One of the most important causes of complaints handled by medical defence organisations is of failure to visit or failure to examine. It is imperative that clinicians conducting remote consultations keep excellent records of the consultation. 

As with every consultation, it is important to allow the patient to speak as much as possible without interruption and to clarify the patient’s own concerns about their condition and expectations of the consultation.

As visual cues maybe reduced or absent it is important, when providing information, to do so in short sentences and to ask patients to confirm what you have said to check understanding of both the diagnosis and management plan.

It is particularly important to provide clear safety-netting advice. Patients have been shown to be more likely to recall specific rather than general advice. For example, they are more likely to remember you saying: “Call me if the temperature has not dropped below 38 by Tuesday,” than “Call me if you are not getting better”.¹

Providing a subsequent written account or recording of this can be helpful.¹ Carefully record in the record any safety-netting advice. 

Be very wary about a patient re-contacting remotely because a problem is not resolving. Have a low threshold to see them face-to-face and to reassess for a physical examination. Always check the patient is happy with the outcome of a remote consultation. If they appear to have reservations about your advice, consider seeing them face-to-face.

There is a potential in remote consulting for doctors to accept at face value patients’ own diagnoses, asking fewer questions than they might do face-to- face.²

Particular care should be taken when prescribing psychotropic medication and strong analgesics. Some doctors ‘play it safe’ in terms of management and may be more inclined, for example, to prescribe antibiotics more frequently than they would face-to-face.³ Clear general advice with safety-netting or a decision to see the patient face-to-face may be more appropriate if the clinician feels uneasy about acceding to a patient request for medication.

Remote consultations may not happen because of technical issues, wrong numbers, or the patient having forgotten the time. Clinicians should have a policy and a strategy for failing to get through to a patient.

Notes

1. Watson PW, McKinstry B. A systematic review of interventions to improve recall of medical advice in healthcare consultations. J R Soc Med. 2009 Jun;102(6):235-43. doi: 10.1258/jrsm.2009.090013. PMID: 19531618; PMCID: PMC2697041.
2. Hewitt H, Gafaranga J, McKinstry B. Comparison of face-to-face and telephone consultations in primary care: qualitative analysis. Br J Gen Pract. 2010 May;60(574):e201-12. doi: 10.3399/bjgp10X501831. PMID: 20423575; PMCID: PMC2858552.
3. Hayhoe B, Greenfield G, Majeed A. Is it getting easier to obtain antibiotics in the UK? Br J Gen Pract. 2019 Feb;69(679):54-55. doi: 10.3399/bjgp19X700829. PMID: 30704991; PMCID: PMC6355282.