Dear Bellman,
If you ‘phone the Medical Practice here in Stonehaven, you will hear a message along the lines of, “Wherever possible, we encourage patients to use E-Consult:” from that, it is clear that this is not compulsory.
However, should you appear in person, if my experience is anything to go by, you will be told that using E-Consult is compulsory. (Your might lie by saying the you do not have a computer, or that it is not working!)
I have had only two such visits. On the first one, about 2 years ago, I suggested to the receptionist that it was not compulsory and to her credit, she sought advice, confirmed my view, and said that someone would ‘phone later in the day which they did.
My more recent experience was totally different in that the receptionist was not persuaded and I was told that I had to fill in an E-Consult online or over the ‘phone or over the counter; otherwise, no appointment. I chose to do it over the counter and it was interesting in that in relation to my sore back, I was asked only how long I had had it and whether I had taken any medication: far fewer questions than is in the online one, or so I am told. I was not asked the question about level of pain, which seems to take no account of the fact that pain-threshold may vary from patient to patient.
The Medical Practice are aware of issues which I air here about E-Consult, but the response is that the system has the blessing of their legal advisers. I do not doubt that, but a lot depends on what they were asked. Were I, as a lawyer, asked, my response would be, “There is nothing, in principle, against E-Consult, provided it is not compulsory and not stated to be.” If it is not compulsory, the risk lies entirely, or almost entirely, with the patient—not so, if it is, as per the receptionist, compulsory.
The benefit of E-Consult is said to be that the patient is directed to the appropriate person and that might not be a doctor, but a nurse, or nurse practitioner, or a physiotherapist. One can see the benefit to the doctor. However, the is not the end of the story. If you ask to see a partner in a firm of lawyers, you are entitled to see one. That partner may suggest that your business could be dealt with by a qualified assistant to whom you should be introduced. if you prefer to deal only with the partner, that is your right. If you wish to see a doctor that too is your right., but not so with E-Consult. Doctors, understandably wish to cut down on time-wasters, but sadly, as with others, it goes with the territory.
Once the patient completes the E-Consult in whatever way, it will be dealt with by the Triage team, who are anonymous. While a patient, in a face-to-face with a doctor, may wish to reveal some embarrassing matter, the same patient may not wish to disclose this to the anonymous Triage team.
Let us assume that the Triage team give you an appointment with someone other than a doctor, despite your request, to see, say a nurse-practitioner about a rash. The nurse practitioner may have concerns about the patient’s colour, or gait, or may have a hunch that there is something which the patient may not reveal. If the patient’s palor, or gait, seems to be of concern, the nurse-practitioner may feel inclined to suggest seeing a doctor. That results in two visits rather than one and for all I know, yet another E-Consult to be done.
Another issue with E-Consult is that, in so far as the patient is required to mention earlier health issues, the patients’ notes ought to be checked, if only because the patient may have omitted something of significance. That involves duplication.
The Practice’s position is that diagnoses are not done over the phone, following an E-Consult. However, I know of many people who have had these and this can be problematic. One example of many will suffice. I know of one person whose elderly mother had fallen in her own home and was lying on her back. The daughter completed an E-Consult and pain-killers were prescribed—fortunately, that was all that was needed. She had been asked if she could take photographs of her mother’s back which she wisely refused to do. Most people are aware that one should avoid moving someone who seems to have an injured back, and I wonder why this course was action was even suggested. There needed to be some inquiry into why the patent fell, assuming that was known.
if the daughter had followed this advice and something untoward had happened, that could have resulted in a claim for medical negligence which it would have been very difficult to defend successfully. The patient’’s lawyer would need to call only one medical witness who would be asked whether a visit to the patient might have revealed something sinister which had resulted from the fall. The answer would have to be “Yes,” or at the very least “possibly.” A failure to visit could be the end of any defence.
E-Consult is not infallible in that someone I know filled it in online during a weekend and was advised that nothing could be suggested and that medical attention should be sought. The person waited for half-an-hour, filled in another E-Consult and was contacted by a doctor on the Monday. Same information—different response! You would do something similar in that if you say the level is pain is severe, you will be advised to dial 999, whereas if you modify that, you will see someone, rather than have trip in an ambulance to ARI.
The issues which I have aired would not arise if the E-Consult is optional and stated to be so not only over the ‘phone but also to anyone who visits the Practice. If that is the position, the only obligation on the Triage team is to check the patient’s notes to ensure that there is nothing in them to indicate that the patient should be seen by a doctor rather than anyone else, and, of course diagnoses done over the ‘phone are fraught with pitfalls for the doctor and may not be the best way, but may be the worst way, of treating a patient.
I once represented a mother whose son died after hitting his head on the bottom of a swimming pool. Despite the mother telling the receptionist her son was being violently sick, the response was that the doctor was too busy and the suggestion was that the boy had probably eaten too many sweets. No surprise that the claim was successful, but not without the practice first denying the ‘phone call and then the concerns expressed in it. The practice did not know, and I did not disclose, that the boy’s older sister was present throughout the ‘phone call. Best keep your Ace up your sleeve.
D.J. Cusine.