Girikumar Venati is a 48-year-old doctor living in Bengaluru, India. He lives in a one-bedroom apartment that is a 10-minute walk from the Fortis Hospital on Bannerghatta Road, where he has worked as a general practitioner for over a decade. He’s a senior consultant and the hospital’s lead immigration physician, examining people seeking visas to the U.S., U.K., Australia, and other countries. International travel restrictions due to the pandemic have robbed him of his most lucrative service, and outpatient work has also dried up.
In 2020, he enrolled as a health care professional offering video consultations on MFine, a mobile doctor consultation application that has over 4,000 registered physicians across India. He works as a general practitioner on the app, offering advice and treatment on everything from gynecology to Covid-19.
Telemedicine has grown dramatically during the coronavirus pandemic. Multiple lockdowns, stay-at-home orders, and an overburdened health care system deepened India’s reliance on technology companies to connect patients with doctors and deliver medicine. There was a 502% increase in online consultations during 2020, and dozens of investors pumped money into the space.
(Note: $1 is approximately 72.98 rupees.)
The first thing I do when I wake up is check my phone to see how many patients I have scheduled. Today is a relatively relaxed day; I only have four consultations in the morning. I sit on the couch and watch the news before the calls start trickling in.
MFine, the app I work through, gives patients 20-minute slots. It has an “auto doc” feature that sends them questions and collects their medical history. MFine has junior doctors who can get in touch with the patients too, if they need more information. That means that by the time I join the call, I already have the patient’s profile.
By 11:03 a.m., I’ve already finished two early morning consults, and I’m onto the third. A woman in her early 30s says she has shortness of breath and fatigue, as well as excess hair and blood loss during her menstrual cycle, which is causing a severe drop in her hemoglobin levels. It’s a recurring problem, and she’s worried that it’s linked to Covid-19, since she tested positive for the virus three months ago. I’m able to tell her that she’s suffering from iron deficiency anemia and refer her to a gynecologist for the next steps.
The app is constantly sending reminders to make sure I don’t miss any steps. After a call ends, I have about half an hour to send the prescription. Before the beginning of each consultation, I get multiple reminders through SMS, WhatsApp, and calls. If I don’t answer the call eight minutes into the consultation, MFine shuts down my entire schedule for the day.
I charge 600 rupees [about $8] per consultation with MFine. The platform takes a fixed fee of 50 rupees per appointment. Ten patients a day for 5,000 rupees is a reasonable amount. During the worst of the pandemic, we were doing four times that. At the height of the second wave, about 99% of my calls were related to Covid-19. The 20-minute slot was not enough for each patient. There were 45 consulting slots per day, and they were always full. I would start from 8 a.m. and go on till 11 p.m. It was calls, calls, calls. And then, once I’d finished on MFine, I’d take calls for another hour or two from my friends and family, who also needed advice.
People were begging for slots. Covid-19 consultations were about explaining things to the patient, addressing their anxiety, and letting them know what would happen while asking patients to diligently monitor vitals. There was a lot of anxiety, and the whole family would get involved. I had to play the role of a psychological doctor, rather than a physician.
I’ve been trying to walk 10,000 steps in the evenings, but that hasn’t happened since March because I was on back-to-back calls. Between April and June, I did 600 calls through MFine a month, and around 1,000 follow-up calls, which are free for the patients. There were times when my 500 rupee unlimited data pack would get exhausted because of the workload.
After so many hours clutching a smartphone, I can’t make a fist with my left hand. It’s swollen, and it hurts to bend it even a little bit. I’ve been trying to do a little bit of exercise, and it’s much better now. I’ve switched to holding my phone in my right hand.
At 11:30 a.m., I have to close my consultations on MFine to join the morning huddle at Bridge Health, an online health care startup I joined in June as the clinical head. Sometimes, like today, I have to juggle the two jobs at the same time. I’m on the Bridge Health morning huddle on my work phone with the mic on mute and finishing an MFine consultation on my personal phone.
I try to get to Fortis Hospital by 1 p.m. for in-person consultations. Sometimes I walk, but mostly I get an Uber. I have immigration patients in the afternoon, doing the battery of tests you need to travel to the U.S., U.K., Canada, and others. Pre-Covid-19, I’d earn 200,000 to 300,000 rupees [anywhere between $2,720 to $4,000] a month doing these, but now it’s peanuts. Alongside its work through MFine, Fortis has its own direct online consultation channels, so I work on that too.
“After so many hours clutching a smartphone, I can’t make a fist with my left hand. It’s swollen, and it hurts to bend it even a little bit.”
I leave the hospital at 4:30 p.m., walk home, take a shower, and doze off in my recliner. I like to unwind through music. Music is my friend, it’s with me through sorrow and happiness. I record my singing and share it with my friends. I am a huge fan of the legendary singer S.P. Balasubrahmanyam. We both are from the same town, Nellore. When he passed away recently, I cried a lot and even visited his home in Nellore to pay my respects.
One of the biggest challenges of doing these online consultations is unruly patients. You can see sometimes that the patients have gone around several doctors before they’ve come to you. They’re doctor shopping, which isn’t fair. It’s because they are not satisfied with the diagnosis, or other doctors haven’t given them the prescription that they expect.
During the pandemic, a lot of people were demanding antibiotics like azithromycin, doxycycline, and ivermectin. They knew that these had been used to treat the virus, and they would expect me to prescribe them. They’d say things like, “My mother got it, and she’s better.” Sometimes it would turn confrontational. It saps your energy. In the end, I’d just look at their symptoms, prescribe what I thought was right, and detail the side effects in the footnotes, so that if something happened, they wouldn’t blame us.
The biggest risk of online consultations is that you can mess up the diagnosis. You have to be really careful and treat it like an in-person consult. The video helps. This morning, I had one patient who had a one-sided headache for three days. The first diagnosis that comes to mind is a migraine. But after examining her, I found she had a fever and dental issues. When I looked at the video, I could see her eye was swollen. If I hadn’t been able to see that and had diagnosed it as a migraine, she would have lost her eye. Misdiagnosis is a problem offline too, but I think the chances of it happening online are higher.
After many months, I’m slowly resuming my walks. I have not hit the 10,000-step mark yet; I’m maybe reaching 3,000 a day. Unless another pandemic or epidemic comes, I don’t think online consultations will ever again be in such high demand. Even during the pandemic, for complicated cases, you need to meet a physician directly. An online consultation can never replace a physical examination.
