Our lives have changed beyond recognition due to the growth of telecommunications and the internet. This is creating exciting opportunities for medicine, but also new risks. Government and charitable organisations are backing a drive towards telehealth as playing a key role in healthcare in the future. An ageing population, increased pressures on the NHS and rapidly changing technology mean that remote access to healthcare seems likelier than ever.
However, alongside the many benefits, there are risks to using fewer face-to-face consultations that GPs must remember the following when conducting telephone and online consultations.
The following four tips should increase confidence for GPs using telehealth more heavily this year - for example, running Skype consultations for the first time, or introducing a phone triage into an appointment-booking system.
1. Ensure you have the patient’s consent to consult them by phone/web
Obtain and document your patient’s explicit consent to online contact and consultation. Whilst many people are used to being reminded of a hair appointment by SMS to their phone, even the fact of a having a GP appointment booked might be sensitive information. There will be some consultations involving particularly difficult or sensitive issues which can only be properly addressed face to face.
Cultural and language issues must be considered since these can require enhanced communication skills which may not be achievable remotely.
2. Keep your conversation confidential
GPs are able to control the confidentiality of their working environment for patients seen at the surgery but those safeguards may not extend to the patient’s home environment or other ‘remote’ location where you are consulting with them. Remote consulting must not compromise the patient’s rights to confidentiality, and this is something to explore with them at the time of exploring consent and the appropriateness of this type of communication.
It is important to be able to establish the patient’s identity when making contact remotely - without inadvertently breaching confidentiality to a third party.
If you wish to make a recording of a telephone or online consultation, you must seek explicit consent. The guidelines are set out in the GMC’s publication, Making and using visual and audio recordings of patients.
3. If in doubt, ask them in
Sometimes what starts out as an online consultation reveals concerns or queries which cannot be safely resolved without the benefit of a face to face consultation and the opportunity to examine, so it is important to be willing and able to ask your patient to stop the online consultation and come in to see you.
4. Ensure your patient is calling/consulting from the UK
If the doctor is advising from the UK and the patient receiving the advice is in India, and something goes wrong to the detriment of the patient, where will a claim be made? Will your indemnity arrangements respond to a claim brought in a jurisdiction other than the one in which you are registered? Limit your remote consultations to your patients in your country of practice and to take advice from your MDO before extending your reach beyond this.
Dr Pallavi Bradshaw is a medico-legal advisor for MPS.