Dr Hilary Pinnock Discusses How the Pandemic Gave Way to Accessible Remote Consultations

There are many conveniences to remote consultations, but they should be weighed against the disadvantages, said Hilary Pinnock, MD, professor and personal chair of primary care respiratory medicine for the Deanery of Molecular, Genetic and Population Health Sciences at the University of Edinburgh in Scotland.

Hilary Pinnock, MD, professor and personal chair of primary care respiratory medicine for the Deanery of Molecular, Genetic and Population Health Sciences at the University of Edinburgh in Scotland, discusses the impact that the COVID-19 pandemic has had on the implementation of remote consultations.


What are some of the biggest reasons why we should be implementing telehealth?

That's a very big question because it depends what you mean by telehealth. My particular presentation is around remote consultations. Telehealth, for example, could be monitoring parameters at home and that's not what we're talking about here. I'm talking about just delivering a consultation remotely either by video, by telephone, or indeed online or using text messaging to communicate with patients. So, that's a very specific aspect of telehealth, if you like.

I guess one of the major advantages of remote consulting is the fact that it's convenient for patients. I mean, obviously, in the middle of a COVID-19 pandemic, the main reason for doing it was social distancing, and to avoid passing on infection. Once we get through that and we're no longer so worried about handling the coronavirus, the advantages, I think, a lot of them are convenience. It's so much quicker and easier for patients to have a telephone review than to have to find their way to a practice or a clinic.

So, there are a lot of conveniences and in fact, we it believe should improve access. I showed in a trial many years ago of telephone reviews for asthma that when we compared patients who were offered their review face-to-face compared to being offered their review by telephone, the telephone group achieved 3 quarters of the patients reviewed compared to only half face-to-face. So, convenience, improving access. And that was within my small town in the United Kingdom. If we also bring in rural areas, of course, you've got the advantage of being able to overcome remote distances. So, there are many convenience advantages to remote reviews.

But of course, you have to balance that against the disadvantages. We're not actually seeing somebody. We can't listen to their chests so easily. There are technology these days that perhaps may allow that in the future but there are things you can't do. And we are thinking about how we can check inhaler technique, for example, when somebody is on the telephone. Well, it's difficult, except that there are apps available now where people can video themselves using their inhaler, and that can allow us to assess it. Video calls, of course, we can watch somebody use an inhaler. So, we question how we can go about overcoming some of the challenges.

The other one is completing an action plan, as part of the support itself management. It's just something we normally do on a piece of paper and give it to the patient. We can actually fill in an action plan online and we can share a screen. And we can actually do the process online. So, we can use technology to do most of the things that we would do in a face-to-face review.

And yet, we also hear from patients that it's not the same. It's not the same as being in the room with somebody. And there is a loss of that empathy, perhaps that comes from being in the same room as somebody and patients definitely told us that when they had more complex problems, that they wanted to see somebody face-to-face. And we heard from clinicians as well how they miss the touch, somebody being in the room and being able to actually feel the patient in the sense. So, there is a change in quality, which is probably not important for many consultations, but can be important for some. So, my perspective very much is that once we've got through the social distancing requirements that have made remote reviews essential, we'll probably settle to a more balanced approach where there's a choice of mode of consultation.