In recent days there have been discussions as to the value of telephone consultation in primary care. Let me add to the discussion with an account of my experience. In the early days of developing Rheumatology Toolbox we used another strategy to try and reduce the workload in Rheumatology outpatient clinic. By workload I mean the time and effort involved in attending a rheumatology clinic this included time off work, travel time, carbon footprint and the cost in time and effort for the accompanying persons.
We set up a small study comparing the quality and quantity of clinical data obtained via an online system and the direct face-to-face consultation. The quality of the information using the two methods was broadly comparable, our study concluded that one could get very useful information via telemedicine. This of course is in keeping with other findings that up to 70 or 80% of diagnostically useful information is obtained by talking to the patient the implication being that physical examination will provide a lesser amount of clinically useful information. Clearly physical examination often confirms the clinicians impression following the questioning of the patient. This stands to reason, the patient is the best witness of their own illness over time, the clinicians skill is essentially in distilling this information, gleaning it from the patient and formulating a diagnostic hypothesis.
At the end of our study we concluded that telemedicine in the form of a video consultation was most useful in seeing patients for review after their initial consultation had been done face-to-face in a conventional clinical setting. Subsequently we set up a very useful rheumatology telemedicine clinic that was well received by the patients and clinicians.