This article appeared in The Guardian on 17 September 2013.
Patients need to be able to consult their doctor online. Having to take half a day off work for a 10-minute consultation is a high price to pay when the technology exists that would allow it to be done online from the patient’s home or work. For some patients, the travel involved in getting to an appointment is harmful in itself. I have seen patients with physical disabilities in pain from the long distances they have had to travel to see their specialist. In a few cases, the appointment itself has risks – cystic fibrosis patients can give each other infections when sat together in the same waiting room.
In my opinion, it’s important to offer online consultations when they are appropriate. But for the best of reasons, many in the NHS remain deeply sceptical about consulting online. Time-pressed doctors and GPs are not sure what an online consultation actually is. They fear it might take up even more of their time.
Many doctors believe online consultation means sending emails – but we already know this doesn’t work well. The back-and-forth nature of email means that getting detailed answers is slow and frustrating for doctor and patient alike. But we do know the right way to do online consultations: asynchronously, where a patient fills out a structured online questionnaire that the doctor checks at a later date; and synchronously, where both parties talk to each other at the same time, using video technology such as Skype.
At the moment, many face-to-face consultations involve the GP or doctor asking the patient the same set of routine questions at points through the year. “How have you been since I last saw you? Are you still taking the meds? Are there any side effects?” The list is long for safety reasons, but the repetition is unnecessary. This type of consultation can be easily switched to an online asynchronous method – saving a visit to the surgery and doctors’ time, and allowing for a richer doctor-patient discussion. Back in 2010, the Mayo Clinic in the US found that online consultations could reduce the need for face-to-face appointments with GPs by 40%.
Doctors can devise the questions themselves and there are tried-and-tested programmes such as Instant Medical History (IMH).
IMH, part of the Mayo Clinic study, tailors the detail of follow-on questions to the speciality of the clinician, for example asking more questions about breathing for a chest specialist than for a GP. One obvious downside of online appointments is that the doctor cannot examine the patient, but not every appointment requires an examination – and if the doctor feels one is necessary they can call the patient in. In synchronous video consultations, a Skype conversation in the patient’s home can give a doctor a valuable view of a patient’s living conditions – information they might have previously missed.
No patient should be forced into using online consultations – but many want to be offered the option. Moving just a small proportion of these face-to-face consultations online can make a big difference for patients. Furthermore, online consultations allow more efficient and frequent interaction with a specialist and the advice received is available for sharing with the local GP. This completes the circle of care and means patients can access the best care wherever they live.
However, for online consultations to work effectively for both patient and doctor, they must be introduced correctly. If GPs and hospital staff give the impression they’re not fully behind online consulting, patients will sense it and avoid the option. Similarly, if patients suspect that it has been introduced purely as a cost-saving measure, they will react badly.
GPs and doctors must move away from thinking they are too busy to consult online – indeed, it is precisely because they are so busy that they need online consultations.