For many of us, a two-week delay to see a doctor in person isn’t unusual, something no-one is happy about.
Doctors and practice managers are always looking for ways to streamline the process, and a lot of them are starting to embrace technology as a way of increasing the throughput of patients. One such way is for patients to see a ‘virtual doctor’ in lieu of a face-to-face examination.
Reactions to the idea are mixed, so we’ve taken a look at the pros and cons but we’d welcome your thoughts on firstname.lastname@example.org – and if you’ve used the service, we’d love to hear about your experience!
What is a ‘virtual doctor’?
A virtual doctor is still a fully qualified GP or consultant and not a computer programme. However, instead of seeing patients face-to-face the consultation takes place via a computer or smartphone; the doctor and patient can see each other but only via a screen.
The lack of a physical examination might not be a problem, either. It’s estimated that up to 90% of all consultations don’t require a physical examination – and for those that do, the ability to send photographs or even to live-stream a video means that not not being in the same room needn’t compromise the quality of either the examination or the subsequent diagnosis and treatment.
Of course, many of us will be reminded of the ‘radio bush doctors’ who have provided an invaluable service for people living in the remotest regions of places like Australia and Africa for decades. The difference here is that the doctor can see the affected area or injury in real-time if they need to, allowing them to get a better understanding of exactly what the problem is.
Where is the virtual doctor service being offered?
Patients across some parts of the United Kingdom are being offered the chance to see a ‘virtual doctor’. The scheme, which started in around 2012 and was the subject of further, more widespread trials in 2017, is now being rolled out after largely positive results.
One such NHS service is GP at hand, which is being offered to patients in London. It’s free but those wanting to take up the offer have to switch to it from their local GP’s surgery. The switch is said to take only three minutes and it claims that most people can access an online consultation within two hours of asking.
GP at hand says that most consultations can be done remotely via its smartphone app but if a personal consultation is needed, it offers five physical clinics across the capital. If the diagnosis results in the need for medicine or another physical product then it will send the prescription to a chemist of your choosing for you to collect.
It does seem to offer some very real benefits other than the speed with which you can have a consultation: the service offers an online symptom checker so you can undertake your own research into your condition, for example. It also lets patients replay their consultation interview afterwards, which would be invaluable if, like me, you sometimes come away with your head spinning and only a vague sense of what was actually said.
When should you see the doctor?
Is it only available via the NHS?
No. The NHS is not alone in wanting to exploit this growing market; private medicine providers are cashing in on burgeoning waiting lists and impatient patients too. Most will charge you a small monthly subscription fee with subsequent consultations being charged on top of that. As a guide, the cost is likely to be between £5-10 a month plus £30 or so for a consultation.
These virtual healthcare providers often also offer medical screening services like cholesterol tests, too. They simply post the test kit to you and you post back whatever sample is needed. Their laboratories then conduct the test and the results are interpreted and discussed with you over the phone or online.
Who are virtual doctors aimed at?
While the NHS trail schemes are open to all, initial results show that 40% of the patients who used the scheme are aged between 45 and 64. People like us, in other words.
Has it led to faster consultations?
Yes; whereas a traditional doctor’s consultation takes about ten minutes per patient, a trial in 2017 showed that up to three patients could be seen remotely in the same time.
Yet some doctors argue that it’s not necessarily just about seeing more patients. Dr Murray Ellender, who founded e-Consult the largest provider of NHS online GP services, said in 2017: “This is not a replacement for the traditional face-to-face consultation, but it can help reduce demand and free us up for cases that need to be dealt with face-to-face.
“It doesn’t mean we are dealing with things faster, we are just making sure we can take longer for those who need it.”
So, routine appointments can be despatched with impressive speed, giving the doctor more time to deal with patients with more complex healthcare needs.
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It’s only suitable for simple stuff then?
Yes. And no. While it could be argued that the biggest benefits come from dealing with patients with simple, easily diagnosed conditions, there is a case to be made for its efficacy in more complex cases too.
Take, for example, someone with a serious, possibly life-threatening chronic illness that has been diagnosed and treated but still needs ongoing care and monitoring. Such a patient could, with the right training and equipment, monitor their baseline medical data like pulse rate, blood pressure, temperature and oxygen levels. This information can then be transmitted automatically to a remote monitoring and assessment centre that would flag up any anomalies.
Don’t people miss seeing a doctor in person?
I’m sure some people do but for others the semi-anonymity of a remote consultation can be a blessing. Patients with conditions that they find embarrassing, such as sexual health problems and mental health conditions, have embraced the virtual consultations as a way of getting their needs met without having to see anyone in person.
This so-called ‘digital disinhibition’ could be a life-saver for patients who might otherwise be too self-conscious and uncomfortable to seek help with their GP via a more traditional consultation and examination.
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Are there any other benefits to the online doctor service?
Oh yes. Increasing GP waiting times allied to our reluctance to seek prompt help mean that many leave their condition undiagnosed and untreated for too long. By the time anxiety has set in, many opt to seek help at their local hospital’s A&E department. This increases the on-site waiting time for everyone else and stretches already scarce resources, often to breaking point.
The availability of near-instantaneous virtual appointments means that these people can seek immediate help without having to use an A&E’s resources for something that their GP could have dealt with more properly.
So, it’s a unanimous thumbs-up then?
Not quite. A number of doctors insist that there is no substitute for seeing a patient in person, arguing that there is a real risk that some conditions could be missed. As Dr Kailash Chand, the vice president of the British Medical Association, puts it: “Medicine is not a perfect science – its about communication and probability and this cannot be done on an e-Consultation. The digital world is not the future for everything – a headache could be simple or it could be a brain tumour.”
It’s inevitable that some patients might resist the idea too, preferring the reassurance of visiting their local doctor’s surgery. Nor should we underestimate the importance of giving patients the opportunity to have some social interaction while they’re there. My local surgery, for example, has an onsite café and it is widely used as a place for folk to meet for a natter.
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Surely there are wider applications for this?
Indeed there are. One of the most exciting opportunities is that the virtual doctor scheme offers doctors the chance to consult with people in remote locations where they might otherwise struggle to meet in person.
It also allows specialists and consultants in obscure conditions to diagnose remotely. Having what might be niche knowledge made available worldwide means that rare and unusual conditions can be more accurately diagnosed, saving lives and increasing the quality of life for people who might otherwise have had to live with an undiagnosed condition.
Take Zambia, for example. It has only 1,600 doctors for a population of more than 14 million people – and most of those doctors are concentrated in urban areas, whereas the bulk of the population lives in remote, rural areas.
The growing availability of virtual appointments and consultations via the charity Virtual Doctors means that many Zambians are now able to see a doctor for the first time in their lives. Trained clinical officers, using a specially issued smartphone and dedicated app, interview patients and send their case notes and photographs (if necessary) to a doctor in the UK who reviews them and provides a clinical diagnosis and treatment plan. In more serious cases, the app allows the doctor to give advice on stabilising the patient’s condition until on-the-spot medical treatment can be obtained.
The results are hugely positive: the patient’s symptoms improved in 93% of cases; 77% of consultations prevented a referral to a hospital; and 98% of consultations led to educational advice being given. The service has been so successful that it is now being rolled out to Malawi; if you’d like to find out more or even make a donation, you can do so here.