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Overuse Of Remote Medical Consultations Threatens The Safety Of Disabled Patients

The human capacity to embrace change and pivot rapidly has been seen as one of the few positives to emerge out of the gloom of the pandemic.

Allied to this has been a desire to carry forward new found COVID-era efficiencies into the post-pandemic world.

An increase in working from home has been one such example but historic changes to the way medicine is practiced are also now on the horizon.

According to an insight report in the U.K. entitled “The Dr Will Zoom You Now: getting the most out of the health and care experience,” produced by local health services monitoring champion Healthwatch, the health and care charities collective National Voices and public servicers consultancy Traverse, 85% of medical consultations are now being carried out remotely.

In a survey of General Practitioners undertaken by the British Medical Association, 88% of those surveyed wished to see an increased use of remote consultations moving forwards.

In the United States, a survey in April of some 1300 physicians found that 85% were deploying some form of telemedicine, with 77% supporting its use after the pandemic is over.

Against the backdrop of these seismic shifts, the U.K. Secretary of State for Health Matt Hancock announced at the end of July that remote medical appointments, whether by telephone or video conferencing platform, should become the default option on an ongoing basis.

Kickback has not been slow in arriving and last week; NHS England sent a letter to GP surgeries stating that it was unacceptable to entirely discontinue face-to-face consultations.

Last month, NHS England primary care medical director Dr, Nikita Kamani acknowledged on Twitter that “significant incidents and events” had arisen from some medical practices closing their doors and opting to go online only.

Risks and benefits

The risk factors and impacts of digital by default approach to healthcare for individuals with disabilities are complex and multi-faceted.

While there are clearly patient populations likely to struggle outright with remote consultations and telehealth, such as those with learning and communication difficulties and mental health issues, the digital divide also cuts across disabled communities in a number of different ways.

For example, disabled people are likely to be overrepresented in the segment of the population with poor access to the internet and low levels of digital literacy. Yet, even those who are highly adept at using technology risk being at the mercy of inaccessible websites and apps.

“Disabled people have been routinely forgotten throughout the pandemic, and making huge sweeping changes like this without considering the impact on the UK’s 14 million disabled people risks turning back the clock on equality,” says Ceri Smith, Head of Policy and Campaigns at disability equality charity Scope.

She continues, “Moving digital by default would risk excluding huge numbers of disabled people who need to speak to their GP in person, and whose reasons for doing so might not be clinical in nature.

“Disabled people’s rights to receive healthcare must be protected throughout the pandemic and beyond.”

By the same token, there are also clear advantages to telehealth for significant numbers of individuals with disabilities.

In the short to medium term, there is, of course, greater protection for clinically vulnerable populations from coronavirus infection. In the fullness of time, however, consulting with medics from the safety and comfort of one’s own home could prove to be a significant boon for those with physical impairments and mobility issues, which can make trips to the doctor’s surgery arduous and energy-sapping.

In the appropriate context, remote options are also potentially great tools for conducting multidisciplinary appointments. Furthermore, if there are functions to record and review remote consultations, patients across the board stand a better chance of taking ownership of their healthcare and getting to grips with the finer details.

Telemedicine may also offer up opportunities for greater participation for disabled people in trials and research studies.

A blended approach

Where, then, does the balance lie for disabled people and those with complex needs to allow them to benefit from the best of both worlds?

“The Doctor Will Zoom You Now” report engaged 49 participants, undertaking remote or virtual consultations across a variety of formats, and results were collated through an online platform, follow-up telephone interviews and a study workshop.

One of the key themes to emerge is that a one-size-fits-all approach is unworkable and it is, therefore, essential for medical practitioners to maintain a “blended offer,” where video, text, phone and face-to-face appointments can be allocated and chosen appropriately.

The report also emphasized the importance of establishing more standardized protocols for scheduling time windows, leaving messages and arranging callbacks.

Additionally, the importance of both practitioner and patient training resources was stressed, with some patients suggesting that demonstration videos on YouTube would be a useful starting point for familiarizing themselves with the process.

Dr Jonathan Leach is the Honorary Secretary of the Royal College of GPs and practices at the Davenal House Surgery in Bromsgrove, Worcestershire, which has been using the telephone for 60% of its consultations for the past six years.

He says that his team at the practice works hard to identify the type of situations and patients most likely to benefit from telehealth.

“We are very mindful that this does not suit everybody,” he says.

“Remote consultations may not be the best option for a range of situations,” he continues.

“Someone may have mental health difficulties, learning disabilities, or be hard of hearing.

“There may also be safeguarding concerns. If someone is in a coercive relationship, we have to ensure nobody is standing behind them telling them what to say.”

Further expanding on the dividing lines governing suitability for remote consultations and the bracket many individuals with disabilities and long-term health conditions may fall into, Leach adds, “I often say that phone and video are brilliant for straightforward things.

“So, for somebody needing a sick note because they’ve just been discharged from hospital or repeat prescription, phone and video consultations are excellent.

“However, when you are dealing with patients with significantly complex medical needs, that’s when you start to see the limitations of remote consultations. We need to be mindful where this can be of value but also situations where a face-to-face consultation is still the best option.”

Providing further insight on the dynamic of the doctor-patient relationship, he explains, “If you have someone with back pain in the waiting room, it can be useful for context to see how they get up from their chair. So, there are some subtle non-verbal cues that I do worry we might lose.

“It’s essential that all patients come away feeling they’ve had a proper consultation, and from our side, to know that we’ve carried out a proper assessment and picked up on all the soft signs and human interactions you get with a face-to-face consultation”

In the end, nothing stays the same. Technological innovations shape and mould every professional endeavour ­— medical practice is certainly no exception.

If disabled patients are to be brought along on the telehealth journey, then, it must first be decoupled from the sentiment of the mad COVID-era rush to embrace the “new normal.”

Due care must be taken to ensure that protocols are refined to meet the needs of the most vulnerable patients.

Though, inevitable pitfalls exist when a trend is new, novelty also brings with it the opportunity to build in both digital and professional inclusion policies right from the outset.

This will always be more efficient than trying to retrofit them after the practice has been well established.

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