New kinds of consultation: Tele-medicine
With the scope of electronic communication growing steadily, (mobile phones, texting, Skype and email) a new form of medicine is beginning to emerge…. telemedicine.
Broadly speaking telemedicine involves interactive audio, video or other media used to deliver healthcare. For individual patients and their doctors, it mainly encompasses the use of telephone consulting, e-mail, and texting. Some doctors favour video consultations using Skype, Webex, Microsoft teams or BT Facetime.
In British medical practice we have been slow to embrace the use of the telephone. but the pandemic has revolutionised our attitudes. Nowadays almost a half of primary care (i.e., GP) contacts are by telephone and this is likely to grow. Many phone contacts are of course with reception staff and nurses but tele-consultations with a doctor, whether GP or specialist, are gaining in popularity with patients and doctors alike.
Telephone consulting is popular for several reasons:
Access: Demand for doctor’s appointments commonly outstrips supply so that, for example, in a GP practice daytime triage has become the norm for juggling appointments, waiting times and prioritising emergencies. Triage means that a health professional, usually a nurse, takes the call and notes the important aspects of your problem. They will allocate a response (phone call with a doctor, clinic appointment or house-call) depending on how serious things appear to be. If you phone in the morning to report a problem you may be called back by a nurse, a nurse-practitioner, or a duty doctor. GPs know that more flexible access is needed, and telephone contact may well fill the gap.
Consumer Demand: Almost everyone now has a mobile phone and is accustomed to being in contact with work or family wherever they are. Medicine is being challenged to respond to this way of working and incorporate modern methods of communicating.
Out of Hours Service: With the transfer of out of hours’ responsibilities to agencies and night cover the use of the telephone as point of contact has become essential.
How useful is tele-consulting for you?
From your point of view telephone consulting can be helpful for simple routine problems like flu or food poisoning but may not be as good when complex or emotive issues are involved. In those circumstances a face-to-face consultation can feel much more dependable. Importantly, a phone call may seem less satisfactory than a traditional consultation because the doctor cannot pick up any clues from your appearance or your behaviour. They will however listen for warning signs such as a cough, breathlessness, anxiety or depression. Obviously, a physical examination is not possible by phone and this may be fundamental to diagnosing the problem. A history of your ailment may not be enough. So, the doctor may well ask you to come in anyway.
If your symptoms are different from those normally anticipated, then the doctor may want to see you too. If you are unknown to the doctor it may be doubly difficult for them to assess what is happening…. easier if you know each other well and can pick up where you left off previously. You will need to give a comprehensive account and cover all the things that the doctor can’t see.
Sometimes a call can be backed up afterwards with some written information about what you have been discussing either sent to your home or to be found online.
Prescriptions of medication for your symptoms or perhaps a course of antibiotics for an infection can be managed efficiently over the phone. The doctor will fax or email a prescription to the pharmacy and arrange for you or a relative to collect it. If you feel you need a prescription you may be offered a “delayed prescription”. This means that if your condition improves spontaneously, you won’t need any medication. If it stays the same or gets worse, then you can pick up the prescription and use it.
Similarly simple tests of blood or urine can be requested after your conversation by fax or email on your behalf.
Talking on the phone to a doctor can be very instructive and help you anticipate what to do next time if you have a recurrent problem, asthma for example.
Remember however…. telephones can also get busy and one should not underestimate the frustration of the sound of a permanently engaged number and the cost both emotional and financial of hanging on to the phone line.
Tips for talking to a doctor on the phone.
- Make sure you get the doctor’s name clearly and write it down with the phone number you are calling.
- Make sure the doctor or their assistant has your phone number too so that they can get back to you if you are disconnected.
- Speak to the doctor yourself. You are the person who knows best what is happening.
- Give the doctor a full account including details that he or she cannot see or feel. (Where is the rash for example, where exactly is the pain?)
- Make a note of what is said and what advice you are given with the time of the call.
- Write down what arrangement is made for follow-up and when you should contact the doctor again and in what circumstances (perhaps if your temperature rises further, or if the pain does not go away in a few hours or you get side effects from some medication.)
Telephone consultation offers many advantages especially for people having difficulty getting about. Used wisely this technique has the potential to make doctor patient interaction more frequent and more efficient.
However, there are also serious limitations. The doctor cannot read your body language, see weakness in one muscle group, see what movement elicits pain, or the distribution of a rash.
In dermatology (skin disease) however, a well-focussed photograph of a skin lesion sent to the doctor’s phone and a well-lit video call have greatly helped make a speedy diagnosis.
Other online medical services
The internet offers other medical services too. Some GPs and some hospital outpatient clinics provide an online booking facility. (These can be found on your GPs or local hospitals website, www.chooseandbook.nhs.uk/patients)
“NHS Choices” is a very useful and extensive website giving a wide variety of information about NHS services, your options, and your rights. Look up for example “Services near you” and learn about the choices available in hospitals and GP practices in your area. Or look up the Delivery Plan For Tackling the COVID-19 Backlog of Elective Care.
A new development now being tested is the use of “Online Clinics”. The online clinic service enables you to get quick answers to your personal medical problems from specialists. A new clinic begins each month on a different topic in a forum format where you can post your questions, anonymously if you wish, and get answers often on the same day when the clinic is open. If you miss a clinic, reading the Q&A posts may well cover the issues you were also interested in.(See NHS Choices website: online clinics).
Finding your own medical information online
Opinions differ about the benefit of looking up medical information online. The main advantage is that reading about your kind of problem equips you with the right terminology and some understanding of the possible causes and effects. You can get an idea of the scope of the problem, and this can help you explain your own situation to your doctor.
However, until you know exactly what your diagnosis is it is very easy to get drawn into a wild goose chase about all sorts of ramifications which are not in fact relevant to you at all. This can be very scary. Better to stay with some simple reading on the general topic and ask your GP or specialist to recommend some useful links specific to your diagnosis (which you will make a note of in writing…. remember!) See researching online in much greater detail below. (Part B number 9.) Many diseases now have specific societies or associations ( e.g. British Kidney Patient Association (BKPA),or the Epilepsy Society) which have usually been started by patients or their relatives who have the disease in question. These sites often give good practical advice and may offer sources of support as well as information.
These are a good place to start.