“The doctor will see you now” is taking on a 21st-century meaning with a move to online and video consultations – a phenomenon well established in the US, and now making its presence felt in Ireland too.
This month, a post office in a shop in Co Kildare became the first location for “VideoDoc”, a service that offers an online consultation with a general practitioner for €28.
Seán Fogarty, proprietor of Fogarty’s Quickpick and Post Office in Ballymore Eustace says: “I built my own website 10 years ago, and times and technology have progressed since then. I have always used technology when I can and I believe that with it we can better our quality of life.”
There is no full-time GP in the village, he says, so VideoDoc is filling a gap. Customers are already using the soundproof, double-glazed booth.
Fogarty says he hopes it will be good for business, but he has “gone past the stage where it is all about money”. “I don’t believe providing a service is all to do with money in a locality like mine but it will help maintain and keep services in Ballymore Eustace.”
But the issue of online consultation is being discussed beyond Ballymore Eustace. “Your Patient is Online” is the title of a discussion this weekend at the annual conference of the Irish College of General Practitioners (ICGP) in Wexford town.
Dr Conor O’Shea, national co-ordinator of the college’s information technology group, accepts that this technology is now part of the medical landscape. “The question is: what is the best use of it? For me a video consultation should be linked to a physical service and is a slightly ‘techie’ form of a telephone call to a patient.”
“Part of the attraction of video is not the face-to-face part, because there are places in Ireland where with our broadband quality you might get fuzzy pictures. The attraction is the immediacy of it.”
“If you are at home at 8pm and not feeling great you might think: ‘I’ll phone the doctor on the app.’ It has that immediacy of a doctor being available.”
He acknowledges there are advantages to seeing a patient, even via a video link: “If you have a child with diarrhoea or upset tummy, and I can see him bouncing around in the background, and I have taken a good history, etc, I can say to you keep giving him fluids, Calpol if needed, etc. But if you say your child has a sore ear, I cannot see inside his ear. We still need to examine patients.”
“If you have a video consult and are told we will send a prescription for an antibiotic to your pharmacy, well I might advise differently about that. In an ideal world, with a child with a sore ear, I would rather see you in the surgery.”
Where it fits into the day of a busy GP is another point. “In any working day I would love to have 10 mins to do a video consultation but I am full up, and it probably would be what I would say on the telephone: if the patient needs to come in then you have wasted 10 minutes [on video].
“Will it replace a trip to the doctor? I don’t think so. It will form part of the landscape, but it will be up to doctors and patients to see how it works best.”
Dr Robert Kelly, a consultant cardiologist at the Beacon Hospital in Sandyford, Dublin, is medical director of VideoDoc. He says the VideoDoc service is to support consultations, not to replace them. “It is not instead of seeing your doctor.”
It is a service whereby you can see a doctor using your phone or iPad and is also used by some of the “several thousand people in Ireland who do not have their own GP because it is difficult to get a GP”.
“GPs can use it for what they feel comfortable with. It is not for urgent care but it can be used as a follow-up or doing a house call via video.”
“As a doctor you have to make the decision as to what you are comfortable using it for. If you want to examine a patient, it is not for that. Clearly it is not the way to deliver a difficult diagnosis.”
He says there are many benefits to actually seeing a person, “ What information you can elicit from looking at people as opposed to just talking on the phone is significant.”
Dr Kelly also accepts that for video consultations to become more routinely used will need the Health Service Executive to buy into it, although there are consultants in hospitals around the country who want to use it in their private practice.
A statement from the HSE suggests ambivalence on the technology: “An online consultation must meet the same standards as a face-to-face consultation. A patient paying for such a service can determine their own interest and acceptance of such a service.”
“Other jurisdictions that have offered this service have done so very effectively and with significant positive patient reaction.”
Then there are what might be termed consumer concerns. Dr Mark Murphy, chair of communications for the ICGP, is concerned about patients paying twice for a consultation or minimising the importance of seeing your doctor offline.
“We do not want to see what I would term the corporatisation of private practice. There are patients who are vulnerable or have vulnerabilities, and it would be wrong for money to be made off the back of them.”
“The internet and smartphones have changed how we do a lot of everyday things, but we must never lose sight of the importance of our interaction with patients and the central role of the consultation.”
“The technology is upon us and there are a variety of health providers who market the video consultation platform quite heavily. It is heavily used in North America.”
“As a general rule, where ICT enhances the communication between healthcare professionals, we support it, and where it enhances the communication between the patient and the GP we support it, but we do have concerns.”
“The primary issue of concern for the ICGP is around quality and safety. For instance: is someone more likely to be prescribed an antibiotic as a result of a video consultation?
“Normally we address developments in an evidence-based way. This is a comparatively modern technology, and we would not like to see it replacing the comprehensive continuous care provided by your GP.
“The face-to-face consultation is at the heart of general practice and should remain so, whatever technology brings.”