Telemedicine
There is huge pressure on medicine, we all know that. Increasing numbers of elderly patients, patients with complex medical needs, and a dwindling number of doctors as many set sail for sunnier shores… (1). We can identify these problems quite easily, but finding solutions is somewhat more of a challenge. And, much to our dismay, there is no single solution or amount of money coming to solve the problems we face. As frontline clinicians, one of the most effective things we can do to begin to address these issues is to make changes to the way we use the system and practice medicine (2). Probably most notably, the use of technology has been hugely advantageous to make medicine more efficient and its presence in clinical day to day practice is increasing all the time (2).
Technology is changing all areas of our lives, in work and play. We live in the day and age of tech-nological advances, and it is natural that these apply to the medical field. We no longer write letters to friends, we send emails. We no longer write memos to colleagues, we send Whatsapp messag-es. We no longer use phone calls so often, we use Skype or Face Time. Many of these advances have made it into the medical field, however Skype… not so much (3).
So... Skype it! At this point, Skype is a household name and is used in all corners of the world to enable live video calls. In fact, to many, it isn't a new amazing technological advance anymore. Many people use Skype as a cheap, quick, and efficient means of communication to speak with family and friends across the globe, or even in the next room... It has made the world feel a bit smaller and more accessible to even the most physically inaccessible places.
Medicine is indeed beginning to utilise Skype today, but it is still somewhat foreign territory, and we are moving towards the use of this telemedicine slowly (1, 4). Private practice has been the most notable yet to jump on the virtual consultation bandwagon, Push Doctor and Doctor Call for example (1, 5), and government-funded practices are following to a degree (4, 6). Generally, the use of this technology is limited to general practice rather than specialty clinics — but for how long?
Skype won’t solve all the problems and difficulties that NHS is facing, and it won’t be a perfect solution even where it is being used. But through experience and some testing there have been many noted benefits.
So what’s so great about Skype? Well, many things. Appointments are typically shorter which means less waiting time for patients, more easily managed clinics for doctors (and with this clearer-headed decision-making), and the possibility of addition of extra slots into clinics (which could then increase access for patients in the future) (4, 6). Patients don't need to physically get themselves to the doctor’s office (6, 7), they can call from wherever they have a connection to Skype (8). This is convenient in particular for patients who already struggle. Some have mobility issues which make navigating health centres very difficult (1, 6). Some cannot get to the GP because of working hours or long commutes (8). Some others struggle to find appropriate childcare, can't afford taxis to and from the GP or can’t negotiate public transport (6). Some patients even will have medical conditions that limit them visiting the office, for example, patients with agoraphobia. A Skype interview can get around all of these issues.
Skype also offers a unique opportunity to catch a glimpse of the patient in their own environment. Much like a home visit would, doctors can get a more thorough idea of the place a patient is living and the functional ability they have in their home. Skype could also offer the opportunity to involve more people, in real time, in patient care. For example, a Skype consultation could easily include patient carers and family, or even secondary care doctors.
These are great benefits, but no system is perfect. There will always be pitfalls of one form or another that we need to think about (7). Signal problems can be prone to annoying cuts in calls, or poor video quality, that sometimes lead to abandoning Skype entirely for that consultation (9). But pitfalls such as these shouldn’t stop us from trying, and can often be ameliorated (to a degree) by ensuring there is a good internet connection and checking Skype is working before the consultation begins. Typically the back-up plan for a poor connection is resorting to a phone call or seeing the patient in clinic. Also, certain consultations will not be suitable for Skype. Examination is extremely limited to things visible (6), and again, only with a clear video connection (1). So, Skype truly is unsuitable for assessing and managing unwell patients (4, 8). However, if a doctor does see a sick patient on Skype it can work well as a triage system (6). Having said that, technology is advancing, and there are already prototypes for different equipment to be able to auscultate or measure certain vital signs that patients can have at home. It will be exciting to see where these can take us.
So what about the cost? A Skype subscription is free for everyone (3), but there are startup costs for extra monitors, cameras and perhaps enhanced internet services. While not a disadvantage or a particular pitfall, doctors who use Skype in practice do need to consider information governance and professional indemnity insurance when using this tool (6, 9). Are we covered by insurance when we have a virtual consultation? Can we ensure confidentiality if we cannot see everyone who is in the room (3)? What do we do if patients record consultations? Skype and technology bring new questions and issues for us to think about and address.
What is the potential for Skype consultations in the future? Skype consultations are mostly being used in general practice at present, but there is no reason why its use couldn't move to secondary care clinics as well. And could we make a bigger step and say we want to try to use Skype in emergency settings in order to avoid getting patients packed and unpacked for no reason? Can we use it to follow up with discharge patients or those we are ambulating? Would we dare to think about it? My answer is an optimistic yes, we should – what do you think, CC4C?
References
1. Are video GP consultations the future? [Internet]. Evening Standard. 2017 [cited 8 November 2017]. Available from: https://www.standard.co.uk/lifestyle/health/are-video-gp-consultations-the-future-a3260456.html
2. Jamieson S. NHS offers appointments with a doctor via webcam rather than in person [Internet]. The Telegraph. 2017 [cited 8 November 2017]. Available from: http://www.telegraph.co.uk/news/2016/09/20/the-doctor-will-see-you-now--via-webcam/
3. BMA - Talking telehealth: crossroads for consultations [Internet]. Bma.org.uk. 2017 [cited 8 No-vember 2017]. Available from: https://www.bma.org.uk/news/2013/august/talking-telehealth-crossroads-for-consultations
4. Rainey S, Rainey S, Lambert V, Rainey S, Rainey S, Rainey S et al. The doctor will Skype you now | The Spectator [Internet]. The Spectator. 2017 [cited 8 November 2017]. Available from: https://www.spectator.co.uk/2014/05/the-doctor-will-skype-you-now/
5. Doctors S. Skype Video Consultations | Speak to a Doctor Online [Internet]. Doctorcall. 2017 [cited 8 November 2017]. Available from: https://www.doctorcall.co.uk/visiting-doctor-services/skype-gp-video-consultations
6. Cite a Website - Cite This For Me [Internet]. Centrallondonccg.nhs.uk. 2017 [cited 8 November 2017]. Available from: http://www.centrallondonccg.nhs.uk/media/24178/CLCCG-Cavendish-Skype-pilot-interim-report.pdf
7. How video consultations can benefit patients and the NHS | GPonline [Internet]. Gponline.com. 2017 [cited 8 November 2017]. Available from: http://www.gponline.com/video-consultations-benefit-patients-nhs/article/1401346
