I have long been fascinated by the tendency for changes in social policy to happen suddenly rather than gradually. The NHS is no exception to this, and, indeed, it is often the case that particular healthcare policies and practices change overnight from being discouraged or even forbidden to becoming more or less compulsory. It looks as though attitudes to telemedicine and to remote consultations fall within this category, with COVID-19 being the catalyst for change.
At the end of July, Matt Hancock gave a speech on the future of healthcare in which he declared “… from now on, all consultations should be teleconsultations unless there is a compelling reason not to.” The following day, Sir Simon Stevens’ letter on the third phase of the NHS response to COVID-19 gave more nuanced messages and acknowledged the place of face to face consultations alongside digital and telephone consultations in some circumstances. Meanwhile, a recent RCGP survey reported that at the present time 61% of appointments are full telephone consultations and 16% are telephone triages. So far, online video consultations make up only 4% of current GP appointments.
Many changes in how patients can access doctors have the potential to offer great benefits to patients and to ease pressures on health systems, so let’s acknowledge straight away that some patients will have better access, swifter responses and a better partnerships with health professionals as a result of technological innovations and changes in attitudes. So what’s the problem? Oddly, it is the excess of zeal that often accompanies the “forbidden to compulsory” paradigm. What is right in some circumstances is not right for all.
There has already been recognition that some patients have no access or limited access to digital means of communications, or lack the necessary skills to use them. Some patients do not even have access to a telephone in conditions of privacy. These are important factors, but the limitations of remote consultations go far wider.
In many situations, there is simply no substitute for person to person interaction, and for patients being able to access it without jumping through unnecessary hoops. Medicine is an art as well as a science and that art includes building personal relationships, the interpretation of subtle non-verbal clues and the use of touch. The strict focus on one particular problem, which may flow from patients having to describe their problem in advance, may also lessen the possibility of seeing one symptom in the context of a wider physical and emotional context. And there must be many a consultation where the patient only discloses their main worries when they are about to leave the consulting room, once a personal rapport has been established and tested.
There are also issues for health professionals themselves. I don’t know of any health professionals who went into medicine or allied professions in order to work in a call centre, but that could be their fate. It’s also difficult to see how doctors and others could be satisfactorily educated and trained if the vast majority of consultations were to be conducted remotely.
So, let’s not be Luddite about all of this. Patients and healthcare professionals will need to work together to explore the positive potential of new types of consultations. But equally, please let’s not throw the baby out with the bathwater. We must be careful not to lose the good bits of what we had while we explore what else we might have in the future. And the good bits certainly included the opportunity to consult with a health professional in person.
Chair of Academy Patient and Lay Committee
© 2020 Academy of Medical Royal Colleges.