving to decrease these hurdles and this will definitely benefit the patients as well as doctors in the long run. It saves a lot of time of the patient, and also avoids unnecessary travel, waiting times, and vehicular pollution. The need is to devise software that can seamlessly combine the role of video consultations, online fee payments, treatment prescriptions, and also make it possible for the entire medical team like receptionist, doctor, assistant, etc. able to interact on such a multiple user format.
One area which has perhaps seen the most rapid evolution is the emergence of webinars and other virtual education/ discussion platforms. Conferences, CMEs and related travel had been getting tiresome, repetitive, and extensive over the last few years. Attendance at some of these events was often very low, especially in the context of the preparation required to arrange such events and the “hospitality”. There will however always be a role for the exchange of ideas and furthering our knowledge in the medical field, and virtual conferences and interaction are certainly the way to go. They eliminate all the waste, are extremely efficient, and again avoid all the travel and save time. In a lighter vein, another benefit is that even if the attendance is really low, it is not as hurtful as speaking in a virtually empty hall.
Modifications to the Work Culture
Most of us have grown professionally, seeing eye camps with numerous surgeries performed in a day. It was a matter of pride and prestige to perform a huge number of cases. Most ophthalmic practices also were accustomed to doing a large number of surgeries in a day, especially during certain times of the year like winter vacations, depending on the local culture. However, it would be wise now for both the patient and the surgeon to avoid such crowded surgeries. This is an opportunity for a sort of “decentralization” of eye care and hopefully will benefit newer practices and surgeons, distributing ophthalmic work more evenly. At the same time, the outpatient clinics will also have to modify their workflow so as to minimize waiting periods, move to more appointment-based visits, and do everything possible to avoid crowds.
Importance of Standard Operating Protocols
One of the major differences in the healthcare approach in the more developed nations and in our country is the emphasis on following Standard Operating Protocols. It is true that all SOPs are not replicable in our milieu, and blind copying is not desirable as well. In recent years, due to the emphasis on accreditation, SOPs are becoming more common. The emergence of COVID pandemic has taught us that it is imperative for us to come up with standard protocols for handling important issues, to keep us safe from medico-legal liabilities. We are all looking to find a consensus on dealing with issues like safety protocols to be followed, screening procedures for outpatient clinics, operating theatre safety measures, and so on to reduce the spread of the novel Coronavirus. The All India Ophthalmological Society has been very active and they have been publishing and revising guidelines related to eye care during the pandemic. It is hoped that this will accelerate the process of finding common ground on such issues so that our Societies can come up with more SOPs on various topics that are practical, and can be uniformly followed, which will protect the patients as well as ophthalmologists.
Changes in ophthalmic technology
This is something that will be used in by the medical equipment industry. We have seen various new modifications in widespread use like breath shields for slit lamps and indirect ophthalmoscopes, and industry has quickly ramped up its capability to manufacture PPEs, Masks, Face Shields and the like. With an increase in production, thankfully the costs are also coming down, though the danger of poor quality equipment is also present. In the future, we are likely to see many new innovations that will make it safer for the ophthalmologist to examine patients. I am sure we will see slit lamps, where the distance between the patient and the ophthalmologist is considerably increased and surgical microscopes with some sort of cover for the patient’s face that will reduce the chances of droplet infection.
The Prime Minister famously talked about being Vocal for Local. In ophthalmic practices, this will translate to patients relying more on their friendly neighborhood ophthalmologist rather than traveling large distances for routine eye problems. This benefits everyone if we can ensure that all of us adhere to a certain basic level of not only patient care but also use this opportunity to upgrade our knowledge, facilities and premises so that Local can truly compete with the Global.
Over the last few years, we have seen that there have been various steps to address the huge problem of inadequate medical facilities for the majority population of this country, including Ayushman Bharat, National Medical Commission Bill, and so on. While many of these steps have not been popular with the medical community and have also been opposed, it is natural for the government to continue to move in a direction of Health and Medical Services for all. In the near future, there will be an increasing focus on health care; some of these changes may be beneficial for us, but we may also come in for greater regulation, as governments all over the world realize the importance of healthcare and put greater emphasis on it.
This is an evolving situation and we are yet to see the full extent of the disease in India. As the Lockdown restrictions are eased, the disease will increase, but also there will be rapid innovations in technology, service, and processes to ensure that a new “normal” life continues despite the threats posed by COVID 19.