Research Shows That Phone and Online GP Consultations Can Endanger Patients
The transition to remote healthcare began at the start of the pandemic as a precaution to prevent the transmission of COVID-19.
A study has cautioned that remote GP consultations, whether over the phone or via online calls, put patients at risk and may result in missed or inaccurate diagnoses.
Conducted by health scientists at the University of Oxford and other UK universities, the study was published in BMJ Quality and Safety. It analyzed 12 general practices across England, Scotland, and Wales, examining data from 95 UK safety incidents between 2020 and 2023, including those that occurred during the pandemic.
The study found that while safety incidents are “extremely rare” in remote primary care, some cases had led to fatalities or serious harm.
Diagnosing patients remotely, the GPs risked underestimating the severity or urgency of a condition and providing an inadequate follow-up or a delayed referral. This created an additional risk for patients with complex pre-existing conditions, cardiac emergencies, and generalized symptoms.
The study stated, “Several safety incidents involved clinicians assuming that a diagnosis made on a remote consultation was definitive rather than provisional. Especially when subsequent consultations were remote, such errors could become ingrained, leading to diagnostic overshadowing and missed or delayed diagnosis.”
In one case, a 70-year-old woman experienced sudden breathlessness, and when she called her GP, she was told that the doctor would call her back. However, the receptionist got distracted by another patient, and the woman’s condition worsened, leading to her death at home that afternoon.
Another example described the case of a 16-year-old girl who was diagnosed with glandular fever by a doctor over the phone. After her parents took her to the emergency department, it was revealed that she had sepsis, and she later passed away in the hospital.
The NHS acknowledges the downsides of remote consultations, including missed opportunities in face-to-face consultations and exclusion of patients without phone or computer access.
However, the NHS recognizes that remote consulting benefits patients in rural or remote areas, providing them with quick care and medical advice, as well as saving time and reducing waiting times for GP appointments.
Shift to Remote Appointments
The shift towards remotely provided healthcare began with the onset of the COVID-19 pandemic.
The number of face-to-face GP appointments plummeted during the first wave between February and April 2020. Simultaneously, the number of telephone or video/online consultations rose, reaching 48% in April (up from 15% in February) and decreasing slightly to 36% in October.
By mid-2021, remote encounters started to be depicted as potentially unsafe, as they were linked to cases where patients were harmed, including avoidable deaths and missed cancers.
Authors of the study recommend a re-examination of where the risks lie in the widespread expansion of remote triage in primary care.
Lates NHS data showed that in September, 70.7% of all GP appointments were carried out face-to-face.
