Written evidence submitted by Mrs Catryn Brogan (FGP0273)

 

Introduction:

The practice of remote medical diagnosis had been on the increase prior to the onset of the Covid Pandemic in 2020.


Since the early days of the Pandemic this somewhat questionable practice has been used across the country due to the restrictions of Lockdown and social distancing.


In my opinion the time has come to completely review the practice through the prism of the Covid Pandemic.

Background:


On the morning of 8/11/13 I woke up to discover that Chris, my dear husband over 21 years, had died in his sleep, he was 57. 

His death was both sudden and completely unexpected. The subsequent post-mortem revealed that he had died of a myocardial infarction, and that he had been suffering from undiagnosed chronic heart disease.

Seventeen days prior to his death Chris had received a telephone diagnosis with a GP from his practice because of a suspected chest infection.

At the inquest in March 2014 the transcript of this telephone conversation was released, and it became immediately apparent to my legal team that the GP had made some fatal errors by ignoring some clear “red flags”. 


This was followed by a protracted clinical negligence claim, which was settled out of court in January 2019.

My mission:


TO SAVE LIVES


By improving the standards, protocols and training for clinicians who practice remote diagnosis.

Social Media Research:


I used my social media footprint to canvass the opinions of my friends and associates. I posed the following question:

What are your views on remote diagnosis, and what experiences and concerns do you have about this clinical practice?

I received what I believe to be both valuable and valid responses all of which echoed my own concerns.

 

Here is a summmary:

*Physical Examination

 

There was a universal concern about the inability to physically examine a patient using this method. Particular concerns were measuring blood pressure, pulse checks, chest examinations, assessing a patient’s general demeanour, facial expressions and looking for visual signs of illness.

*Communication concerns.

 

Everyone has different levels of communication skills. Concern was expressed about the right questions being asked, the patient response being interrogated properly. The difficult of communicating effectively with the elderly and also children/teenagers who do not yet have the skills to verbalise their symptoms accurately.
There were also concerns about language barriers in a multiethnic society, together with how this practice would work for people with hearing impairments.

 

 



*Mental Health issues.

 

Concern was expressed about how accurately this could be assessed remotely, which could lead to serious issues not being diagnosed.

*Choice and Privacy.

 

A number of respondents were concerned that post pandemic this would become compulsory with no element of choice. There was also the issue of location privacy e.g. if the patient is being diagnosed in the workplace.

A number of my respondents gave examples of poor/inadequate diagnosis that they had received remotely.
I have singled out two which are particularly concerning [ I am sharing this with their full permission]:

Jack, London


In May 2021 Jack approached his GP with worrying stomach issues. The diagnosis was remote due to Covid restrictions. His GP prescribed antacids. Jack continued to feel ill, during a second remote consultation he was given Lifestyle advice. Six weeks later Jack collapsed, he was rushed to hospital where it was discovered he was suffering from advanced bowel cancer.

Judith, Somerset 


Judith is a friend of Jack, and it was his experience that prompted her to call her GP as she too had stomach problems. Her GP also prescribed antacids, followed by two courses of antibiotics. Judith finally decided to seek a private examination, which revealed that she was at the very early stages of bowel cancer. Judith is currently in hospital having part of her bowel removed.

 

General Practitioners Assessment of Remote Diagnosis:

As part of my social media research I have prevailed upon four GPs within my network for their thoughts and recommendations:

The common, and quite frankly reassuring message, from all four was:

*GP’s need to always put themselves in a position to make an accurate diagnosis.

Here are their individual thoughts. 

Mark, Cardiff, Retired GP:

Telephone diagnosis is fraught with problems, there is so much that can go wrong.
There needs to be a safety net, if it’s not already happening ALL conversations need to be recorded. The accepted clinical threshold of determining when to have a face-to-face appointment with a patient needs to be lowered.

Kath, Blackburn, Practising GP

Reviewing medical history is absolutely key always.... but especially when the patient is not in front of you. The questions need to drill down, patients can be very reticent to go into detail over the phone.
This practice comes with concerns.

Karen, Kent, Retired GP 

A full review of the remote diagnosis practice would be advantageous, however given funding issues I doubt that this is practical.
The Audio Consultation Tools could be extended into GP assessment.

Peter, London. Practising GP
See attached document Attachment A

Medical/Legal ramifications:
Please see attached document Attachment B

Conclusion:


The Covid Pandemic has resulted in remote consultation and diagnosis becoming the standard form of practice.

Whilst there are positives to this form of consultation there are concerns both from the Medical Practitioners and more importantly their patients. 
Patient confidence is crucial for this form of practice to succeed, without this confidence the NHS will be further stretched, i.e. increased admissions to A&E.

My proposed solution:

*A granular nationwide review across all UK medical practices focusing on their experiences of remote diagnosis during the pandemic.

*To establish individual definitive protocols for remote diagnosis across its different mediums, i.e. telephone, video, email.

*To establish ongoing training programmes across all mediums, responding to the needs defined by annual reviews.

 

Dec 2021