On 14 July,2020 | In Features

 

Following the London Consultants Association urging doctors to think twice before accepting 50% fee cuts from insurers for virtual consultations – see our 17 June story – surgeon Mr Ian McDermott spells out why this work is worth every penny.

Only someone who has not been forced into doing tele-consults with their patients would ever try and tell you that they are easy . . . because they are absolutely not.

So-called ‘telemedicine’ via platforms such as Zoom or Micro­soft Teams has been a life-saver over the Covid lockdown period, and it has allowed doctors to still be able to have consults with those patients who need to be ‘seen’. 

We have read a lot about the positives of telemedicine and how this could ‘transform’ the way that we work. The reality, however, really is not quite that simple. 

Time-consuming process

Scheduling video consults oneself is somewhat tedious and time-consuming.

Some platforms such as Doctify or Meddbase are now offering video consult facilities, which might make scheduling and setting things up easier – but only ever always at a price, adding even further to consultants’ costs. 

However, the real problem with telemedicine is the significant disruption that occurs to the normal human-to-human interaction. 

With telemedicine, one loses a large proportion of the usual non-verbal communication cues that can be so vital when trying to form a rapport with a patient or when trying to work out a complex problem or discuss difficult or bad news. 

Far from ideal

It is also far harder to guide or direct a conversation when speaking to someone remotely, which makes it more difficult to target key areas and focus the discussions on key issues.

In some instances, it is possible to do a very basic elementary visual clinical examination; for example, asking someone to move their knee within the field of the camera. However, this is far from complete or ideal and of no use whatsoever for many specialties.

In my practice, Zoom and Teams have been an absolute blessing, but to think that they have made clinical appointments easier would be completely wrong. 

A proper tele-consult is more difficult, more tiring and slower than an equivalent face-to-face appoint-­ment, with a higher propensity for miscommunication and for errors. 

Indeed, prior to the lockdown, some medical negligence insurance companies did not actually cover video-consults, although thankfully they did issue special cover notes once it became apparent that tele-consults were becoming a necessity.

Personally, I am very thorough in what I do and my tele-consults tend to take up the full half hour or even one-hour slots that I allocate each patient – depending on what prior warning I receive as to how complex their case might potentially be. 

However, after the consultation, one then has to dictate the patient’s clinic letter, and this can take several minutes. 

At a later stage, one also then has to check and edit one’s clinic letters too. This normally adds on at least an extra 15 minutes in total to each patient slot. 

Additional time

Added to this, however, is the enormous amount of additional time that it now takes to actually get anything done, in terms of trying to book patients in for investigations or actual treatments. There is now a myriad of additional forms and new processes, which seem to change on a weekly basis. 

There are also constant obstructions imposed on us due to the stifling bureaucracy of the NHS. So, everything is now more than twice as difficult and is taking more than twice as long as normal.

So, what is the reaction to all this hardship by some of the private medical insurers? To cut reimbursements for tele-consults by 50%.

It has been quite evident for a long time now that certain of the insurers have opted to pursue a strategy of ‘cheap’, with a blatant ‘race to the bottom’.

Blinkered approach 

However, this approach is deeply cynical and really quite blinkered, and will only serve to damage the entire sector.

At a time when:

• The number of private patients seeking treatment has plummeted;
• Access to clinic space for most people was removed for all except just a tiny number of emergency cases;
• Private consultants’ and private patients’ access to theatre slots has been decimated and relegated in most private hospitals to just limited evening and weekend slots only;
• It is taking more than twice as long to get anything done;
• Theatre productivity rates and throughput have dropped to well below 50%;
• The very future of private practice itself is under significant threat. It defies belief that any insurer should kick us even harder when we are already down by imposing a 50% cut in reimbursement rates. 

And all this at a time when most of us are still carrying enormous inevitable ongoing costs.

The recent London Consultants Association (LCA) survey has highlighted that many consultants no longer view private practice as worthwhile or financially viable. This act by some private medical insurers will be just another nail in the coffin of private practice for some.

Reducing slots

For others, like water inevitably finding its way to the sea, they may simply choose to find a way round this latest hit – with the only feasible option being to reduce tele-consult slots to 15 minutes or even less. 

Lowering quality lowers safety and takes away one of the unique selling points and the raison d’être of the whole private sector, which is its differentiator from cheap low-quality conveyor belt-style medicine.

Perhaps some cynical insurers believe that some consultants might be using tele-consults as an excuse to rack up reams of fees for a host of quick five-minute ‘how are you doing’ check-ups? 

If some consultants are actually doing this, then they need to be identified and routed out. How­ever, for the vast majority of consultants, we are in medicine specifically to deliver the very best care we can for each and every patient and, in current times, tele-consults have been somewhat of an evil necessity and a burden, as well as a positive blessing.

Increasingly, as the financial consequences of the Covid crisis hit, individual policy-holders and corporates will question the value and necessity of private health insurance. 

To those insurers who seem determined to rush ever faster in their race to the bottom – good luck with what you might well eventually end up finding down there.

Mr Ian McDermott (above) is consultant orthopaedic surgeon at HCA’s London Bridge Hospital and Managing Partner of the London Sports Orthopaedics practice.

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