The COVID-19 pandemic led to a shift in healthcare delivery, with many services being provided remotely to reduce the risk of virus transmission. This included remote consultations with general practitioners (GPs) via phone or online calls, which researchers warned could lead to missed or inaccurate diagnoses. A study published in BMJ Quality and Safety analyzed safety incidents in remote primary care and found that while extremely rare, some cases resulted in deaths or serious harm due to underestimating the severity of a condition or delayed referrals.
Patients with complex pre-existing conditions, cardiac emergencies, and general symptoms were highlighted as being at an increased risk of missed or delayed diagnosis due to remote consultations. Additionally, the study noted that clinicians assuming a diagnosis made remotely was definitive, rather than provisional, could lead to diagnostic overshadowing and errors.
These warnings were supported by examples of patients who received inaccurate diagnoses or calls for tests after contacting their GPs remotely, which resulted in adverse outcomes including deaths. The study also highlighted the risks of remote consultations, including the exclusion of patients without access to technology and the inability to pick up on subtle cues during a face-to-face consultation.
Despite these pitfalls, remote consultations have been recognized for their ability to provide fast care and medical advice to patients in rural or remote areas and reduce waiting times for GP appointments. The COVID-19 pandemic saw a significant decrease in face-to-face GP appointments, with a corresponding increase in telephone or video/online consultations. However, the safety of remote encounters began to be questioned, with cases of avoidable deaths and missed diagnoses being linked to remote care.
While remote triage and care were considered partial solutions to healthcare system pressures, the study emphasized the critical question of safety in remote healthcare delivery. As the prevalence of remote triage in primary care continues to grow, stakeholders need to re-evaluate the associated risks. Nonetheless, recent NHS data showed that a significant portion of GP appointments were still being conducted face to face, highlighting the ongoing importance of in-person healthcare services.