Telemedicine or Face-to-Face Consultations?
During the Covid-19 epidemic many GP practices have been offering patients video or telephone consultations. The Health Secretary, Matt Hancock, is so delighted by this development that he wants GP practices to make telemedicine their primary means of serving patients. We have been researching telemedicine for over 20 years and the evidence is very clear: whilst telemedicine can serve many very useful purposes it cannot be a replacement for face-to-face consultations.
There is often a euphoria associated with a new digital technology that assumes it will replace existing ways in which people get things done. But what often happens in practice is that the new technology becomes a complement to existing practices rather than replacing them. The demise of paper has, for example, been forecast for over 30 years but it is a very useful and flexible technology and is still flourishing alongside electronic publishing. We have every reason to believe that the same will happen to telemedicine: it will find its own niche alongside face-to-face consultations but it will not replace them. The task now is to work out when it can be most usefully and safely deployed and when face-to-face consultations are essential. Then we need to promulgate this knowledge as advice to help all medical practitioners.
Some distinctions are obvious. There are many diagnostic procedures that depend upon the doctor making a physical examination of the patient and face-to-face consultations will remain essential for these purposes. And there are many circumstances where the patient needs the doctor’s best ‘bedside manner’ to support them through anxious times. Who can imagine giving a patient bad news via Zoom!
What of the value of telemedicine? We have found examples where it adds substantially to what the medical profession can offer. One example is offering the patient support whilst they engage in home medical care: for example, having a diabetic nurse available via a telemed link whilst a new diabetic patient gives themselves an insulin injection. Recently we did some research with home dialysis patients who were supported through this complex process by a telemed link to dialysis specialists in the local hospital. We have also been working on the value of telemed links for people with learning disabilities for whom a visit to a GP practice can be a traumatic event: far better for them to ‘see’ the doctor in the familiar setting of their own home.
But some more general lessons have emerged from an evaluation conducted by Ipsos-Mori of the Babylon ‘GP at Hand’ service.
Patients who join ‘GP at Hand’ leave their existing GP practice and opt for a telemedicine-first service. The evaluation found that the service was popular with young, fairly healthy patients who were busy with work and could not easily get to a GP surgery during the day. It was not so popular with the elderly or those with complex needs. And when the young patients found they had a more complex condition and they wanted a face-to-face consultation they often became dissatisfied with ‘GP at Hand’ and reverted to their original practice.
On this basis telemedicine has an important role to play in routine consultations but there needs to be an easy way to switch to face-to-face consultations if conditions become complex and patients become anxious.