Please do not prescribe medicine to a patient over phone or mobile as tele medicine or online consultancy on different video audio apps and system without examining a patient without a proper diagnosis made after examining a patient or any alteration in medicine in examined and diagnosed patient too as it may be a gross negligence as of culpable homicide not amounting to murder to be booked under IPC 304 where life imprisonment and un bailable sentence may be imposed by a court. Observing that prescribing medicines to patients without diagnosis amounted to culpable negligence, the Bombay High Court has turned down the anticipatory bail pleas of a gynaecologist doctor couple booked for the death of a woman patient.

                       How ever  many other negligence factors were too against doctors in this judgement which was overruled by Supreme court later as it granted bail to both Doctors but a serious debate is going on in Medical society of India whether such Tele Medicine as practised by all most most doctors of modern time who are prescribing for common problems to their  known patients or even new patients whom they know personally or altering medicines of followup patients for new complications or Government & private hospitals or even few companies have started telepathy to treat patients living in rural areas or far away regions from the superspeciality hospitals for primary or first consultation by listening reading patients problem and getting tests done locally and than prescribing medicines or suggesting second opinion for lready examined patient by other doctors and even many doctors or patients ask online consultation from many experts in India and abroad over phone or net.

                      Is all these are illegal is highly debatable as there is neither legal opinion or ruling is present by Supreme Court or any other high court except in above case nor Medical Council of India or Government of India has given any guidelines.Indian Medical Association has suggested that Ethically only on seeing a patient only  a Doctor can prescribe Medicines or advice  the treatment to be followed.A history of the ailment, clinical examination is needed to prescribe any medication.Hence a telephonic consultation without seeing the patient is not Ethically or Legally valid.A regular patient seeking advice on phone is also not valid as the call will be on any change in symptoms or signs which has to be examined before we alter the medication or advise further.An instruction given by the consultant to his patient to inform the investigation results by phone and thereby advising may be held valid as the consultant is responsible for the Patients action.On the issue of Telemedicine it is between a Doctor and a Paramedical or a patient or between a Doctor and super specialist hence each other are VICARIOUSLY responsible for any Negligence.                        

                      Deficiency of service occurs when there is deviation from common practice and lack of reasonable care causing damage to the patient. The common practice involved in treating a patient is eliciting history, physical examination ( inspection, percussion, palpation& auscultation), going through investigations and arriving at a diagnosis. Treatment is instituted after diagnosis. In TELEPHONIC CONSULTATION all or part of the above may not be undertaken. Hence there is always a possibility of alleging and finding negligence on the part of the doctor in cases of TELEPHONIC consultations, by the legal fora.But in situations where physical examination is not required ( eg: adjusting insulin according to blood sugar levels in a regular patient, analgesics for acute exacerbation of chronic pain under regular treatment etc.) telephonic consultation will not amount to negligence. Also in situations of managing emergencies, till the doctor arrives TELEPHONIC CONSULTATION can be undertaken in a judicious manner.

                  But their is trend in society that many patients wants telephone or mobile number of doctors and want to have opinion on these too.Dr Arun Gupta,president Delhi Medical Council,in his article suggested  not to give mobile number but office number to patients and if they call in emergency,they should be suggested to come to clinic or nearby hospitals rather suggesting medicines over phone except simple like ORS or paracetmol and in normal patients they must be asked to clinic in office hours but treated patients or operated or antenatal/post natal cases we must inform patients where to go in the emergecy if doctor is not available or provide minimum assistance to these patients as Court has booked  Doctors for not providing assistance to follow  patients in emergency.To provide treatment on whatsapp or net after complains or pictures shown of patients or symptoms or examination done by a paramedic or investigations carried out will be counted illegal by court if patient file case against doctor  of any untoward complication following such prescription or advice as in above case.  

                     So Online Consultation/Telepathy/Mobile/Whatsapp consultation is Ethical dilemma as MCI or Court in India or parliament has not formulated guidelines on this new rapidly advancing technology of consultancy till date as in few developed countries.Therefore,clear cut message to medical fraternity will be to avoid such treatment of advice to new patients and for  follow up patients minor suggestions can be advised in emergency with a plea to get examined at near by hospitals or treating Doctor's place where Doctors must be present for taking care if complication occurs otherwise such present day overactism of Judiciary will hamper  Doctors badly and cases of medical negligency or even Criminal negligency may be imposed where Doctors may be punished for doing good to patients on patient requested for their convenience and benefits even charging nothing.

                          What as a practicing Doctor you think regarding such widely prevalent and practised  Consultancy on phone/whatsapp or on net by different mobile apps or video systems ?