Telehealth no replacement for doctor-patient connection

Professor Gregory King believes telehealth undoubtedly has a place within the respiratory field but warns against virtual consults at scale.

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It is no secret the huge uptake of telehealth during the coronavirus pandemic has transformed the way doctors and patients connect. 

But for one respiratory physician, phone and video appointments cannot replace the opportunity to get an intimate insight into their patient and their illness that only face-to-face consultations offer.

Professor Gregory King, staff specialist at Sydney’s Royal North Shore Hospital and research leader at Woolcock Institute of Medical Research, believes telehealth undoubtedly has a place within the respiratory field but warns against virtual consults at scale.

Otherwise, it would run the risk of disintegration in the relationship with specialists and their patients, Professor King said.

He is not convinced adequate care can be achieved in telehealth consultations, when treating patients for a new problem or those with complex chronic diseases.

“There is a lot to be said about speaking face-to-face to a patient because you pick up a lot of queues from patient’s expression and body language which in respiratory medicine – and probably in every other speciality – can be extremely important,” Professor King said.

“There is a lot of subtly in symptomatology, which you really cannot pick up at all on a telephone and arguably difficult to pick up on video conference as well.

“I think the most efficient way to do things is to have lung function testing at the consultation with the doctor, and that obviously requires face-to-face contact.”

On the other hand, he supports offering telehealth if it is a routine follow-up to give a patient straight-forward results, or when the patient is someone he has been treating for a long time and has rapport with.

“In this situation, it is actually much more efficient because I have already dealt with the in-depth questions and complex issues face-to-face.

“It is good for a follow-up for a patient who has been stable over a long period of time.”

Providing phone and video consultations to patients in rural towns has helped to overcome the tyranny of distance, he said. 

Professor King chooses to offer his patients phone appointments, because it is more reliable than video, which has an added layer of difficulty when it fails to connect to the internet.

But the impact coronavirus has on how respiratory outpatient services are offered vastly differs across the country, he said.

“Outpatient services have been mostly face-to-face for quite a few months now at Royal North Shore Hospital.

“But at other hospitals, appointments are still geared toward telehealth whether that be phone or a video service.”

He warns new technologies need to be extremely simple to use and reliable, otherwise it creates a barrier, particularly for elderly patients.

Medicare-subsidised telehealth services will continue until the end of the year, with the Federal Government set to include a six-month extension in next week’s budget.

But what will happen beyond that, Professor King said would be difficult to predict.