Video call doctor appointments can be disastrous for some patients

By Tom Campbell via SWNS

General practioner consultations may be more convenient over video for some but disastrous for others, scientists have warned.

Patients who suffer from mental health or hearing problems could lose out as health services swap face-to-face appointments for heads on screens, according to a new study.

Video consultations increased dramatically during the global pandemic as it was unsafe for patients to consult their GPs in person, but few studies have examined what impact this shift has had on patient care, especially for those suffering from complex health conditions.

Now scientists at the University of Cambridge have found most patients and doctors agree face-to-face meetings trump digital ones when it comes to giving a diagnosis.

One patient from the study complained, saying: “My rheumatologist cannot see or hear how I move, look at my skin, eyes, hair, hands, bones, how I am.

“I was diagnosed with something over the phone, which I know isn’t right, and it’s getting worse.”

Lead author postgraduate researcher Melanie Sloan said: “Our research exposes the inherent risks and benefits of telemedicine for patients with complex conditions, which may have important implications for patients who have other serious or unpredictable long-term conditions.

“As the NHS develops a telemedicine strategy, we hope there will be a thorough assessment of the clinical and psychological risks and steps taken to mitigate those risks, as well as action to address the possibility of worsening existing health inequalities for those less likely to be able to benefit from remote consultations.”

An online survey involving 1,340 patients and 111 clinicians was carried out by the researchers between April and July 2021.

In-depth interviews were also conducted with 31 patients and 29 clinicians during the study period.

In total, 96 percent of participants were from the UK, while 32 percent suffered from arthritis and 32 percent from lupus.

Most clinicians and patients agreed that it was harder to build trusting medical relationships over video links but said if a strong bond had already been established, it was easier to ‘go remote,' the researchers found.

Doctors stressed the importance of responding quickly to “flaring” patients with a rapidly worsening condition.

However, only around half of patients believed their urgent request would be dealt with within 24 to 48 hours by their GP or hospital team.

While some patients praised “prompt responses," others struggled with administrative systems to get an answer or book an appointment at all.

One young lupus patient said: “Waiting for a call back after four voicemails…feel sad and scared knowing that when I really need medical help I have no one.”

Concerns were also raised that video consultations could increase inequalities in treatment, with certain groups of patients at a “substantial disadvantage."

These included people with undiagnosed or more complex health conditions, those for whom English was not a first language or who had hearing difficulties.

Also, patients with cognitive or speech difficulties and those experiencing social or economic hardship or mental health problems were also identified as vulnerable.

A senior GP who took part in the study said: “We’ve had some local Practices only allowing contact through e-consult, so that means that if you can’t use it, you’re elderly, English is not your first language, you’ve got learning difficulties…it’s not fair.

“They’re doing that whole barrier to protect their time.”

Over 60 percent of patients and clinicians reported that video consultations were more convenient than meeting face-to-face, pointing out benefits including no need to travel, a reduction in wait times and safety during the Covid-19 pandemic.

This was especially true for those in employment or who just needed a quick check-up, prescriptions or administrative queries.

One of the lupus patients said: “I am very glad that telemedicine has become an option as it not only makes me feel more relaxed and safer, but I often have great difficulty getting to hospital.”

Concerns were also raised surrounding the NHS and hospital management using video consultations as a cost and time-saving measure.

Overall, the vast majority of respondents - 86 percent of patients and 93 percent of clinicians were critical of remote consultations, with some reporting misdiagnoses.

In contrast, just three percent of clinicians felt video appointments were better than meeting face-to-face.

They also felt that the NHS and managers were pushing the remote agenda more than their own preferences.

A senior clinician who took part in the study said: “The rapid digitalization and use of telemedicine must stay but appropriate patient selection is key, it is perfect for some but disastrous for others”.

Video consultations could be made more palatable by improving training for clinicians and offering patients more choice, the researchers say.

Carefully selecting people who are suitable for remote appointments is also key.

Co-author Professor Caroline Gordon said: “Some stable rheumatic disease patients can benefit from telemedicine but new patients, those with worsening symptoms or more complex conditions such as lupus need quickly accessible, face-to-face appointments to manage their conditions.’’

The findings were published in the journal Rheumatology.