While use of technology in delivering medical services has been slowly evolving over the years, covid-19 has fast-tracked large-scale adoption and led to policy change. The benefits have been indisputable during the pandemic—enabling patients to access healthcare and clinicians to work remotely—however there are naturally concerns arising around its limitations, and the need for support and training due to the different skills required when consulting in this way. There is also some apprehension around the expected role of virtual care beyond the pandemic.
At MPS, we have been working with doctors during the past months to help them adapt to the rapid increase in teleconsulting and mitigate risks. Our risk prevention programmes focus on the medicolegal, ethical and communication challenges which telemedicine can, by its nature, create and demand for support and guidance has been high.
A recent MPS survey of 1250 UK doctors explored some of the key concerns for doctors and makes for interesting reading. 70% of the doctors surveyed agree that the benefits of telemedicine have been unquestionable during covid-19, and that it will remain a fundamental tool in practice. However, 83% raised concerns about some vulnerable patient groups being left behind if there is an expectation for more appointments to be delivered remotely after the pandemic. Access to remote services could be impacted by factors such as digital literacy, disability, language, location or internet connection.
Digital inequalities and the potential for this to create disparities in healthcare, is a complex topic which requires ongoing research. However, research aside, a significant number of doctors—those best placed to know their patient base—have raised concerns around the potential impact on vulnerable patients. These concerns must be listened to, and furthermore, the burden should not be on doctors to address the digital inequalities across society.
In the MPS survey, 80% of doctors went on to say they are concerned that if some patients feel excluded from telemedicine, this may result in a breakdown in the doctor/patient relationship, or conditions being left untreated. 76% also said they are generally more worried about missing something in a remote consultation, with 60% saying they are more worried about a claim or investigation arising.
Perhaps unsurprisingly, only one in five (19%) of doctors said they had no concerns around the increased use of telemedicine.
Telemedicine is no longer part of a distant digital future—it should be considered a mainstream form of practise and not something out of the ordinary. After all, it isn’t a different kind of medicine; it is just medicine delivered in a different way and still requires the nuanced clinical judgements of a skilled physician.
But this shift will take time. Covid-19 may have accelerated the uptake of telemedicine, but it has still only been used on this scale for a relatively short time. It’s possibilities, as with its limitations, are bewildering for many patients and doctors alike and there is a need to tread carefully.
This is why at MPS we feel the government and healthcare ecosystem should take a long-term strategic approach when considering the role of virtual care beyond the pandemic. This should be based on the experiences of patients, an ongoing evaluation into the barriers to accessing telemedicine for vulnerable patient groups, regulation and the medicolegal concerns raised by doctors.
Doctors must feel properly supported by the government and should not be left to deal with any unintended repercussions from an increased use of telemedicine.
Pallavi Bradshaw is Medicolegal Lead in the Risk Prevention department at the Medical Protection Society.
Competing interests: The MPS provides the right to request access to expert advice and support on clinical negligence claims, complaints, GMC investigations, disciplinaries, inquests, and criminal charges such as gross negligence manslaughter. This article was not commissioned.