Mixed benefits from virtual outpatient appointments: a patient perspective Free

The COVID-19 pandemic has altered clinical service immeasurably, not least the provision of virtual outpatient appointments, which were originally seen to be a temporary measure to minimize contact and protect the vulnerable.¹ However, now virtual appointments are becoming part of routine practice.² It seems commonplace that doctors make decisions on patients whom they may never have met. Gone are the opportunities to examine those with infirmities, along with the occasion to learn from the non-verbal communication that presents itself in a face-to-face consultation.

As a retired physician, I had been struggling with longer-term respiratory complications of COVID-19.³ One clever cardiologist had suggested that my continuing breathing difficulties might be due to sleep apnoea, as I had right heart strain on my electrocardiogram. I was referred to the respiratory clinic at my local hospital and eventually, sleep studies were arranged, a prelude I thought to an actual physical consultation. However, to my surprise, I was contacted after the test (and without warning), by a junior doctor who did not introduce herself—my first discussion of any sort with a respiratory physician. The line was poor, as I was on a busy, moving bus, but the doctor seemed keen on continuing talking—as she said ‘it would only take a minute’. What I gleaned through the crackly reception (and set against the background hubbub of my fellow passengers) was that I was going to be given a continuous positive airways pressure (CPAP) machine. Not being in a place of privacy, I felt unable to ask why such major decisions were being taken without someone seeing me.

Shortly afterwards, my sleep study results arrived in the post, appended to a copy of a letter to my general practitioner (GP) from the respiratory trainee. It was typed up as if it had been a formal clinic appointment, set in stone, it appeared, for all time. I now knew the doctor’s name and the letter did convey beyond reasonable doubt that I would benefit from CPAP. It was at least some reassurance that medical professionals were genuinely taking sensible and reasoned decisions, but I felt that a formal consultation and the opportunity to ask questions in privacy would have been welcomed.

I imagine that my experience is not unique. While those in the United Kingdom National Health Service (NHS) hierarchy hail virtual appointments as being ‘greener’ (and I do not doubt, cheaper from an administrative point of view),⁴ I would urge those undertaking virtual clinics not to rush through box-ticking exercises with lists of phone numbers to dial as quickly and efficiently as possible, without due consideration for the circumstances of the patient at the other end of the line, who might be otherwise inconvenienced with the activities of daily living. Whereas traditional appointments need time in a patient’s life, virtual consultations seem to slip in at inconvenient moments for the unwary. It is a duty of care to ensure that each patient is in a place of privacy and security for any medical consultation, even if it ‘will only take a minute’.

Acknowledgements

I am grateful to Professors Marsha Morgan, Myra McClure and Guglielmo Trovato; to Drs Julia Selby, I. Jane Cox, Jay Watts, Nimzing Ladep and Obinna Oleribe; and to my brother and my still academically active father for constructive comments.

Funding: None.

Conflict of interest: None declared.

References