Widespread access to telemedicine increases the workload of family physicians

While technology is making doctors’ help more accessible, this can lead to a decrease in the quality of patient care and increase the workload of already stressed doctors, says Magnus Wanderås, a general practitioner who did his doctoral thesis on the subject at the University of Agder (UiA).

Now getting in touch with your GP has become easier. With just a few key presses, you can start an online consultation to discuss all your concerns. You can also ask your doctor for a video or phone appointment if you prefer not to visit the clinic.

This trend gained momentum during the COVID-19 pandemic and has now stabilized at a high level.

“One in five consultations in Norwegian general practice is now digital, i.e. by phone, video or in writing,” says Wanderås.

In his doctoral thesis, he interviewed 24 general practitioners about how they thought remote consultations had changed their work.

Remote consultations are a doctor’s appointment via video or telephone or a written request initiated by the patient, for example via apps that provide information and access to health services.

Need for follow-up visits

These remote consultations are faster than face-to-face visits and allow GPs to see more patients. At least in theory. The truth is that nearly one in five people who receive a digital consultation still need a face-to-face appointment to resolve the problem.

“Before COVID, there was hope that remote consultations could reduce the workload of GPs, but it is likely that instead they have led to a significant duplication of GP appointments,” says Wanderås.

Throat lozenges

Increased accessibility is leading some people to see a doctor for issues that can be dealt with on their own.

“One GP in the study told of a patient who sent an e-consultation request to ask what throat lozenges the doctor would recommend for a cold,” explains Wanderås.

At the same time, it is not easy for GPs to distinguish serious requests from the less serious ones that arrive in their inbox. Some of them tell us that they check requests for e-consultations late at night to make sure there are no life-threatening conditions among them.

“It’s like a direct line to a GP, and it’s like making already tired and conscientious GPs burn out,” says one of the doctors involved in the study.

“Doorknob” questions

Some things can be solved digitally, and that’s fine. But the more we move to digital platforms, the less room there is for quality medical work.

We’re talking about physical examination, non-verbal communication and what the researcher calls “doorknob questions” – important questions that patients often raise at the end of an appointment. Several GPs noted that some patients reveal the real reason for their visit when they are about to leave.

This is when they may disclose alcohol problems, for example, after initially coming to the doctor for a hurt elbow.” In digital counseling, that space disappears.

The day before the interview with Wanderås, the Norwegian government proposed several measures to make GPs more accessible, including a commitment to provide video consultations.

Wanderås is skeptical of such a commitment.

He emphasizes that most GPs have already found a good way to work with digital consultations and that they should remain free to find their own ways of working.

“This is an area where it is difficult to have a clear opinion. My interviews with 24 doctors are by no means enough to draw conclusions. There may be GPs who think digital consultations work perfectly,” he says.

Nevertheless, he reminds that new technologies must be used wisely.

“Innovation is not always progress. If we see that a technology is not having the effect we expect, the wisest decision is to take a step back.”