It’s a common scenario in general practice: “Well doctor, to be honest the pain is sort of everywhere around my tummy”.
Let’s say you’re on the phone to this poor patient- what’s your reaction? Probably to pop on your best deerstalker hat and begin naming anatomical landmarks (is it around the belly button? Up where your ribs start? Round the side above the pelvis? Into your groin?).
The difficulties of phone consultations often present themselves in frustrating circumstances: we think we know what the problem might be, but we just need to see it to be sure. Hence, there is an undeniable benefit to the pandemic-driven increase in video conferencing software for remote consultations. However, issues around isolation, mental health and data security have opposed telemedicine in general for some time. Just because we’ve started using video consultations more, doesn’t mean these issues have necessarily gone away. Let’s take a step back and evaluate their use so far.
The Benefits
1. Distance It goes without saying that video consultations are a key tool in a pandemic. Even without the pressing weight of the virus, video consultations can be used to reduce exposure of high-risk patients to other people (and therefore diseases). In addition, patients who lack both physical and social mobility (such as those without cars or in remote locations) are still able to receive care. Thinking more broadly, video consultations will probably reduce the number of missed appointments (and missed work time), providing an economic as well as individual benefit.
2. Comfort GPs and hospitals can be an intimidating environment (hence “white coat hypertension”); for certain patients, discussing personal information may feel more comfortable from home. From my personal experience, home visits can be invaluable when assessing how the patient interacts in their familiar home setting. This can also give insights into how they are coping (from general tidiness and hygiene) and identify any risks such as trip hazards. Although video consultations don’t quite offer a full house tour function (unless you ask the patient to show you), they can still provide this contextual information.
3. Integration One of the most exciting applications of video consultations is the potential integration with IT and telemedicine. On a basic level, GPs using AccuRx can send patients messages, text notifications and link NHS patient information. Patients are, in return, able to send pictures of their ailments. Even with relatively little use of this, I can attest to the benefit of a more efficient, focused subsequent consultation. This centralised approach to patient care is surely what we should be striving for and may accentuate the individual benefits (such as text reminders for patients [1]). Simply, putting everything in one place makes it easier for everyone involved!
The Challenges
1. Buffering to suffering Like any technology, there is the potential for things to go wrong. Video consultations require a dependable Wi-Fi connection, appropriate devices and IT literacy. There is the potential for any mass roll-out to exclude certain patients, such as certain elderly populations, those of lower socioeconomic standing and those who struggle to communicate effectively.
If video consultations are to become a staple then we must ensure ease-of-use via clear instructions and user-friendly interfaces. In addition, it will be important to avoid guilting those patients who lack technological literacy; we must remove as many barriers to health as possible, especially those we may make ourselves.
2. Not quite the same Video consultations could have considerable value for assessing non-urgent patients, following up from clinics and conducting medication reviews. Common presentations, such as coughs, rashes and even headaches [2] can be effectively triaged and there is always a safety net of “come back if…” and asking the patient to visit in-person if any doubt.
However, there are two main issues with this. Firstly, we shouldn’t discount the personal touch of a face-to-face consultation. Being the same space as a patient provides a personal, human experience which may put some patients more at ease. In addition, certain groups (such as psychiatric patients) may find the video interface challenging, or even impossible in the case of paranoid delusions. In the near future at least, we must enable these patients to see doctors in the flesh when medically appropriate.
3. Security and confidentiality Whenever technology is in the conversation, we must consider the safety of patient data. This can be as simple as making mistakes on an individual level, such as accidentally sending an invitation or information to the wrong patient. In addition, if a patient needs to see a doctor discreetly (such as for contraception, domestic abuse or even just to avoid worrying another) then a video consultation would only be useful in an empty house with devices that aren’t shared.
Of course, there is the security risk on a larger scale and introducing new programmes, technologies and webcams into the mix provides new foci of attack for cyber criminals. There would have to be robust safety mechanisms and assurances of encryption, especially given the relative distrust of technology in certain populations- only made worse by historic NHS data breaches[3].
The future
The NHS long term plan includes an intention to incorporate technology into healthcare, and video consultations very much fit that narrative. They provide a convenient, useful method of seeing patients and help to improve efficiency. The huge increase in telemedicine uptake during the pandemic tells the story of a population willing to adapt to new technologies and from my experience, most patients are happy to be seen via video.
After this second lockdown bleeds into the new year, it would be worth taking a step back and evaluating this technology, both for its merits and to identify the issues. Ultimately, much like any treatment, medication or initiative, if video consultations are to blend into a permanent healthcare fixture then the technology will need to stand up to the many tests, to ensure we are pushing healthcare forward for patients and professionals alike.
Author: Hardeep Lotay
I’m a Cambridge medical student with an interest in medical communication and education. In particular, I enjoy creating content for students, patients and professionals that addresses lifestyle education and general wellness; nutrition, exercise, sleep, stress and mental health. I hope to contribute to a pro-active healthcare model that embraces personalised healthcare and telemedicine.
References
[1] Schwebel FJ, Larimer ME. Using text message reminders in health care services: A narrative literature review. Internet Interv. 2018;13:82-104. Published 2018 Jun 21. doi:10.1016/j.invent.2018.06.002
[2] Müller KI, Alstadhaug KB, Bekkelund SI. Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations. J Med Internet Res. 2016;18(5):e140. Published 2016 May 30. doi:10.2196/jmir.5221
[3] NHS data breach affects 150,000 patients in England. (2018, July 02). Retrieved November 03, 2020, from https://www.bbc.co.uk/news/technology-44682369