Doctors can pick up things just watching patients come into the room

There are many patients who I could have easily made the wrong diagnosis on if I had to see them by video.

They include a woman who told me she had cut her finger in her bartender’s job and that there was still glass in it. I doubt if I could have seen it properly on video. It turned out to be a malignant melanoma on her finger, but an early diagnosis prevented it from spreading.

There was a family of three children with norovirus and it would have been easy to say, “Keep them hydrated and call me if they are not better soon” but on examining one child I saw that his stomach pain was in fact appendicitis and needed urgent hospital admission.

There was also a woman who had all the symptoms of indigestion but the way she kept touching her chest throughout the face-to-face consultation made me suspect a cardiac problem and I referred her to hospital which diagnosed it. Would I have seen this hand fidgeting on a video camera consultation?

I have also had patients who have mentioned, as they reached the door on their way out, bleeding which turned out to be bowel cancer. Would they have done this had I not gained their confidence in a face-to-face consultation?

Another woman was brought to the surgery by a worried sister who insisted that her breast lump was examined. Are patients likely to do this on video consultations or want to discuss this by video if not?

You also see so much as a patient walks into a consultation room – their demeanour, colour, their gait. This drive for online consultations is driven by the failure to recruit enough medical students 10 to 15 years ago, students who would now be experienced GPS.

What is particularly worrying is that by putting consultations online, GPS are being set on a fast track to litigation if they make the wrong diagnosis.

I have always said to junior GPS, see the patient and check your diagnosis, because the responsibility is yours, not the health board or NHS chiefs.