Opinion piece: telemedicine!

On Sunday, I attended an international health conference, and I was inspired. Listening to top medical professionals from around the world helped me to learn a lot and understand the health services and its inner workings immensely. One of the topics that came up was telemedicine, it was a concept I had heard, but didn’t know a lot about. After hearing the panel discussion, I was intrigued, and I started doing some of my own research into the field. My intrigue was spiked further when the topic arose again at a webinar by the Royal Society of Medicine. So, I decided to compile an opinion piece of my own views on the matter:

Even before the pandemic, there has been a push towards telemedicine and digitalising the NHS. Like everything nowadays, this is a double sided coin, some positives being the ability to give consultations and advice to disadvantaged patients who may not be able to make it to a GP surgery, like the elderly or disables, less waiting room time and cost efficiency; some negatives include the actual ability to carry out some tests to create an accurate diagnosis over a web link or phone line, and eliminates jobs, as HCPs can see more patients per day; another immediate argument was ‘isthe NHS even prepared for the change?’ The answer was yes.

When the pandemic struck and lockdown was enforced, the NHS moved quickly to cancel primary and secondary care appointments and the ICU has expanded a lot. The pandemic saw a sharp decline in face to face consultation and a sharp increase in telephone consultation, facilitated by apps like Zoom and Meddbase. Complementary to this, the conversations about contact tracing began.

From what I understand, contact tracing works like this:

Trained staff interview people who have been diagnosed with a contagious disease to figure out who they may have recently been in contact with. Then, they go tell those people they may have been exposed, sometimes encouraging them to quarantine themselves to prevent spreading the disease any further. It works via a tier system: tier 3 is call centre type calls; tier 2 is NHS trained staff; and tier 1 is Public Health England. Despite the main public offence being it being new and untrained and untested, this is wrong. Contact tracing was used in 2014 for Ebola outbreaks, SARS in 2003, for STIs and other communicable diseases. In fact, in the COVID-19 pandemic, countries like South Korea and New Zealand have used it quite aggressively in the attempt to control outbreaks. The main problem with this, is the rate and flow of information. This is the main reason for the perceived failure of it in the U.K. the data required to make tracing a success has been very slow, resulting in the system not working. However, the system is improving. Another point is where it works best. It works best at local level, as the data sets are smaller so a far greater accuracy can be obtained to spot any potential spike and contain it effectively. Another reason for this is that different areas work differently ie. A system used for London will be very different to the system used in Edinburgh, and even in neighbouring populations, there will be slight differences. Due to this, a nationwide, general system simply wouldn’t work. Th system also needs public involvement. Not only would this increase patient – doctor trust, this would help ensure that the public listen to the advice given so they don’t place themselves in danger. To conclude this section, the contact tracing would work best if it was implemented at a local level, and the information was fed up the chain to create a nationwide map to show a more accurate potential spread and containment rate of the virus.

Telecare will only continue to grow over the years, becoming stronger, more popular and more effective as time goes on, even with specialist care. Digital communications can be given very easily to a community, ensuring that accurate information is conveyed clearly, to all, even those who aren’t normally accessible.Ironing out a few communication issues in terms of language barriers and those with a mental illness is needed, but despite public reception and confidence in digital communications being initially low, it has improved majorly, predominantly due to the convenience, the lesser treatment burden, the lack of queues, the quickness of booking an appointment and the high quality of care and advice they receive just via a web link Another great thing is that except training to develop and conduct tests digitally, minimal training is required to speak to patients across a web link.

Also, telecare could greatly alleviate the A and E department. Rather than going straight to A and E to get an issue resolved, you could communicate online to a HCP who could help or advise you on your next steps, or visit a visual diagnostics centre or a hub instead of entering emergency car. Another great thing about telecare is that health and social care can grow together to benefit social care. One of the main problems with healthcare is social care for the elderly. Not only can telecare be used to reach the less accessible elderly but it can also be used to tier patients to give higher quality, more effective care. Telecare can help decide which patients just need someone to talk to, and which need more specialist care, such as nurses going over to care for patients, and medication to be prescribed. Inter HCP transmission has also drastically reduced, with virtual MDT conferences really helping to slow the spread of viruses in hospital settings. In conclusion, telemedicine only has the capacity to grow, and an integral part now is the ability to communicate with the family of a patient much moreeasily to convey the needs of a patient. Research now needs to be more focused on how we can iron out some of the issues mentioned earlier and how doctors can carry out physical consultations over the phone or web link using remote monitoring with instruments like stethoscopes etc. It is also sad to witness the decline of physical consultation, as physical consultations are great, and the crowning experience for many doctors, the ability to sit down face to face with a patient and work out a solution to solve their health issue, but we do need to move on, times are changing, and so must we. The biggest thing that could impede or boost telecare is public co-operation. Like any treatment or consultation, the patient is needed to give their support and so it must be with this. Telecare provides the opportunity to gift more and more people with a higher quality of care, but it is only with the trust and support of our patients that we can move forward with this great endeavour!

Guest blog: Manveer Singh Wilkhu, Year 12