Video consultations are suitable for diagnosing acute conditions, according to doctors in the UAE.
A study led by Abu Dhabi's Khalifa University found that for the ongoing monitoring of chronic illnesses, such as diabetes, doctors tended to regard audio consultations as adequate.
The findings come after more than a year in which many hospitals and surgeries have minimised face-to-face consultations and opted for virtual appointments.
The study's first author, Dr Noora Alhajri, said with acute conditions, clinical outcomes were likely to be better with video consultations compared to telephone calls.
"You can see the patient. You can evaluate virtually the site of pathology," she said. "If the patient says, 'I have a swelling in my arm,' it can show the clinician the place of the trauma. The physician can conduct a guided examination.
"Sometimes the facial features will give an insight about how bad the pain is and the underlying conditions. If that's missing, it will make the clinical diagnosis harder."
The new research, published in the JMIR Medical Informatics journal, was based on responses from more than 623 doctors at outpatient facilities in Abu Dhabi that had telemedicine services in November and December last year.
Just over half of doctors had confidence in managing acute conditions by video, with less than one-fifth taking the opposite view. Only about 40 per cent had confidence in managing acute conditions using audio consultations.
When managing chronic conditions or carrying out follow-up appointments, about four-fifths of doctors had confidence in audio or video consultations.
The research also found doctors with prior experience of telemedicine were more confident that conditions would not be misdiagnosed when using the technology.
According to figures published last year by consultancy McKinsey, the proportion of patients in the US using telemedicine went up from 11 per cent to 46 per cent during the pandemic.
Healthcare institutions are now considering how to manage consultations over the longer term in a world where Covid-19 is likely to remain.
As much as $250 billion of US healthcare spending could involve telemedicine, McKinsey said, up from just a few billion dollars before the pandemic.
While some technology companies are poised for a windfall, such as those in the UK, patients have expressed concern about being unable to secure face-to-face appointments.
Dr Alhajri said that with technology platforms able to record a patient's blood pressure or heart rate, video consultations could, in some circumstances, be as useful as face-to-face appointments.
"If such platforms are implemented … they may simulate the in-person visit," she said.
"They might in time replace the in-person visit, but you cannot apply that to every case.
"There are cases involving trauma. You cannot assess someone with a gunshot wound through telemedicine."
One approach is, she said, to have a nurse make initial contact with the patient and decide if audio, video or in-person consultation was needed.
“As technology takes a huge place in healthcare services, we need to reduce the pressure load on physicians and healthcare systems,” she added.
Dr Davinder Pal Singh, a cardiologist at NMC Royal Hospital at Dubai Investments Park, agreed that telephone consultations tended to work well for patients with previously diagnosed chronic conditions, such as hypertension and diabetes. He added, though, that video consultations offered additional information.
“You can have a look at the patient,” he said. “It can give us some more views about his illness. It will add to the consultation. Maybe we can get a better view [of the] symptoms and he can show us something.”
With audio consultations alone, doctors may miss useful information sometimes available by video, said Dr Ashar Jamal, an emergency doctor at Al Zahra Hospital in Sharjah.
“With the video consultation, you’re looking at them rather than talking to them, which is superior to the audio consultation,” he said, while adding that in his speciality, physical consultations were typically needed.
“Sometimes patients are calling from home for advice, but in the emergency, it’s a bit of a risk to diagnose over the phone. We prefer to see the patient.”
