Medical Consultations for Breast Concerns Amid COVID19 Crisis and Enhanced Community Quarantine in Metro Manila and Philippines
For some introduction on current situation, need for telemedical consultation and ROJoson Telemedical Consultation, read first:
The main question:
What are the medical conditions and diseases of the breast that should be consulted under a telemedical set-up and which should be consulted under a face-to-face set-up.
Strictly speaking, all types of medical conditions and diseases of the breast can be and should initially be consulted under a telemedical set-up.
There is rarely a type of medical condition or disease of the breast that should warrant an outright face-to-face consultation with a breast specialist except for a postoperative complication of massive bleeding after a breast surgery.
All types of breast concerns (postoperative as well as non-postoperative concerns like breast pain, lump, nipple discharge, breast enlargement and nipple erosions) should initially be consulted under a telemedical set-up. The telemedical consultation initially screens patients with breast concerns. It will advise patients whether a face-to-face medical consultation is needed or not. It will save the patients from unnecessary trips to the hospital as well as unnecessary expenses and risk to COVID19 infection when a telemedical consultation suffices.
The breast specialist can readily diagnose the breast concerns using a telemedical set-up by interviewing to gather data and information and doing physician-patient-relative-assisted and still-video-picture-guided physical examination.
It is true that the limitation of the telemedical consultation is the physical examination by the breast specialist, specifically the palpation part. Physical examination of the breast consists of inspection and palpation. Inspection can be done easily and telemedically through the use of the triple picturing of the breasts: 1) video-camera on the computer or cellphone; 2) still picture of the breasts; and 3) video picture of the breasts. The still and video pictures are by the patient or relative and sent to the breast specialist for scrutiny.
The more challenging part of the physical examination of the breast telemedically is the palpation with the latter being the most important tool in the clinical diagnosis of breast conditions or diseases. Actual and personal palpation by the breast specialist is not possible in telemedical consultation. However, it can be done by the patient herself or by a relative upon coaching by the breast specialist. For certain, the findings on palpation by the patient or by the relative will not be as accurate as those that will be obtained by actual and personal palpation of the breast specialist. The breast specialist just has to make the best out of the physician-patient-relative assisted palpation by correlating with the inspection findings and data from the interview. If there is a need for the breast specialist to do the palpation, then a face-to-face medical consultation is arranged.
See samples of how a physical examination of the breasts is being done through a physician-patient-relative-assisted procedure as well as being guided by still and video pictures. (will publish these in the near future)
At the end of the telemedical consultation, depending on the outcome and shared decision-making by the patient and the breast specialist, it will either be NO more need for face-to-face medical consultation anymore or there is a need for a face-to-face medical consultation. There is usually a need for a face-to-face medical consultation after the telemedical consultation if there is a need for the breast specialist to do an actual physical examination of the breast and other parts of the body.
There is usually NO need for a face-to-face medical consultation anymore if:
· The breast specialist is quite certain of his clinical diagnosis and patient can be treated with no surgical procedure, just an advice or at most, a prescription.
· The breast specialist is not quite certain of his clinical diagnosis and prescription for a diagnostic test (such as ultrasound) is given. Another telemedical consultation is needed after the diagnostic test is done.
To repeat:
All types of breast concerns (postoperative as well as non-postoperative concerns like breast pain, lump, nipple discharge, breast enlargement and nipple erosions) should initially be consulted under a telemedical set-up. The telemedical consultation initially screens patients with breast concerns. It will advise patients whether a face-to-face medical consultation is needed or not. It will save the patients from unnecessary trips to the hospital as well as unnecessary expenses and risk to COVID19 infection when a telemedical consultation suffices.
A breast specialist should be able to readily diagnose the following medical conditions and diseases of the breast concerns using a telemedical set-up by interviewing to gather data and information and doing physician-patient-relative-assisted and still-video-picture-guided physical examination:
· Fibrocystic Changes
· Breast cancer
· Fibroadenoma
· Macrocyst
· Galactocoele
· Mastitis and breast abscess
· Intraductal papilloma
· Benign cystosarcoma phyllodes
· Tuberculosis of the breast
· Paget’s disease of the nipple
· Mammomegaly
Please read this link:
NOTE: Medical consultation, whether telemedical or face-to-face, is defined as a patient or a relative of the patient voluntarily seeking out a physician to get professional ADVICES on certain medical concerns.
The physician, as a matter of basic routine, interviews and does physical examination on the patient to get to a clinical diagnosis. If the patient has previous medical records, these are reviewed with the interview and physical examination data to get to a clinical diagnosis.
After the clinical diagnosis, the physician explains his clinical diagnosis to the patient or relative and then advices on the subsequent steps in the management. The advices on subsequent steps of management may include medications, diagnostic and treatment procedures, or just a watch and wait or monitoring approach.
A medical consultation strictly speaking ends on the physician giving advices. It does not include prescription of medications and performance of diagnostic and treatment procedures on the patient. However, prescription of medications and request for diagnostic procedures can be included in a medical consultation usually with no additional or extra service charges to the patients. Performance of diagnostic and treatment procedures is entirely separate from medical consultation and carries additional service charges to the patients.
ROJ@20apr24