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Telehealth is not fit for purpose in primary care

As a response to Covid-19 in Australia there is the scope to consult a doctor by telephone or video. The appointment is scheduled at a specific time and the doctor will ask your name, date of birth and address to confirm your identity. Some practices will offer these consults to people who are not eligible for the government rebate for a private or insurance fee.

The type of problems presented to doctors vary from acute to chronic illness. There might be requests for repeat medications or a discussion about test results. Reflecting on the variety of problems presented it is evident that in many cases people are seeking to talk to doctors about issues that need a face to face appointment to be managed safely.

Do you know what this tiny red spot is on my eye lid?

I just want a referral to a psychologist. I don’t want to talk about why on the phone.

My two year old daughter had a rash yesterday. It’s getting better I just need a note to say she can go back to child care.

I think I’ve got meningitis, but it’s getting better today. What do you think?

I had a migraine yesterday and need a day off work.

I think my daughter has nappy rash.

I’ve got iron deficiency anaemia. Another doctor far away did the test for me. I don’t like eating meat and I don’t like taking iron tablets. I’ve googled it and I want a injection of iron. Please leave a script at the desk for me.

It may be true that the patient should not travel to the clinic if possible to reduce any risk of infection. On the other hand it may also be true that the convenience of having an appointment when it suits has made it all too tempting to present problems that need an in person visit. It is often impossible to diagnose the problem based on an exchange over a crackly telephone line with patient who may not be able to hear or speak the language fluently. The patient may believe that a doctor who they know has been paid for the service will satisfy them with a script, certificate or referral in the way that any other telephone service operates. However the model for Uber Eats or Amazon does not fit healthcare where the need for information exceeds just the name, address and date of birth.

Covid will change everything including the way we consult doctors however not all changes will be for the better and telehealth consults that nurture unrealistic expectations will do more harm than good. It is rarely possible to meet the needs of all patients who might possibly have a telephone call with a doctor. In a trial of telephone consults more than 60% of patients needed to be seen face to face. If then those patient are advised that they must be seen in person, notwithstanding Covid the reality that the doctor is unable to meet their expectations may become a source of dissatisfaction and stress for all concerned. The art of doctoring is primarily an in-person activity. Telephone consults are adding to the challenges in primary care at the most stressful time.

Photo by Julian Hochgesang on Unsplash