" X hasn’t shown any particular doctor before and feels his local doctors may not be able to solve his problem of headache that has been bothering him for quite some time.
Then he receives another SMS which says:
AY-Guidance:
“Now receive a solution to all your physical, mental and social problems through a friend, philosopher and health-guide. Call toll free 5000002.”
He tries it out and as soon as he dials the number he hears an automated but pleasant voice informing him the terms and conditions of the ‘online clinical problem solving,’ project.
Mobile based ‘informed consent’
He is informed that his voice will be heard and converted into text by a person working for the project who is unlikely to recognize/identify him (although this cannot be guaranteed). It will be further read by a panel of health professionals (including students in training) who are unlikely to recognize/identify the patient (although this cannot be guaranteed).
The students are going to make an initial assessment of the patient data so that it is improved, processed and forwarded to the panel of expert physicians for their feedback to the patient after finalization by the panel moderator (who is our expert Dr A) in consultation with other expert doctors in the ‘online clinical’ team.
It is possible that the initial data the patient sends us may be inadequate, un-understandable and the patient may receive a few queries for clarification of his initial inputs from our panel.
The panel shall try to prepare an ‘electronic health record’ of the patient based on the informational input (both by the patient as well as the heath professional panel) and it is possible that a proper health record may take 5 to 10 phone calls from the patient over a period of days to weeks depending on the patient’s as well as the healthcare panel’s involvement.
If the patient agrees to share his health details after listening to this entire information he may consent to talk/SMS his complaints including his entire history (as much as he can remember/understand to the best of his capacity) by dialing another 1 digit number.
Methodology:
Patient X agrees to the voice recorded message and after dialing the one digit number, proceeds to talk about his headache as much as he can think of reporting.
His voice data is accessed by the frontline project staff that constitute students of an ‘online clinical problem solving’ course that is delivered from another Coimbatore based institute.
The mobile "online clinical problem solving" web-page, houses patient data in the form of innumerable patient profiles that are locked, anonymized (see case scenario 1) and accessible only to registered students of the ‘online clinical problem solving course.’
These students go through the initial data and formulate a feedback that contains a few/many queries that enable them to gather data optimal to satisfy the needs of solving the particular problem.
Patient A actually in his first voice post just mentions that he has been having headache for some time without mentioning anything else and leaves it at that.
He gets an initial response through a phone call in a pleasant recorded voice message that doesn’t sound automated but X feels as if his concerns have been specifically addressed although in a manner that requires him to answer a few more queries:
“Thanks Mr X for your query. We have received you input and we need to know a few more things about you like:
How long have you suffered from headaches? _____ weeks / months / years
Age at onset of headaches ________ years old
Approximate frequency: 1x/month or 1x/week or 2-4x/week or daily
Is your headache DAILY?
If daily, how long have you had daily headaches?
What do you do when you have a headache?
Can you continue doing what you were doing?
Do you have to take a medication for headache daily?
How often?
What do you take?
Does it work?
Does the headache come back?
How long have you been taking a daily medication for your headaches?
If not daily, how many days per week do you need to take medication for headache?
Have you noticed you have to take more of the same medication for it to take effect?
Have you kept a diary of your headaches?
Duration of headaches: Is it brief 30-60 minutes or 1-2 hrs or 3-6 hrs or 6-24 hrs or lasts days?
Side: both sides? right side? left side? changes sides?
Starting location: Forehead temple Top of Head Back of Head Ear Neck Face Eye?
Overall location: Eye Forehead Temple Top of Head, Back of head Face Ear Neck?
Quality: Pounding Boring Aching Tight band Shooting Throbbing Pressure?
Associated complaints: Flashing Lights Blurred Vision Dizziness Nausea Vomiting?
Have you experienced Blindness or One Sided Paralysis or dizziness, Numbness and Confusion?
How do you identify a severe headache starting? ______________________________
Are there warning signs before the headache pain starts? ____________________________
Yawning?
Irritability?
Lack of concentration?
Nausea?
Flashing lights?
These questions have been copied from a website http://www.
More specifically:http://www.
This has been copied by one of the ‘online clinical problem solving’ students who has typed ‘headache question’ into google and reached this site.
This student uses a few questions from the available web resources and prepares an individualized feedback and sends it back to patient X after verifying it from the moderator who is a generalist if not a subject matter expert for that particular symptomatology.
Once X’s record is created in this manner and the subject matter expert (in this particular case Dr A) is convinced that this is ‘Migraine’ he asks X to visit him once in his clinic following which Dr A prescribes appropriate medicines through an E-prescription that is SMSed/whatsapped to X (from Dr A’s phone) and ‘X’ keeps taking tablet Sibelium 10 mg everyday as a migraine suppressor and sometimes takes tablet Paracetamol 1gm for acute attacks. His initial attacks that were coming daily have improved after 3 months and come only once in a month now which also responds well to tablet paracetamol 1gm.
