Telemedicine Arrives in the U.K.: ‘10 Years of Change in One Week’
LONDON — A housebound 92-year-old man had red, throbbing legs. A younger patient was complaining of a lump in his armpit. And the self-isolating residents of a nursing home needed checkups.
Those maladies and needs, once a waiting room’s worth of problems, are now being handled online and over the phone as the coronavirus fans out in Britain and across the world, rendering medical offices no-go zones for all but the sickest patients.
In a matter of days, a revolution in telemedicine has arrived at the doorsteps of primary care doctors in Europe and the United States. The virtual visits, at first a matter of safety, are now a centerpiece of family doctors’ plans to treat the everyday illnesses and undetected problems that they warn could end up costing additional lives if people do not receive prompt care.
“We’re basically witnessing 10 years of change in one week,” said Dr. Sam Wessely, a general practitioner in London. “It used to be that 95 percent of patient contact was face-to-face: You go to see your doctor, as it has been for decades, centuries. But that has changed completely.”
In Europe, virtual medicine has been held back by strict privacy regulations and patients reluctant to give up in-person doctor’s visits. British primary care doctors, too, have been barraged by growing workloads of late, with patients living longer and more problems being rerouted from hospitals, leaving them little time to train on virtual tools.
But technology companies are racing to capitalize on a regulatory pullback by governments as they battle the virus.
Neighborhood doctors, many of them once skeptics, are rushing into the new age, too, singing the praises of virtual visits that they say save them time and offer a useful complement to physical exams.
In the past, telemedicine had often involved companies beaming in doctors from hundreds of miles away for a quick prescription or piece of advice. But doctors are now using the same tools to prove to their usual patients that the same level of convenience is available at their local clinics.
“I think a lot of it will remain this way after this crisis,” said Beccy Baird, a senior fellow at the King’s Fund, a health care research charity. “What’s really key is that we don’t lose patients’ ongoing relationships with a group of professionals at their home practice.”
Desperate as health systems are to keep coronavirus patients out of general practitioners’ offices, British doctors say the dams have broken. The telephone system for triaging virus patients is overwhelmed, leaving people pleading with their family doctors for help. Doctors are reluctant to treat infants with serious coughs over the phone. And some patients have other complaints on top of symptoms of the virus.
In some large primary care practices in London, doctors are setting up so-called dirty zones where they examine patients with respiratory symptoms and clean zones for everything else. Other primary care networks have set up entire clinics, known as “hot tubs,” devoted to possible coronavirus patients who have other pressing health problems.
Even so, general practitioners have been making do with almost no protective gear. Doctors have recently peeled back the labels on some shipments of surgical masks only to find years-old expiration dates.
With fears running high that some general practitioners could already be infected, they are all the more eager to treat anyone who can afford to stay home with a video session or a phone call.
And as lockdowns in Britain and across the rest of Europe continue and older people are advised to stay home, doctors see virtual visits as the only way of caring for people who can ill afford to lose track of everyday ailments.
“The risk I pose to residents of a nursing home by going in there is pretty significant, yet they are some of our most frail patients,” said Dr. Paul Deffley, a general practitioner in Brighton, a coastal city in Southern England. “Being able to eyeball someone, to engage in a consultation with them and assess for clinical signs, is an absolute game changer for how we’re able to safely manage people.”
Before the virus, video appointments made up only 1 percent of the 340 million or so annual visits to primary care doctors and nurses in Britain’s National Health Service.
But the health service told thousands of clinics across the country to start switching to remote consultations last month and said it had fast-tracked approval of digital providers to ramp up their offerings.
Push Doctor, a telemedicine company, said its weekly orders had grown 70 percent since the outbreak. Docly, another company, said demand had increased by 100 percent from one week to the next as the virus spread.
In the United States, too, Medicare said it would expand coverage for telemedicine across the country, giving millions of older people the chance to get help without leaving their homes.
The shift is striking in Britain, where regulatory hurdles and a cluttered bureaucracy have left telemedicine companies complaining for years about access.
Even Germany, where strict standards of privacy and data protection have kept virtual consultations out of the mainstream, has started loosening its rules in response to the virus. The changes could have huge economic implications: The European Commission said in 2018 that the telemedicine market could surpass $40 billion globally by 2021.
“At the moment, the digital providers are rushing to meet demand,” said Graham Kendall, the director of the Digital Healthcare Council, which represents British telemedicine firms.
Not all doctors are so sanguine about the shift. Primary care doctors in Britain said they were prescribing more antibiotics, abandoning their usual caution about overuse to avoid in-person appointments.
They also worry that they would still be missing cancer diagnoses, for example, that come out of routine, in-office visits.
“It definitely is medicine in the dark,” said Dr. Sean Morris, a family doctor in London. “It’s risky, and it’s not what we’re familiar with. There’s a concern that if we’re bringing in patients less, we may not be seeing more subtle signs of things like cancer.”
For more superficial needs, though, doctors said the virtual appointments had put an end to having to wait for patients to arrive and asking them to travel without good reason.
Sometimes, tech-savvy relatives can help: Dr. Shivani Tanna, a family doctor in Liverpool, England, recently had a patient’s granddaughter click a link to activate a smartphone video meeting and then touch her grandfather’s legs to determine if they were warm. The remote diagnosis was cellulitis.
In another case, a patient measured the lump in his armpit before Dr. Tanna prescribed antibiotics.
“We’ve got to work with what we’ve got,” she said. “It’s helpful just to glance over a person to see how they’re breathing, how they’re walking around. It’s going to play a big role in the next few months.”
Many doctors attributed the mass adoption of remote appointments to a company called accuRx. Already a trusted tool for doctors who wanted to send text messages to patients, accuRx built a video-calling system over a weekend after the virus hit Britain. It quickly became the go-to provider for online appointments, offering a stripped-down interface and the comfort of having long been in primary care clinics.
More than 90 percent of primary care clinics in England are now using it. Even some hospital specialists have used accuRx to speak with coronavirus patients in other parts of the same building.
“The health system is making years of progress in the space of weeks, if not days,” said Jacob Haddad, the co-founder and chief executive of accuRx.
Doctors said patients had seemed to adapt quickly, with the help of occasional coaching in how to open text messages and video links.
Dr. Pete Deveson, a family doctor in Epsom, England, said he still worried about what the new pressures of remote working would do to doctors’ lives.
But he said: “I’m a convert — to a degree. This is a better way of keeping patients at home.”