Tuesday, January 15, 2013

The Skype Consultation: a Technological Step Too Far?

This guest post is authored by Niqui Stubbs, a 4th year medical student.

In the UK, around 835,000 people make appointments to see their GP every day, and 1 in 10 of these appointments are missed, wasting the doctor’s time as they could have used that appointment to see a patient who actually needed it. Some people may miss their appointment because they forget about it, but some may not be able to attend their GP due to a physical ailment or possibly because they are frail and live in a very rural area. It is because of these reasons that health secretary, Jeremy Hunt, is supporting a new type of GP consultation: the Skype appointment.

This call for video consultations opens up a lot of possibilities for people who were previously unable to see their GP, but also for people who may only have a minor ailment such as a sore throat or runny nose, as these people are unlikely to need a physical examination. The worries though, are centred on this: the fact that a physical examination is not possible.

80% of a diagnosis comes from a well told patient history, but the physical examination still makes up a very important 20%. Without a proper examination by a health professional a rash could be diagnosed as dermatitis when it is in fact meningitis, a headache could be diagnosed as a migraine, when it is really the first sign of dangerously high blood pressure; the video consultation could well be a fast track to a medical malpractice claim. The physical examination is an important part of the consultation as it allows the doctor to confirm his theories of a diagnosis, but also find other signs that the patient may not have been aware of.

A conversation over Skype may be appropriate to talk to friends, but is it appropriate to talk to a doctor? The doctor-patient relationship is a very important thing; the patient needs to trust and respect their doctor completely so they feel at ease telling them things they wouldn’t ordinarily want anyone to know. The worry is that a video conversation may take away air of professionalism that encourages patients to have faith in what the doctor says. There is also the problem of confidentiality; could there be a computer virus that would allow details from the seemingly private consultation to be intercepted and stored? This is unacceptable in the medical profession.

A pilot of the Skype scheme has been taking part in Newham University Hospital and they have reported a fall in missed appointments by 11%, and when asked the patients involved said the quality of care they were receiving was no different to that of face-to-face consultations. Video calls obviously have their advantages over telephone consultations, a simulated face-to-face experience for one. The patient feels as though they are still in the presence of a doctor, and may make them feel more like they are there in the surgery. These results may look promising, but will the novelty soon wear off?

The Skype consultation could well be a technological advance for better, but that is only if it not abused. The video appointment is for people who are too ill or too far away from a surgery to see a doctor when they really need to, or for patients who need a very brief appointment about something that they think is a minor problem; it is not for patients who cannot be bothered to leave the house. This type of appointment is not a replacement for a normal consultation, it is merely the next best thing for when people are truly unable to attend a real appointment, and will save the GP a lot of time as they would not have as many house visits to attend, subsequently increasing the amount of patients they are able to see in a day.
Would you feel satisfied that your health worries had been properly addressed in this type of consultation?

About the author:

Niqui Stubbs is a 4th year medical student with particular interests in medical negligence, who works on behalf of Pannone; a specialist in medical negligence. She also has a passion for new technology and gadgets, and enjoys writing about how they are transforming the medical world for the better.


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