*Article originally published in April 2020
Even before the pandemic of 2020, technology developments had made remote consulting by telephone, message and video conference much more realistic than before, and various companies were already investing in this area as an attractive option for some patients. But there was an immediate increase in the use of tele-medicine because of the Covid-19 pandemic, and the U.K. government’s various lockdowns, Tier restrictions and self-isolation rules aimed at slowing its spread. At the time of writing the mass vaccination program has started, although there has also been a worrying increased in cases. Therefore it seems clear that remote clinical consultations will continue to be necessary at least for the short-medium term.
But what are the insurance and risk management considerations for specialist surgeons who may be offering remote consultations in their private practice?
A vital consideration is whether the surgeon’s medical indemnity insurance for their private practice covers them for remote consultations. Any surgeon who is unsure should seek immediate advice from their broker. Incision members are indemnified for remote consultations.
Even where there is cover in principle, there can still be insurance technicalities. In particular, the physical location of the patient can make a difference to whether there is cover for a particular remote consultation, because many policies have “Territorial Limits”. If the patient is outside of the UK, surgeons should get advice about whether their policy would respond.
Patient confidentiality can also be tricky in remote consultations. Surgeons need to think about the security/encryption of the device or telephone/video conferencing service they use for remote consultations. If a third party could eavesdrop on an unsecured communication channel, that has very serious ramifications for the surgeon. We cannot recommend any particular service, but www.nye.health is an example of a telephone/video conference service especially designed for doctors, that might be more appropriate than generic services that are not designed with patient confidentiality in mind.
Similarly, surgeons need to advise patients to take responsibility for their confidentiality wherever they are, for example by making sure that they cannot be overheard while having the remote consultation.
The GMC already has guidance on remote consultations – https://www.gmc-uk.org/ethical-guidance/ethical-hub/remote-consultations. Patients need to understand the limitations inherent in a remote consultation, and make sure that they give informed consent to any agreed treatment plan, bearing in mind any risks arising from the surgeon’s inability to carry out a physical examination.
A successful remote consultation will depend on the surgeon’s ability to communicate clearly with the patient. Therefore patients should be warned in advance to be prepared to spend time describing their physical condition in detail. The surgeon should consider where there are any language barriers or disabilities that might need to be taken into account. Even the patient’s broadband speed or mobile phone signal strength can have a bearing on whether a consultation can go ahead safely and without disruption.
With Covid-19 precautions causing very significant disruption to many surgeons’ practices, remote consultations could be a good way of providing care. Being alert to the risks can avoid surgeons facing liability problems down the line.