Leading GP slams e-consultations

Government plans for doctors to email diagnoses have been bashed by a leading GP, who claims it could put patients’ health at risk and would fail to save money.

Emma Richards, academic GP registrar and honorary clinical research fellow at Imperial College London, claims government pilot schemes to develop so called e-consultations have resulted in “no clear evidence” to warrant their credibility.

Richards argues that e-consultation will result in doctors missing out on emotional and clinical clues and could lead to the isolation of elderly or poor patients who may have limited access to online resources.

Dr Richards wrote in an article for thebmj.com that ”consultations using telephone or email share many characteristics, but telephone consultations offer emotional cues, such as tone of voice, as well as clinical clues, such as a wheeze.

”Telephone facilitates two-way discussion in real time, to gather information, ask and answer questions, and check understanding. None of this can be done with a single email.

”Those in the greatest need of healthcare, such as elderly or infirm patients, may struggle to engage with email because of a lack of facilities or knowhow. Similar barriers exist for ethnic minorities and poor people, potentially creating a ‘digital divide’ of widening health inequalities.”

Dr Richards concluded: ”Given the complexities of using email and understandable caution among GPs, it seems premature to be insisting that patients can have email communication with GPs. The Department of Health should first issue clear guidance on what can safely and appropriately be communicated by email and what resources are needed.”

But arguing in favour of the move, Elinor Gunning, a locum family doctor in London and a clinical teaching fellow at University College London Medical School, said ‘‘Email services might facilitate access for those patients less able to use traditional methods of communication , such as housebound patients, those with hearing difficulties or younger patients who may be more likely to engage with this modern approach.”


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