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Rise in remote consultation use during Covid ‘increases risk of patient complaints’

21 October 2020

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The rise of remote consultations in general practice during the Covid-19 pandemic has increased the risk of adverse outcomes and complaints from patients, a medical risk expert has said.

Speaking at the Management in Practice virtual festival today (21 October), Diane Baylis, the Medical Protection Society’s (MPS) clinical risk educator, said the wide scale adoption of remote consultations has come with ‘an increased risk of misunderstanding, unmet expectations and dissatisfaction in the care offered or provided’.

The MPS advice line has been receiving calls from its members about a range of issues during the pandemic, Ms Baylis added, including potential misdiagnosis.

She said: ‘Some patients with issues deemed non-urgent may have had their appointments delayed, which could have an impact on relevant investigations and receiving a diagnosis and starting treatments.

‘For example, a skin lesion that looked innocent over a video consultation [in one case], wasn’t referred as a two-week-wait. However, when reviewed face-to-face, a number of months later at the hospital, there were signs of a malignant melanoma.’

Ms Baylis added that doctors have also expressed concerns about receiving intimate images taken remotely and the need to ensure consent is appropriate, while patients have made complaints about video examinations of a similar nature.

‘Communication is more difficult when you consult remotely, and the patient is not in the room with you, so it is therefore easier to be misunderstood, which can result in a complaint. So in certain circumstances, it would be prudent, before the appointment, to alert the patient of the possibility of having a chaperone, who could be present virtually,’ she said.

‘It is something that might not spring to mind so readily when consulting remotely, but in the current climate, the patient point of view is key.’

Disruption caused by Covid-19

Ms Baylis went on to say that the impact Covid-19 has had on clinical care during the pandemic is also anticipated to be a potential cause of adverse events and complaints.

She said that doctors have been sending queries to the MPS about reduced outpatient capacity, referrals being rejected, and delays in patients accessing treatment or being referred between primary and secondary care for physical examinations, following a remote consultation.

‘In secondary care, there have been issues with patients refusing to attend hospital for a review or follow-up appointment, and members have been concerned about what action and advice they should give patients in these situations,’ she said.  

She added that patients in primary care have been demanding home visits, when perhaps they clinically do not need one, but are worried about coming into the surgery for a face-to-face examination – although this was more of an issue at the start of the pandemic.

Ms Baylis has also heard reports of ‘lots of concerns’ around PPE, especially with some patients refusing to wear masks for healthcare appointments.

Others have pointed to the impact that masks have on communication between a clinician and a hearing impaired patient, or those who do not speak English as a first language, and therefore rely on more visual information, she added.

‘Members being made aware of the adjustments they might need to make to ensure that communication is as clear as possible, without jeopardising anyone’s safety,’ she said

Ms Baylis advised practice managers to really ‘take stock and embed lessons learned from the Covid peak’ and to try and ‘preempt some of the issues already encountered’.

The Management in Practice virtual festival runs until 18 November, with live sessions running all this week.