Teleconsultations

The COVID-19 pandemic has transformed how everyone, in particular how medical professionals work. Having been doing predominantly virtual consultations over the phone for the past few weeks while working in GP, here are some main thoughts about the entire process.

 

Shorter consultations, sort of?

So in general I've felt consultations go by quicker over the phone than in person. The main contributing factor is that there is no need for a full physical examination, meaning clinical diagnosis hinge on a good history, and however much your patient is able to provide in terms of examination findings (not a lot, mainly inspection such as whether their joints are red/swollen). Whilst I will bring patients in based on clinical needs, a lot of common diagnoses can be reached with history alone, perhaps with some supplementary information (e.g. patients can send photos of their rash in advance). However, this can also mean that I have to be very cautious and ensure that I can get all the key information based on the history, which sometimes mean spending longer time asking questions, whereas I would've just invited the patient to the examination couch and look myself.


Losing the non-verbal communication

We all learnt from medical school how important this is. I won't deny there are some instances where I was glad that the patient is not right in front of me, like when I am a nervous wreck or when they are being violent/aggressive. But as a whole, a lot of emotions I want to convey is lost over the telephone. For example, breaking bad news to a patient or emphasising the importance of certain symptoms when providing safety net advice. I feel like patients also lose the doctor-patient relationship with time as they are unable to put the voice to a recognisable face.



Phone problems

My biggest pet peeve. This ranges from patients not picking up their phone, to wrong numbers on the system, to the connection being poor. I don't think it is the fault of any particular person, but an intrinsic problem with the system relying on telecommunication. Every time a person is unable to pick up, I do try later on in the day, otherwise we slot them in for the next available day. With the limited number of slots, this is still equivalent to patients not attending their appointment, which meant that the precious time slot that could be used for another patient's consultation is unnecessarily lost.


Solitude

If the surgery you work in does mainly telephone consults with the occasional face-to-face appointments, it does feel very quiet at times. Long gone were the days where patients were chatting away in the waiting room, babies crying and children running around. And all your co-workers work in separate rooms, sat in front of your computers and chatting to patients like a call-centre employee. I am not usually a very sociable person to begin with, but even I feel somewhat lonesome at times working in GP with only teleconsultations.

 

I think there are pros and cons of the system. Currently we are forced to adopt this system due to the pandemic, but even as we come out of it, I think some aspects can be kept. It can be an efficient tool if used correctly along with a good triaging system. Share your thoughts below on telephone consults!

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