Online Consultation for my patients

Dear Patients, 

For those of you who have been consulting me for their medical ailments, and for those who would like to do so, .....

I am on a leave of absence for a short while and am out of Pune. 

In case you need to consult with me, you could send me a message on Whatsapp. 
I usually respond within a few hours . 

I prefer an initial consultation on voice call so that I can get required details and advise on management. 
I will call you back

A timing for the call can be scheduled as per our mutual convenience. 

I would like to clearly state that this Consultation is not a substitute for a clinical examination in person. 


Best wishes for a healthy you!

Online Medical Consultation

New technologies that support alternatives to face-to-face consulting are seen as potentially improving the financial efficiency as well as the clinical effectiveness of services.

As well as video, these technologies include: 

• Telephone, with various models for assessment and triage of acute problems, with or without clinical advice; GP consultations; call-back services from a doctor to manage heavy demand in general practice, which have been increasingly promoted (see http://www.productiveprimarycare.co.uk/doctor-first. aspx) ; ‘cold calling’ to offer health education; and follow-up of chronic illness. Systematic reviewers have tended to conclude that while telephone contact for acute illness may allow minor problems to be dealt with without a face-to-face visit (and sometimes with apparent cost savings), it may miss rare but serious conditions and/or lead to higher rates of face-to-face visits in subsequent days—perhaps because even when patients have been adequately assessed, they may be inadequately reassured. This is particularly the case when call handlers with limited training are working largely to algorithm. Telephone consulting, it seems, requires considerable skill and judgement, perhaps because of lack of visual cues. Qualitative studies using conversation analysis have found that compared with traditional face-to-face consulting, telephone consultations have a more linear format and tend to focus on a narrow range of preplanned themes, with less opportunity for the patient to raise issues spontaneously. 

• Text messaging, for example, for supporting young people with chronic illness; conveying results of tests or sending health promotion messages. These studies showed that the text-messaging medium was popular with patients, who used it proactively to send questions  as well as passively to receive messages sent by health professionals.

• Email consultations. Systematic reviews of a large number of primary studies have confirmed proof of concept (ie, it is technically possible to consult via email) and that some sectors of the population desire such contact, but have also raised the possibility of increased inequality of access (the service is likely to be used most by young middle class patients, potentially increasing inequality of access for those who are older, poorer and with lower health literacy). Qualitative studies have highlighted professional uncertainty about safety, workload and remuneration, and about the ‘rules of engagement’ for online interaction.
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• Online portals for prescription ordering, appointment booking and patient access to their online record. While these and other research studies have demonstrated proof of concept, such portals are not widely used by patients outside the research setting. 
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• Telemedicine, in which one part of a health service, usually in primary care, links remotely to another, usually in secondary care (eg, telepsychiatry or teleradiology). There are many proof of concept studies and examples of up-and-running services, mostly in remote regions. But the adoption, spread and sustainability of telemedicine services is often disappointing for complex reasons, including cost, logistics and subtle adverse impacts on professional roles, interactions and work routines.
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• Telehealth, based in the patient’s home, in which data on biometric variables (such as blood pressure or oxygen levels) are sent to a data processing centre and (sometime later) evaluated by a health professional who contacts the patent if needed by email or telephone; and telecare, in which sensors carried by a person or installed in the home allow remote monitoring of position and/or detect smoke or flooding. Also known as ‘assisted living technologies’, telehealth and telecare are the subject of much debate. On the one hand, proof of concept (that the technology ‘works’) has been shown for many such technologies and some randomised trials have demonstrated improved outcomes such as reduced hospital admission and mortality rate.
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• Combinations of the above—for example, a systematic review of the cost-effectiveness of ‘telehealth’ that included both home-based and telemedicine services, which showed that both the efficacy and costs of such services varied considerably across studies.

Reference Citation: Greenhalgh T, Vijayaraghavan S, Wherton J, et al

Virtual online consultations: advantages and limitations (VOCAL) study

BMJ Open 2016;6:e009388. doi: 10.1136/bmjopen-2015-009388

Live Healthy! A call to Action - Part 2 of 2

Live Healthy! A call to Action

Part 2 of 2

Dr Parul Cariappa,MD

Consultant Physician and Diabetologist

In modern India, cardiovascular disease (CVD) and other non communicable diseases (NCDS) in their various forms are quietly making inroads into our population. There are a large number of people (possibly you know some, or are related to them, or are already one of them) who are having elevated blood pressures, high blood sugar, heart problems etc due to possibly hereditary factors but also exacerbated by an unhealthy lifestyle. Children too are at risk from these diseases given the pressures of ‘modern lifestyles’.

We all need to be aware of the importance of dealing with these threat to the wellbeing of our families and to us which are posed by CVDs which apparently are a bigger killer than most other diseases combined. We all must be aware and well informed on the subject to safeguard our families.

1.         Know your BP - Visit a healthcare professional at your nearest clinic or hospital who can measure your blood pressure, cholesterol and glucose levels, together with waist-to-hip ratio and body mass index (BMI). Once you know your overall risk, you can develop a specific plan of action to improve your health.

2.         Limit your alcohol intake - Restrict the amount of alcoholic drinks that you consume. Excessive alcohol intake can cause your blood pressure to rise and your weight to increase. If you drink , drink less, If you don’t drink, don’t start.

Ideas for you to implement

1.         Insist on a smoke-free environment. Dont encourage second hand smoke. Implement a tobacco ban - ensure your home and your workplace is 100% smoke-free. Encourage smokers in seeking help to quit tobacco.

2.         Make exercise a part of your life - Include physical activity in your plan for every day, even standing up and moving around counts.

3.         Choose healthy food options- Check your home menu to ensure that healthy food is prepared and served. Do not eat out more than once a week.

4.         Encourage stress-free moments - stress is related to smoking, excessive drinking and unhealthy eating, which are risk factors for heart disease. Remember that an “Aall iz Well” attitude is good for your health.

Live Healthy! A call to Action - Part 1 of 2

Live Healthy! A call to Action

Dr Parul Cariappa,MD

Consultant Physician and Diabetologist 

Our society is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCDs) which are emerging as the leading cause of death in India accounting for over 42% of all deaths with considerable loss in potentially productive years of life. It has been projected that, cardiovascular diseases (CVDs) will be the largest cause of death and disability in India by 2020.

Major risk factors for these NCDs are raised blood pressure, cholesterol, tobacco use, unhealthy diet, physical inactivity, alcohol consumption, and obesity which are all modifiable by individuals through healthy lifestyle choices. A majority of cancers and CVDs can be prevented and treated if diagnosed at an early stage.

I advise my patients to choose their options wisely

1.         Healthy food intake - Eat at least 5 servings of fruit and vegetables a day and avoid saturated fat. Beware of processed and packaged foods and cut down on your intake of salt. Do not eat out often. Home cooked food is better for your health.

2.         Get active - Even 30 minutes of moderate intensity activity daily can help to prevent heart attacks and strokes.

3.         Say NO to tobacco - Your risk of heart disease will be halved within a year and will return to a normal level over time. Quit today, any time is the best time to quit.

4.         Maintain a healthy weight - Weight loss, especially together with lowered salt intake, leads to lower blood pressure. High blood pressure is the number one risk factor for stroke and a major factor for approximately half of all heart disease and stroke.

Continued in part 2