27 May 2020

GPs push for balance between remote and in-person consultations

3:03 pm on 27 May 2020

Consultations with doctors over the phone or by Zoom have proven much more convenient for some and GPs are arguing they should remain, but not in all cases.

Portrait of young Middle-Eastern doctor wearing glasses sitting at desk in office and speaking by smartphone, filling in patients forms

Photo: 123rf

With Covid-19 and the lockdown forcing people to take particular care not to infect their doctors, or others in waiting rooms, GPs needed to adapt to a new way of doing things.

Remote consultations became the norm, but with restrictions lifting the Royal New Zealand College of General Practitioners has published a manifesto that argues that a return to normal would be a mistake.

College president Samantha Murton told RNZ's Morning Report there were several benefits to having remote consultations that went far beyond reducing the risk of spreading disease.

"There is increased access to GPs in a variety of ways not just the one way - which was you need to come in and be seen ... it would be a bit of a shame if we went 'oh no we're going back to absolutely what we did before and only that."

"It's massive - and especially for rural communities... a lot of our rural patients end up having to travel to see a doctor at the hospital and if you can do it by phone or zoom that makes an enormous difference to their costs or personally."

"Our elderly who haven't been able to get out [during lockdown] - having access to their GP without getting out of their house has been really important.

"The other thing is there's a whole sector of our popoulation that's really struggled to get time off work and we're penalising them more by saying 'you need to take an hour or two off to go see your gp for 15 minutes, and - their bosses aren't helpful."

Remote consultations also made it easier for people who were travelling.

"I've had patients who have been looking after family members out of town and we've been able to consult.

"I had one who was in Auckland ... because she'd moved back from overseas, and she said 'let's just do this over the phone until I move back to Wellington'."

Murton told Morning Report there were moves afoot to have more remote consultations even before the coronavirus hit.

Remote consultations were not the best option in every case however, and doctors would continue to need to see people face to face in some cases, she said.

"We still have to have a quality practice that has the rooms and the space and the gear - and we still need to see people in person when it's just a physical examination; for doing procedures we still need to do that.

"Sometimes it's easier for peopel to be honest about how they feel over the phone ... [but] sometimes you do have people who go 'no I'm fine' and you go 'hmm, I can hear that you're not' and so those people sometimes need to come in.

"Every GP in the coutnry will have people who walk into their room and talk about their big toenail but then burst into tears because things are terrible at home or their job's bad or whatever it is."

There was also a need to ensure changes to the way GPs practiced community medicine did not leave some people behind.

"Ability to have a phone sometimes is a tricky thing - some people don't have zoom, don't have the data ... we need to be really cautious that we don't increase inequity by saying 'we're just gonna do this' without thinking about what other inequity issues come up."

Murton said the College had been having conversations with others in the medical community during the lockdown about ensuring patients were receiving the appropriate care.

"We do need to be really cautious, and GPs with the move to telehealth we had a conversation with the Medical Council and the Health and Disability Commissioner to make sure that we're wise about this and that we are very cautious when someone is on the phone and we have any inkling that things aren't exactly what they're saying."

She said that post-Covid, those conversations would need to continue to ensure the gains found through necessity were not lost, but without introducing new problems to the equation.

"It will be sort of a combined effort from all parts of the community medical sector to try and work forward and head in a direction that helps us embrace technology and also change what happens with equity."

She seemed optimistic about the prospect of achieveing that.

"With the Covid crisis, the GP leaders of all GP PHOs (Public Health Organisations) and everywhere have been talking a lot together and I think all of us are sort of heading in the same direction."

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