Is ‘telemedicine’ our new normal?

The COVID-19 pandemic has resulted in significant changes in healthcare nationwide, including haematology. To minimise virus transmission, changes have been made to the way the NHS normally operates in order to adapt to this challenging situation. This includes a reduction in the number of face-to-face hospital and GP appointments. Instead, the practice has shifted towards offering online, telephone and video consultation where possible. Is ‘telemedicine’ our new normal?

The most obvious advantage here is that there is a huge convenience in telephone consultations. Both patients and carers have noted a huge benefit in saving time, stress, and expense of travel to hospitals and finding somewhere to park. Many patients might not live close to the hospital where their appointments are held, thus, travelling to and from their appointments can be expensive and time-consuming. In the future, telephone consultations could make healthcare more accessible and less stressful for those who struggle to afford this cost and who have difficulty taking time taking time off work. This would mean a significant reduction in stress and anxiety for both patients and carers.

Another benefit of keeping telephone appointments for the future is the reduced risk they pose to CEV leukaemia patients, who have compromised immune systems and are vulnerable to the transmission of viruses and infections. Reducing the number of face-to-face appointments in the future could potentially be a safer option for CEV leukaemia patients. For example, many leukaemia patients who chose to shield long before COVID-19 may prefer the option to have a telephone appointment over compromising their health with travel and exposure to more people.

The fundamental flaw here is that a physical examination cannot take place. Visual clues such as facial expressions are lost, and symptoms patients would present with like a wound, or a rash are not always conveyed across a telephone call. Video consultations might be an option for this concern; however, telemedicine could be an even more ideal arrangement for results monitored with blood results; patients are now able to take their own blood test at home in the future. While this is perhaps a great alternative, this won’t be a preferred option for everyone, many of whom may struggle to administer tests themselves or feel anxiety around doing so.

Additionally, some components of a face-to-face consultation cannot be replaced, such as familiarity, knowledge of one’s history, seeing a person you trust – all the aspects that enrich a sense of being cared for are difficult to replicate remotely. Many patients are happy to have telephone consultations if they know they have the option to see their clinician face-to-face, if necessary, for aspects that cannot be replicated remotely. People can experience significant anxiety at the loss of a physical examination for an indefinite period so knowing that a face-to-face appointment is an option would sustain faith in the future of telemedicine.

Overall, there seems to be a consensus that there is a place for telephone consultations in the future, however, there will be times when a telephone appointment is not suitable. Most patients would prefer to know that they can see their clinician face-to-face if necessary. Considering how to cultivate familiarity with patients and health care professionals over telephone appointments should be considered and there should be reliable access to the support between appointments, such as a clinical nurse specialist (CNS). Furthermore, sometimes face-to-face appointments are necessary in the case of breaking bad news, an unstable illness, or the necessity of a complicated and technical conversation such as consent to a stem cell transplant.