Which types of patient and which types of condition are likely to be unsuitable for telephone and video consultation?

Patients: Clinicians generally consider some groups of patients to have particular challenges in managing telephone consulting. These include people with hearing or speech difficulties, those who do not have a strong command of the same language as the clinician, or those with learning difficulties.¹

Language difficulties can be obviated, to a degree, with real-time, online interpreting, but this can be difficult to organise, particularly at short notice. It is very easy to misunderstand important information. Interpreters should be professional and, if possible, have some training in medical terminology. It is not good practice to involve family and friends in interpretation, which may make sensitive issues more difficult to discuss. Accept that consultations involving interpreters are much longer than regular consultations. In addition, people with brain injury such as stroke have difficulty recalling telephone consultations.²

Video consulting can overcome some of these problems, particularly in relation to signing for deaf people, if an interpreter can be included in the call. Some older patients unused to technology, or who have cognitive impairment, may struggle with video consultation, but if set up by a relative or friend this can be overcome. 

Assessing very young children is considered particularly difficult, especially by telephone.¹

Conditions: Any condition that needs a physical examination is clearly best conducted face-to-face. A limited examination of skin lesions (particularly follow-up) and some observations (such as joint swelling, external eye examination, red throat) can be undertaken, but are rarely as comprehensive as in-person and there is a risk of something important being missed. Examination which involves palpation, elicitation of neurological signs, locomotor examination, are much more challenging. Highly emotionally, charged consultations and those breaking bad news are probably better conducted face-to-face, although they can, if sensitively handled, be managed remotely. 

Notes

1. McKinstry B, Watson P, Pinnock H et al. Telephone consulting in primary care: a triangulated qualitative study of patients and providers. Br J Gen Pract. 2009 Jun;59(563):e209-18. doi: 10.3399/bjgp09X420941. PMID: 19520019; PMCID: PMC2688070.
2. McKinstry B, Watson P, Elton RA et al. Comparison of the accuracy of patients' recall of the content of telephone and face-to-face consultations: an exploratory study. Postgrad Med J. 2011 Jun;87(1028):394-9. doi: 10.1136/pgmj.2010.101287. Epub 2011 Mar 3. PMID: 21378007.