The thing about being a health professional is that you are held to the standards of care even in emergencies or times of challenge due to COVID. Whether you an employee or own your own practice the buck stops with you when making decisions about the delivery of your service.
Covid lockdowns and exposure events have led to the need to incorporate virtual consultations into medical practice. So, is this good practice and how do you keep yourself safe?
The Medical Council guidelines on telehealth [i] provide guidance. The applicable standard is that the treatment you provide to a patient in another location should be equivalent to the care provided in a face to face consultation within the limits of a distance consultation. You should:
ensure you have the patient’s informed consent for a distance consultation
consider the challenges of conducting a physical examination
ensure knowledge of the patient’s history and confirm identity
ensure confidentiality
ensure the technology will work.
If there is compromise to care, then you need to inform the patient of this and try to address this for example by arranging an in person consultation. The Code of Health and Disability Services Consumer’s Rights, specifically provides that health care providers are not in breach of the code if they can prove they took reasonable actions to provide reasonable care. Studies have found that men prefer face to face consultations as do people with a university degree.
Consultations not suitable for or that ideally should be rescheduled for in person consultations are those where:
an examination is required or tests necessary
technology problems make communication sub optimal
strong accents, speed of speaking, softness of speaking or other issues make the information exchange unreliable
the doctor and patient do not have an existing relationship particularly where the issues are complex
where the patient cannot communicate in confidence from their location and this is adversely impacting on the information they provide
where the patient is anxious
where the patient is uncomfortable with or objects to a distance consultation.
first consultations where patients seek a class A of B controlled drug.
Consultations which work well for distance consultations:
follow up where verbal representations are sufficient.
where you know the patient well and they are able to give a good account of their issues
where the patient is well aware of their medical issues and able to self-monitor, such as diabetic patients
repeat prescriptions
persons with limited mobility appreciate this service
people who do not like wearing or speaking with health care providers wearing a mask
[i] https://www.mcnz.org.nz/assets/standards/c1a69ec6b5/Statement-on-telehealth.pdf (mcnz.org.nz)
Article written by Dr Peter Robinson