Should patients avoid video consultations like the plague?

“Personally I would not use such a service. I’d sooner phone Psychics Live.” This was the response of HSE director general Tony O’Brien to a recent question on Twitter about whether a GP video consultation service was good practice.

Unsurprisingly, his answer sparked something of an online and media storm. Laya Healthcare, which has launched Gplive, a video consultation facility for its half a million customers, was not amused. It labelled the comparison “wholly inappropriate”.

The Irish Medical Organisation weighed in with the view that online GP consultations should not and cannot replace a face-to-face consultation with a doctor. It urged patients to  “proceed with caution”, warning that, in the absence of a physical exam by a GP, an online consultation could lead to an incorrect diagnosis or non-compliance with clinical guidelines.

Dr Padraig McGarry, chairman of the organisation’s GP committee, said: “ Online GP consultations cannot offer (a) holistic approach and will fall well short of a standard which should be offered and acceptable for our patients.”

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Responding to the IMO leader's points on RTÉ's Morning Ireland, Dublin GP and clinical director of webdoctor.ie Dr Sylvester Mooney, emphasised that services such as his were not attempting to replace general practice but rather sought to complement it. "It's not for emergencies," he said, acknowledging that a patient may be told they have to physically go to see their GP at the conclusion of the video consultation.

So should patients avoid video consultations like the plague, or do they have a role in modern healthcare? In fact, a form of video consultation has been in use globally for several decades. Remote communities in the Australian outback and in northern Canada have systems in place whereby their primary care doctor or nurse can request a specialist opinion from a consultant hundreds of miles away. But these tend to be three-way consultations in which the specialist can request the local health professional to examine or zoom the camera in on some part of the patient’s body. And of course the specialist has full access to the person’s medical files as part of the process.

Doctors are more relaxed about online and video consults involving their own patients. Continuity of care is not an issue in this scenario; the GP has full access to past medical history, family history and medication details and doses. All of which reduce the inherent risk to patient safety present in ad hoc clinical encounters.

In my view a key issue that needs to be clarified is what Dr Mc Garry refers to as “standard which should be offered and acceptable to our patients”. The key question that arises when considering standards is the absence of a facility to physically examine the patient at the other end of an electronic link. Do regulators need to define new standards of care they would expect from doctors who undertake remote consultations, in the knowledge that physical examination of the patient is not part of the interaction?

The current Medical Council guide to professional conduct and ethics states: “You must satisfy yourself that the services you provide through telemedicine are safe and suitable for patients. You should explain to patients that there are aspects of telemedicine that are different to traditional medical practice – for example, a consultation through telemedicine does not involve a physical examination and any additional risks that may arise as a result.”

My personal view is that there is a need for greater regulation of telemedicine. In the meantime, it's very much a case of caveat emptor. There is a significant difference in risk when seeking a repeat prescription for the contraceptive pill online compared to initiating a video consultation in the evening because you are concerned that your 18 month-old is off form, has a rash and a slight temperature.

Hands-on clinical evaluation is the only acceptable level of doctoring for a child presenting in this way. mhouston@irishtimes.com.   @muirishouston