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IS it possible that the video consultation may replace the in-person consultation as the default consultation in Australian general practice?
There are no data on the proportion of GP consultations in Australia that are appropriate for video. The final Bettering the Evaluation and Care of Health (BEACH) data (2015–2016) are consistent with video being appropriate for more than 50% of GP consultations. The Registrars’ Clinical Encounters in Training (ReCEnT) project does not capture appropriateness for video consultation or requirement for in-person consultation.
Professor Martin Marshall, Chair of the Royal College of General Practitioners, has stated that “around half of GP consultations are likely to be delivered remotely on a permanent basis following the pandemic”. In the United Kingdom in July 2020, 77% of GP consultations were done by phone; 4% were done by video; 11% were in-person, 6% were done by SMS or email, and 3% were home visits and care home visits.
Video consultations potentially provide benefits for patients, GPs, general practice, population health, and communities, although the evidence is yet to accumulate.
Benefits for patients
Choice, preference, opportunity and convenience are enabled. Patients can save time, money and stress by not needing to travel, take time off work, or attend a clinic.
There is no risk of the transmission of infection related to travel or clinic attendance.
Patients may be more at ease, and rapport may be enhanced, when they attend a consultation from the comfort of their own home.
The consultation can be captioned for hearing-impaired people and for transcription. The consultation can be recorded if this is deemed appropriate (here).
GPs must use a video platform that is private and secure, such as Healthdirect Video Call (HVC).
Benefits for GPs
GPs can choose to work from a private room at their clinic or in their home. Benefits may include convenience, avoiding travel, and the ability to work outside normal hours.
There is no risk of transmission of infection associated with travel or with working at a clinic.
Virtual home visits and virtual residential aged care facility visits are cost-effective and potentially efficient for time and medical care.
Benefits for general practice
There is improved access and equity for some disadvantaged groups, such as single parents, the unemployed, people with mental illness, people experiencing domestic violence, and people who have difficulties with mobility or transport.
Waiting rooms will be less crowded, reducing the risks of infection and stress.
Video consultations have the potential to improve outcomes across acute care, chronic disease management, prevention, and population health, although so far the evidence is lacking. Patients may be more likely to make, accept and keep appointments due to accessibility and convenience. Patients may engage more actively in their care as their share of the consultation is greater by video than in-person.
The Voluntary Patient Enrolment (VPE) initiative is predicated on management by telehealth. The VPE model will be modified as part of the “10-year Primary Care Plan” (here, here and here).
Benefits for the community
Video consultations may help to reduce general practice’s environmental footprint due to reduced travel (139 million GP consultations in Australia in 2019).
There will be less use of personal protective equipment and, therefore, less waste.
Video may improve the provision of after-hours services to the community. More GPs may participate in after-hours services as consultations are efficient for workflow and clinical care, convenient (from home or clinic) and safe (no personal risk from a home visit).
Evidence
There is evidence for safety, outcomes, and patient and clinician satisfaction for video consultations (here, here, here, here and here). However, there are no data on video consultations in Australian general practice.
Indications
Consultation dialogue is similar, whether by video or in-person. Modified examination is possible by video.
Contraindications
These include emergencies, the requirement for an in-person examination or procedure, patient refusal, technical problems, and GP preference.
General practices must have systems to prevent patients from booking video appointments for contraindications. GPs must arrange an in-person attendance at the clinic or at the emergency department for the patient who attends a video consultation with a contraindication.
Patient safety is the principal factor in determining if a video consultation is appropriate.
The direct “hands-on” in-person physical examination
Do GPs overestimate the proportion of consultations that require an in-person physical examination? Do GPs overvalue the physical examination? Do GPs perform unnecessary in-person physical examinations? There are no relevant data to answer these questions. What would be the implications for the role of in-person physical examination if the answers were “yes”?
The primary objective of the direct physical examination is to obtain information for diagnosis, and its value for this has been described by many authors (Verghese and Horowitz [2009], Elder et al [2013], Elder et al [2017]).
However, “evidence-based studies show that many physical signs are useless” (Verghese and Horowitz [2009]). The sensitivity, specificity, and likelihood ratios of physical examination, signs and manoeuvres (PESMs) are difficult to determine due to poor reliability (variability in clinician technique and interpretation), bias, and different clinical contexts.
Secondary objectives of the direct physical examination include enhancing the therapeutic relationship through patient-centred interaction and physical connection (touch), demonstrating the clinician’s professional identity, increasing the clinician’s perceptual awareness, and enabling time for reflection and clinical reasoning.
Several authors have described these phenomenological attributes of the direct physical examination (Zaman [2018], Das [2020], Hyman [2020], Kelly et al [2015], Verghese [2016], Costanzo and Verghese [2018]).
The indirect “hands-off” physical examination by video
There are no published studies on the use of physical examination in video consultations in general practice. It is not yet known if examination by video meets the primary objective for physical examination. Is it reasonable to assume that the same PESMs in-person and by video will have the same diagnostic value (and limitations)?
Except for physical connection, the phenomenological attributes also apply to the indirect physical examination. Physical connection is a complex concept. It may be therapeutic. But, the GP touches, and the patient is touched; this may confer authority and control on the GP. Touch may be perceived by the patient as invasive (Lida and Nishigori).
There is the risk of transmission of infection between the patient and the GP during direct physical examination.
I have previously described the four dimensions of the physical examination via video:
- The first impression: GPs use clinical acumen to recognise the seriously ill patient.
- Observation by active and purposeful “inspection”.
- Patient-assisted observation: the GP can demonstrate to the patient how to self-examine (eg, pulse, palpation for tenderness); movement can be assessed. An unknown proportion of patients may have equipment that can provide clinical data to assist the physical examination; for example, a camera, wearables, a thermometer, a blood pressure machine, an oximeter, or a blood glucose monitor, assuming the patient has this equipment.
- The mental state examination.
Some components of the physical examination are not possible by video. These include examination of the eye and the ear, palpation by GP, testing sensation and reflexes, and auscultation.
Virtual chaperones are not a substitute for in-person chaperones; for risk mitigation and patient safety, GPs should avoid examinations of the breast and genitalia via video.
If examination is necessary, and not possible by video, then an in-person consultation must replace or complete the video consultation.
Physical examination: direct (in-person) versus indirect (video)
Clause 3.1.1. of the Medical Board of Australia’s Good medical practice: a code of conduct for doctors in Australia states that “good patient care includes … an appropriate physical examination”. In-person examination is not stipulated.
In conclusion, the indirect (video) physical examination can be a substitute for most components of the direct (in-person) physical examination. Direct and indirect physical examinations have limitations.
The place of the phone consultation
Phone consultations will continue to have a role in general practice for low-acuity focused encounters; for example, follow-up, results, repeat prescriptions, and triage.
In general, a phone consultation is not a substitute for an in-person or video consultation.
Improving the uptake of video consultations
Australian GPs have not yet embraced the video consultation. In the period 1 April 2020 to 31 October 2020, for GP consultations at levels B, C and D, 68.6% were in-person, 30.6% were by phone, and 0.8% were by video according to data on requested Medicare items (here).
GPs can get information, resources, and advice on telehealth from the following guidelines:
- Royal Australian College of General Practitioners (RACGP) (here and here).
- Australian College of Rural and Remote Medicine (ACRRM).
- Video consultations: a guide for practice.
- Video consultations in primary and specialist care during the COVID-19 pandemic and beyond.
Education and training for GPs, GP registrars, and medical students needs to be provided and promoted to embed video consultations in medical practice and medical culture. Courses are available here and here (both RACGP-accredited), and here. ACRRM provides education modules.
Anecdotally, patients’ attitudes and their phones are barriers to video in general practice. Video is “difficult”, phone is “easy”. Patients may not perceive the significant disadvantages of phone versus video for consultations: no visual interaction, no visual cues, no non-verbal language, no examination, and restricted rapport.
GPs and their practices can promote video consultations to patients by developing a “pro-video culture” and presenting a positive and enthusiastic attitude about using video for consultations.
There are roles for the federal government, the Australian Medical Association, and the GP colleges in promoting video consultations and providing education about video consultations for GPs and for patients.
HVC, which has been installed in 25% of general practices in Australia (personal communication, Jo Hughes, Video Call Service Manager, Healthdirect Australia), enables video consultations that are easy and intuitive for GPs and patients. HVC fits in with general practice workflows. It enables files and images to be shared securely in the video call. It enables relatives, carers, and interpreters to join the video call remotely.
Anecdotally, GPs and patients complain about poor internet connections. Some patients have no internet. HVC only requires a 320 Kbps internet connection.
There must be ongoing funding via Medicare for video item numbers and HVC, and ongoing support from Primary Health Networks to assist general practices with their video systems. The Australian Government has committed to telehealth as a permanent feature of Medicare for general practice.
All Australians should be able to access a GP by video. Governments could provide computer devices and internet access for people who need them, in the same way that the Victorian government provided them for families in the learning from home in a school setting program.
Eligibility for a Medicare benefit for a GP video consultation requires the patient to have had at least one in-person consultation in the previous 12 months with the GP, or at the GP’s clinic. There are exemptions; however, the 12-month condition denies access to Medicare benefits for many vulnerable and disadvantaged people (here and here). Medicare benefits for video consultations could be restricted to GPs who provide services at clinics that provide in-person consultations.
There is a need for research in this area. This will inform discussions for GPs and patients.
In my opinion, general practice should adopt a “whole of telehealth” solution, that includes video, phone, webchat, email, store and forward, and remote monitoring.
Attitudes and perceptions will also change positively as GPs and patients become more familiar with video consultations. This is the “diffusion of innovation”.
Dr Andrew Baird is a GP at the Elwood Family Clinic in Victoria. He is a tutor in professional practice for medical students at the University of Melbourne.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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Here are the latest Medicare data.
These data are for Australia, for November 2020 and December 2020, for GP consultations at level B, level C, and level D. The data include the item numbers for in-person consultations after-hours.
Percentage of consultations at levels B, C, and D, by attendance type:
IN-PERSON: 76.7%
PHONE: 23.0%
VIDEO: 0.4%
TELEHEALTH (VIDEO or PHONE): 23.3%
%age of TELEHEALTH by PHONE: 98.5%
%age of TELEHEALTH by VIDEO: 1.5%
My definition of telehealth includes video and phone. Medicare’s definition of telehealth is ‘video only’. Medicare describes phone attendances as ‘phone services’.
… We have got a long way to go until video becomes the default consultation in general practice in Australia.
Re: Dr Ratnakar Bhattacharyya, February 3, 2021 at 1:06 pm
I agree with your comments about phone consultations. Phone consultation between GP and patient is appropriate for low-acuity well defined encounters (eg repeat prescriptions with no clinical review required; certificates; discussion about results that are not clinically significant). Phone consultation between health professionals (eg between Resident and Consultant, between Rural Doctor and tertiary care ED physician or retrieval service, etc) is vital for appropriate patient management, advice and transfer of care where appropriate.
Video consultation is a different paradigm to a phone consultation. Video provides ‘the visual interaction’ enabling rapport, and indirect examination.
There will always be a place for in-person consultations in general practice for the contraindications to video consultations as described in the article (emergencies, direct examination required, procedure required, poor AV quality, no consent).
The video consultation will not replace the in-person consultation in general practice altogether. However, the video consultation can – and will, I believe – replace the in-person consultation as the default consultation in general practice.
The comparisons with UK general practice are reasonable and appropriate. Patient registration is not an issue. The issue with minors is the same as the issue with minors who present for an in-person consultation. Is the minor a ‘mature minor’, in which case the patient has all the privileges of capacity for consent and privacy. There is no problem with non-mature minors if the parent/guardian is present at the patient ‘end’. I agree both GP and patient need appropriate equipment and a reasonable internet connection. GPs – irrespective of age – must be proficient in IT skills. It is not acceptable to say ‘I don’t understand IT’, or ‘I don’t like IT’. GPs must learn. IT is a part of the way that we communicate not just in medicine, but in many areas of our lives (social, shopping, banking, etc). It is expected by the profession, and by patients. It is reasonable to see new patients via video.
Your description of the patient with the head injury is a good example of telemedicine. There was no direct telehealth contact between the remote doctor and the patient (difficult to do a consultation with patient who is GCS 3). The contact was between the doctor ‘on site’ and the remote doctor. The story demonstrates the importance of communication and teamwork in achieving optimal outcomes, and telemedicine can be a part of that communication and teamwork.
To increase the profile and acceptance of video consultations in general practice:
1. Introduce training in video consultations for medical students, GP Registrars, and GPs
2.Include video consultations in ACRRM and RACGP exams
This will also increase confidence and skills in video consultations.
In reply to: Dr Ratnakar Bhattacharyya, February 3, 2021 at 1:06 pm
I agree. Telehealth is not new. It has been in use in general practice since the introduction of the telephone into general practice. I know that Alexander Graham Bell invented the telephone in 1876 but I do not know when it made its debut in general practice. In the early 1900s? Any medical historians here?
Here’s an interesting story about telehealth – by .telegraph.
In 1917, in the Kimberley, stockman Jimmy Darcy sustained massive internal injuries when his horse fell on him. He was taken to Halls Creek, where Fred Tuckett, the Postmaster, operated to repair Darcy’s ruptured bladder, using a penknife, morphine, and instructions provided in Morse Code by telegraph from Dr Joe Holland in Perth, 3000Km from Halls Creek. The surgery was successful.
Unfortunately, Darcy developed complications and malaria. Holland decided that a telehealth consultation wasn’t appropriate now. So, he did a home visit, via ship, Model T Ford and horse.
It took two weeks to get to Halls Creek.
Unfortunately, Holland arrived just hours before Darcy died.
Fortunately, we can expect better outcomes from telehealth now. This incident was the impetus for the development of an outback aeromedical service that became RFDS.
An example of a health crisis driving innovation in health services (the COVID-19 pandemic is driving innovation – like telehealth – in health services).
Thanks, George.
Professor Trish Greenhalgh and her team at Oxford University have done some studies on video consultations in general practice. Of course this is UK data, and may not apply to Australia and New Zealand. If you scholar.google.com for ‘trish greenhalgh video consultation primary care general practice’ you will get some of the papers.
The Centre for Online Health, UQ, has published several papers on video consultations, but not in general practice, most are hospital based, specialist clinics, rural outreach, and First Nations’ populations. Go to: https://coh.centre.uq.edu.au/research or scholar for ”video consultation’ and Anthony Smith and/or Liam Caffery.
I understand that Australian psychiatrists have researched the use of video (telepsychiatry) but I cannot find any published reports, apart from some reports about telepsychiatry during the COVID-19 era.
Remote consultation by phone has been in practice since phone service/pager bacame readily available all over Australia especially in remote areas where retreival service can be harnessed by phone consultation. As regards telehealth with or without video it simply cannot and will not replace face to face consultation as far as I am concerned. Furthermore you cannot compare what happens in UK to what happens in Australia where a patient can see any doctor or doctors anywhere without registering into the practice. Much depend on ready avialbility of IT at both ends where doctor and patient can communicate freely and if patient is minor or incapable verbalise then there should be legal guardian or authorised carer of the patient at the other end. Ideally such patient should be on the data base of the computer already and patient or carer should be able write down the reason for consultation. Under such circumstances a video consultation will be more meaningful. Adequate IT support must be in place as unlike younger genration older doctors including myself may not be IT proficient.
As an example many years ago in a remote hospital my senior resident rang me at 1AM ” there is bad head injury in high in high dependency unit…” I advised to call retrieval team from nearest teaching hospital.. within a few min. I arrived at the unit to find a man in his 20s with stertorous breathing , baggy swelling in right parietal area , fixed dilated right pupil and contrlateral paralysis .. we immediately opetaed on him and relased a massve extradural haematoma from ruptured middle menigeal artery from fractured skull. Retireval team from Royal Adelaide Hospital(RAH) arrived by this time and took the patient , patient being brought to Broken Hill Base Hospital by RFDS with CMO personally assisting in the operation. This patient recoverd fully without any neurological deficit . This all happens by huge teamwork and prompt attention to the patient in person in respose to a timely phone call. I am sure such cases are happening in many other places as well. Improved accesss to IT sholud make thing better but if misused or oversused outcome will be worse .
Andrew, you are right that there is a dearth of research on video consultations. There is virtually none on multi modality care yet it provides a great opportunity to digitally enable care.
The challenge is for the profession to take ownership of this agenda and not leave it to commercial or technology groups to hijack it. We have a responsibility to lead the practice of medicine to ensure good outcomes for patients AND good experiences for providers.
Video consultations may have the potential to replace the in-person consultation as the default consultation in Australian general practice.
This may apply if the sum of emergency, direct physical examination, and procedural consultations is less than 50% of total consultations in Australian general practice.
This may not apply in some GP situations (eg procedural general practice, and mass vaccination programs (COVID-19))
In general practice, it is possible that the number of consultations that need a direct physical examination is overestimated, and that the direct physical examination per se is overvalued.
Video consultations in Australian general practice have not yet been evaluated. Research is needed on use, attitudes, and outcomes. Research must involve GPs, patients, epidemiologists, and health economists.
Thank you very much, Sue.
Your comments about assessing and managing sick kids and RACF residents in their respective home environments also apply to general practice. If assessment and management in the home setting via video are appropriate, then in the case of a sick child, one avoids the need for parents to travel to a GP Clinic with a sick child (possibly after hours), and in the case of a resident in a RACF, one avoids transfer to an ED with all the decompensation and disorientation that would entail, not to mention the ED workload (where well-intentioned interns may ‘work up’ the resident with a comprehensive but unnecessary suite of pathology and imaging investigations). Clearly, if the GP determines that video is not appropriate for assessment and management, or that in-person assessment and management are required, or that transfer to ED or to another Specialist is indicated, then management must be implemented accordingly.
I commend Specialists for supporting GPs in using video consultations. Medicare data show that about 15% of non-in-person consultations by Specialists are by video (the rest are by phone). For comparison, only 2% of non-in-person consultations by GPs are by video (the rest are by phone). These data do not include consultations by email and text messaging and webchat, but it’s assumed that these make up only a very small proportion of non-in-person consultations.
Video consultations are virtually a new paradigm in Australian general practice since March 2020. It is going to take some time for GPs to determine the place of video consultations in general practice.
In Australia, Specialists have been familiar with using video for consultations since 2011, when Medicare introduced item numbers for regional and rural patients to see Specialists by video, with or without the GP in attendance at the patient ‘end’ of the video axis.
I think it is useful to consider what this ‘new paradigm’ can bring to general practice – as I have attempted to describe in the article. For example, improvements in patient access, and convenience, opportunities for more effective and appropriate care (eg care in the home setting – as described for RACF residents and kids in this comment), reduced risk of transmission of infection, and so on.
I think it is less useful to think of this ‘new paradigm’ in terms of what may be potentially lost in comparison to in-person consultations. The comparison is not always helpful, and the in-person consultation may not be the ‘gold standard’ consultation (heresy?).
George Margelis makes a good point – telemedicine is just one more option in a suite of options. While many of the comments focus on the potential harms of “missed” details of patient assessment, the discussion also needs to address the harms that can be avoided through the use if Telemedicine. The Emergency Telemedicine service that I work for can assesses the elderly in Aged Care facilities. We often avoid after-hours ED transfer, which can not only waste resources but can lead to a frail person with dementia becoming agitated and ending up with injuries from restraint, falls or sedation. Similarly, we can assess sick children at home in their own environment, rather than crying with fear and tiredness in the scary ED environment. If they need ED care, we can direct them there. If they don’t, and we can solve their problem in the Teleconsult, we avoid the time and stress of transfer – not to mention the load on ED.
Like every practice setting, clinical care must be done diligently and rationally, with the appropriate modality that matches the patient’s needs.
Reply to George Margelis.
Thank you very much for your comment. I agree++. As I wrote in the article, ‘general practice should adopt a “whole of telehealth” solution, that includes video, phone, webchat, email, store and forward, and remote monitoring.’ You have expanded this to include in-person consultations and other modes of patient-general practice interaction. I agree with you. This requires research and collaboration to develop models and systems that work for the benefit of patients and general practice.
There is a dearth of research on video consultations in Australian general practice.
The real hallenge is to deliver multi modality care which includes video, phone, email, messenger, in person, and access to multiple data streams to deliver the best possible care.
To do that we need to redesign the care model, thd business model and the reimbursement model. That requires co design between all associated parties and ongoing research to develop a new healthcare system.
I am a GP who works in emergency medicine.
I have also worked for Western Australia Telehealth. This service assesses people in remote locations where no doctor is available.
They have a video consultation system plus a nurse available to assess and examine the patient.
Despite these optimal circumstances I feel that this is a substandard option.
This is due to both the difficulty in assessing non verbal clues and the inability to look into adequately examine a patient.
I’d suggest that the GP video assessments are probably more restricted than the service which Telehealth provides and as such will provide worse outcomes
Hi Sue,
Thank you for your comments. I agree. It is interesting to get an Emergency Medicine Physician’s opinions and perspectives on the role of the video consultation.
History is paramount. Findings on physical examination must be interpreted in the context of the patient’s history. Physical examination is not a standalone assessment. I agree. Many clinical encounters can be managed appropriately by history and by limited examination, either by video or in-person. As you have commented, if limited examination will compromise clinical care, the consultation must be converted to an in-person attendance with the same GP, another GP, an ED Physician, or some other Specialist, whatever is appropriate for the clinical scenario.
I have a hunch – no evidence unfortunately – that with video consultations, GPs concentrate more when doing ‘inspection’ than they do when doing ‘inspection’ in an in-person consultation. In a video-consultation, there is no direct examination by palpation or by auscultation. To compensate for this, in a video consultation, GPs may focus even more attention on inspection than they would in an in-person consultation, in order to get as much clinical information from inspection as possible. Looking and observing – thoroughly.
Indirect palpation is possible – by the patient, or, if the patient is a child, by the patient’s parent. In time, devices for remote auscultation will be available.
I agree with your comments about patient-assisted examination. In addition to the clinical tests you have described, I have found the ‘heel drop’ test (Markle sign) to be useful for assessing possible peritonism in patients whom I see by video. Again, no evidence base to support (or refute) its use for this purpose. I ask patients to call out the pulsations when checking their pulse, rather than asking them to count the pulse. I do the counting. And, one day, who knows, I may pick up a patient with previously undiagnosed AF this way.
In response to Dr C., February 1, 2021 at 10:46 am
Thank you for your comments. I am sorry to read that you have had poor experiences attributed to ‘Telemed’.
With 0.8% of GP consultations by video during the COVID era, video consultations in general practice are neither a fad nor common. Not yet, anyway.
There are no published data showing a surge in Emergency Department attendances due to patients presenting who had had a video consultation with a GP.
There are no published data showing a surge in Emergency Department attendances due to patients presenting who had been misdiagnosed and/or mismanaged by a GP who had failed to examine the patient at a video consultation.
As described in the article, the need for a direct (in-person) physical examination is a contraindication to a video consultation. At the start of a video consultation, or during a video consultation, a GP (or non-GP) may determine that a direct physical examination is necessary, In this case, they must arrange a follow-on or follow-up in-person attendance (with a GP, or at the ED, as clinically appropriate) to continue and to complete the consultation,
This article is about video consultations. It is not about phone consultations. As described in the article, phone consultations have a role in general practice for low acuity, well-defined patient encounters. With audio-only communication, rapport is limited, and physical examination is very limited (eg does the patient sound drowsy, confused, breathless, hoarse, physically distressed with pain, emotionally distressed, or depressed? Is the patient coughing? … and that’s about it)
GPs and non-GPs are perfectly capable of failing to examine their patients when they see patients for in-person consultations. Failure to examine is probably not an exclusive domain of the video consultation.
So I have a different point of view. I believe that incorporating video consultations into general practice will improve quality of care and outcomes for patients, and will also improve GPs’ work experience and satisfaction.
In my long experience in ED, more diagnostic error occurs due to not taking a thorough history than not doing an examination, though both are important. Being rushed, not listening or being excessively risk-averse can lead to poor decision-making in all sorts of settings. Telemedicine is appropriate for many encounters, but not for all. Far from disappearing, telemedicine brings access to specialist skills to those who currently lack access. If a problem can be solved using remote consultation with appropriate review and follow-up, so much the better. If the issue cannot be adequately or safely solved, the service should default to face-to-face or referral.
It would be interesting to see the data for “Hospital Emergency departments are out of control with huge numbers of walk in patients ever since this Telemed fad became common” – can “Dr C” reference it? Of course, its analysis would need to include a wide range of influencing factors caused by the pandemic itself, not just telemedicine.
Thanks for a useful article. While video consultations do not allow for hands-on physical examination (however valid its different components might be), they do allow one to conduct the most important component of the examination – the patient’s overall wellbeing. Seeing the patient’s level of alertness, respiratory effort, colour, speech pattern, posture etc tell us so much about their physiological state. Then we can add patient-assisted examination – get the person to walk, move different joints, jump on the spot, count their pulse, measure their BP if they have access to a machine. Parents of children can also assist – many are able to look into the child’s pharynx, or palpate their abdomen. When the video interaction reaches the limits of what can be gleaned, but further information is needed, face-to-face interaction or referral can proceed.
Utter nonsense.
I have seen so many people come to hospital with problems that have been misdiagnosed or not able to be properly managed because a GP has not examined the patient. Hospital Emergency departments are out of control with huge numbers of walk in patients ever since this Telemed fad became common. The sooner it disappears the better, except in certain situations such as rural or remote areas and patients who genuinely cannot get to a doctor.