‘Video vis­its’ to GPs could help pa­tients in ar­eas with poor med­i­cal ser­vices. But some doc­tors are scep­ti­cal

The Irish Times - Weekend Review - - NEWS REVIEW - Elaine Keogh

‘The doc­tor will see you now” is tak­ing on a 21st-cen­tury mean­ing with a move to on­line and video con­sul­ta­tions – a phe­nom­e­non well es­tab­lished in the United States, and now mak­ing its pres­ence felt in Ireland too.

This month a post of­fice in a shop in Co Kil­dare be­came the first lo­ca­tion for VideoDoc, a ser­vice that of­fers an on­line con­sul­ta­tion with a gen­eral prac­ti­tioner for ¤28.

Seán Fog­a­rty, owner of Fog­a­rty’s Quick­pick and Post Of­fice in Bal­ly­more Eus­tace, says, “I built my own web­site 10 years ago, and times and tech­nol­ogy have pro­gressed since then. I have al­ways used tech­nol­ogy when I can, and I be­lieve that with it we can bet­ter our qual­ity of life.”

There is no full-time GP in the vil­lage, he says, so VideoDoc is fill­ing a gap. Cus­tomers are al­ready us­ing the sound­proof, dou­ble-glazed booth.

Fog­a­rty says he hopes it will be good for busi­ness, but he has “gone past the stage where it is all about money”. “I don’t be­lieve pro­vid­ing a ser­vice is all to do with money in a lo­cal­ity like mine, but it will help main­tain and keep ser­vices in Bal­ly­more Eus­tace.”

But the is­sue of on­line con­sul­ta­tion is be­ing dis­cussed be­yond Bal­ly­more Eus­tace. Your Pa­tient Is On­line is the ti­tle of a dis­cus­sion this week­end at the an­nual con­fer­ence of the Ir­ish Col­lege of Gen­eral Prac­ti­tion­ers, in Wex­ford town.

Dr Conor O’Shea, na­tional co-or­di­na­tor of the col­lege’s in­for­ma­tion- tech­nol­ogy group, ac­cepts that this tech­nol­ogy is now part of the med­i­cal land­scape.

“The ques­tion is, what is the best use of it? For me a video con­sul­ta­tion should be linked to a phys­i­cal ser­vice and is a slightly techie form of a tele­phone call to a pa­tient.

“Part of the at­trac­tion of video is not the face-to-face part, be­cause there are places in Ireland where, with our broad­band qual­ity, you might get fuzzy pic­tures. The at­trac­tion is the im­me­di­acy of it.

“If you are at home at 8pm and not feel­ing great you might think, I’ll phone the doc­tor on the app. It has that im­me­di­acy of a doc­tor be­ing avail­able.”

O’Shea ac­knowl­edges that there are ad­van­tages to see­ing a pa­tient, even via a video link. “If you have a child with di­ar­rhoea or up­set tummy, and I can see him bounc­ing around in the back­ground, and I have taken a good his­tory, etc, I can say to you, ‘Keep giv­ing him flu­ids, and Calpol if needed.’ But if you say your child has a sore ear, I can­not see in­side his ear. We still need to ex­am­ine pa­tients.

“If you have a video con­sult and are told we will send a pre­scrip­tion for an an­tibi­otic to your phar­macy, well, I might ad­vise dif­fer­ently about that. In an ideal world, with a child with a sore ear, I would rather see you in the surgery.”

Where it fits into the day of a busy GP is another point. “In any work­ing day I would love to have 10 min­utes to do a video con­sul­ta­tion, but I am full up, and it prob­a­bly would be what I would say on the tele­phone: if the pa­tient needs to come in then you have wasted 10 min­utes” on video.

“Will it re­place a trip to the doc­tor? I don’t think so. It will form part of the land­scape, but it will be up to doc­tors and pa­tients to see how it works best.”

A sup­port, not a re­place­ment

Dr Robert Kelly, a con­sul­tant car­di­ol­o­gist at the Bea­con Hospi­tal in Sandy­ford, Dublin, is med­i­cal direc­tor of VideoDoc. He says the VideoDoc ser­vice is to sup­port con­sul­ta­tions, not to re­place them. “It is not in­stead of see­ing your doc­tor.”

Will it re­place a trip to the doc­tor? I don’t think so. It will form part of the land­scape, but it will be up to doc­tors and pa­tients to see how it works best

It is a ser­vice whereby you can see a doc­tor us­ing your phone or iPad and is also used by some of the “sev­eral thou­sand peo­ple in Ireland who do not have their own GP be­cause it is dif­fi­cult to get a GP”.

“GPs can use it for what they feel com­fort­able with. It is not for ur­gent care, but it can be used as a fol­low- up or do­ing a house call via video.”

“As a doc­tor you have to make the de­ci­sion as to what you are com­fort­able us­ing it for. If you want to ex­am­ine a pa­tient, it is not for that. Clearly it is not the way to de­liver a dif­fi­cult di­ag­no­sis.”

He says there are many ben­e­fits to ac­tu­ally see­ing a per­son. “The in­for­ma­tion you can elicit from look­ing at peo­ple, as op­posed to just talk­ing on the phone, is sig­nif­i­cant.”

Kelly also ac­cepts that for video con­sul­ta­tions to be­come more rou­tinely used will need the Health Ser­vice Ex­ec­u­tive to buy into the con­cept, although there are con­sul­tants in hos­pi­tals around the coun­try who want to use it in their pri­vate prac­tices.

A state­ment from the HSE sug­gests am­biva­lence about the tech­nol­ogy. “An on­line con­sul­ta­tion must meet the same stan­dards as a face-to-face con­sul­ta­tion. A pa­tient pay­ing for such a ser­vice can de­ter­mine their own in­ter­est and ac­cep­tance of such a ser­vice.

“Other ju­ris­dic­tions that have of­fered this ser­vice have done so very ef­fec­tively and with re­ac­tion.”

Then there are what might be termed con­sumer con­cerns. Dr Mark Mur­phy, chair of com­mu­ni­ca­tions for the Ir­ish Col­lege of Gen­eral Prac­ti­tion­ers, is con­cerned about pa­tients pay­ing twice for a con­sul­ta­tion or min­imis­ing the im­por­tance of see­ing a doc­tor in per­son. sig­nif­i­cant pos­i­tive pa­tient

“We do not want to see what I would term the cor­po­rati­sa­tion of pri­vate prac­tice,” he says. “There are pa­tients who are vul­ner­a­ble or have vul­ner­a­bil­i­ties, and it would be wrong for money to be made off the back of them.

“The in­ter­net and smart­phones have changed how we do a lot of every­day things, but we must never lose sight of the im­por­tance of our in­ter­ac­tion with pa­tients and the cen­tral role of the con­sul­ta­tion.

“The tech­nol­ogy is upon us, and there are a va­ri­ety of health providers who mar­ket the video-con­sul­ta­tion plat­form quite heav­ily. It is heav­ily used in North Amer­ica.

“As a gen­eral rule, where ICT en­hances the com­mu­ni­ca­tion be­tween health­care pro­fes­sion­als we sup­port it, and where it en­hances the com­mu­ni­ca­tion be­tween the pa­tient and the GP we sup­port it, but we do have con­cerns.

“The pri­mary is­sue of con­cern for the Ir­ish Col­lege of Gen­eral Prac­ti­tion­ers is around qual­ity and safety. For in­stance, is some­one more likely to be pre­scribed an an­tibi­otic as a re­sult of a video con­sul­ta­tion?

“Nor­mally we ad­dress de­vel­op­ments in an ev­i­dence-based way. This is a com­par­a­tively mod­ern tech­nol­ogy, and we would not like to see it re­plac­ing the com­pre­hen­sive, con­tin­u­ous care pro­vided by your GP.

“The face- to- face con­sul­ta­tion is at the heart of gen­eral prac­tice and should re­main so, what­ever tech­nol­ogy brings.”

The prince lives out his days with his bedrid­den wife in Da­m­as­cus, where the sounds of con­flict rum­ble


Cor­po­rati­sa­tion of pri­vate prac­tice

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