We need to push against remotecontrol medicine .

Dr Rachel Glasson GP in Sydney , NSW .

REMEMBER one of my first days of seeing patients by telehealth , right at the beginning of the pandemic in 2020 . The scary new coronavirus was looming on the horizon like a tsunami that we knew was going to hit eventually ; everyone was nervous , and our first lockdown had just begun .

I sat in my room and picked up the phone to call my first patient . His presenting complaint ? “ I ’ ve been having headaches .”

I was a bit stumped . “ Do you have any respiratory symptoms ?”

No , he didn ’ t , and the headaches had been going on for months .

I sat considering how I would manage to diagnose this situation over the phone and finally said : “ I think you ’ d better come in .”

He duly appeared ( wearing a mask ) with a BMI of 42kg / m2 , blood pressure of 210 / 100mmHg and BSL of 26 .

I was not sure which part of this was responsible for his headaches , but I knew one thing : none of this could have been ascertained over the phone .

“ Do you have a fever ?” I asked one of the next telehealth patients , trying to figure out how sick they were .

“ Oh , I don ’ t have a thermometer , but I feel a bit warm .”

By this point , of course , all the local chemists had sold out of thermometers .

I attempted to broaden my diagnostic skills by asking the patient to take their own pulse .

After several minutes trying to explain how to do this , I said : “ Okay , look at the inside of your wrist . Now

press just below where your thumb meets your forearm . Can you feel something there ?

“ No ? Try a little bit further towards your hand .”

The patient could not feel a thing , and I was getting fed up .

I said to them : “ Well , maybe you are dead .”

One time , I attempted to do a mental health treatment plan using FaceTime .

The patient — experiencing social anxiety — had their iPad angled in

such a way that all I could see was the top of their forehead .

Affect , eye contact , body language — it is hard to assess that sort of stuff when your view of the

He clarified that my role was not to check the spot ; it was to write an immediate referral to a local dermatologist .

patient is mostly their bedroom ceiling .

Telehealth has lived on post- COVID-19 , and for a very select few situations , this is a good thing .

But most GP consultations require a physical examination of some kind , and that remains near impossible to achieve over the phone .

PICTURE CREDIT

This fact has not stopped people from wanting to see their doctor over the phone for all sorts of inappropriate things .

I have just started in a new practice where telehealth seems quite popular , mostly for reasons of convenience , and it is like a time machine right back to the frustrating days of 2020 .

I recently refused to do a Zoom consultation to complete a medical clearance for a patient to participate in a demanding physical exercise program in another country .

Unfortunately , the patient could not attend in person for the required examination — because they were already overseas .

Then there was a phone consult from last week . The patient told me she had recently been discharged

from hospital after an admission with pneumonia and that her ankles were still “ really swollen ”.

The discharge summary asked for the GP to “ assess fluid status and kindly chase brain natriuretic peptide ”.

Although I am not a dog , chasing a result is at least something I can do over the phone . But assessing fluid status ?

The patient did not seem to realise that a physical assessment would also require in-person attendance and told me that she was not feeling up to coming in .

I wonder if we will do another phone call to discuss her elevated brain natriuretic peptide result , which came in later that day .

Finally , a patient rang — from the NSW South Coast , where he was on holiday — in a state of panic .

He had noticed a dark spot under one of his fingernails , which a medical family member had said he should get checked urgently .

When I enquired how he expected me to do that over the phone , he clarified that my role was not to check the spot ; it was to write an immediate referral to a local dermatologist and then phone the dermatology practice to personally request that the patient be seen urgently .

I really do not like feeling like a vending machine for scripts and referrals , so it was with a degree of glee that I read the dermatologist ’ s subsequent report of a subungual haematoma that would self-resolve .

I could have told the patient that and the whole urgent appointment panic would have been avoided .

I read somewhere once that at least 80 % of GP work requires the physical presence of the patient , and I think that is probably an underestimate .

We need to push back somehow against the growing belief among patients that their GP can do everything they need over the phone or Zoom or otherwise somehow by remote control .

Let ’ s not get stuck in 2020 — it was bad enough the first time around .

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