The COVID-19 pandemic has affected the number of face-to-face consultations with doctors, reducing patients to either no contact with their healthcare providers or the substitution of telehealth. Telehealth is a new frontier for many doctors and patients alike. Across the country, doctors are having to familiarise themselves with the technology, professional standards and changing billing requirements for telehealth consultations. Many are changing the way they practise and in doing so, are facing potentially new medico-legal risks.

Inability to physically examine patients

Although it is up to the patient to provide an accurate history during telehealth sessions, the inability to physically examine patients is an area of concern.

In general, claims primarily about diagnosis are common. An analysis of Avant’s data revealed that the incidence of such claims is one in five¹. Of these, failure to diagnose or a delayed diagnosis were the most common issues, often stemming from no or inadequate physical examination.

If, in a telehealth consultation, a patient leaves out an important symptom that might have been noticeable during in-person care, diagnosis can be compromised. A doctor may therefore need to ask more detailed questions to ensure they obtain a comprehensive health history. They also need to consider whether a physical examination is necessary and have a plan in place for referral of the patient if they themselves are in self-isolation or otherwise unable to see the patient.

Reductions in necessary testing and screening

The Royal College of Pathologists of Australia has expressed concerns about the consequences of people not seeking medical care. The College reports that up to 40% of routine private and community pathology testing is not being conducted as people are not visiting medical practitioners and having pathology samples collected. Although a smaller decline, the College also notes a drop in the public sector.²

According to the Cancer Council, up to one in 10 Australians have put off cancer screening during the pandemic.³ While cancer screening services for breast, bowel and cervical cancers are currently operating, many are postponing or avoiding recommended tests to detect, monitor or guide the treatment of cancer.

The reduction in testing and absence of face-to-face consultations may result in a ‘new wave’ of diagnoses yet to come. Reassuring patients, particularly higher-risk patients, of safe options for receiving testing and care and the importance of early intervention is critical to help curb this ‘wave’.

Challenges in coordinating care

When a patient needs medical attention, accessing telehealth first can delay care if that patient then needs to be physically seen for examinations, tests or treatment.⁴ What can be achieved in one consultation in person may be stretched into multiple consultations.

Although it might be more feasible and efficient to conduct necessary tests and examinations in a single face-to-face consultation, in the current environment, telehealth may be the critical difference between receiving treatment versus no treatment at all. Given the challenges, the actions needed for effective care coordination, such as follow-up of diagnostic test results or communication with the specialist a patient sees for further investigations, need additional attention.

Good diagnostic practice

While it appears a new era of healthcare is upon us, the same principles of good practice in diagnosis apply now as before. Doctors working with patients to reach a diagnosis should still aim to take a thorough patient history, use referrals appropriately, use follow-up systems, and take thorough notes documenting their discussions with the patient, investigative findings and follow-up actions.

If you receive a complaint, contact our Medico-legal Advisory Service on 1800 128 268 for expert advice on how to respond, available 24/7 in emergencies.

Useful resources

• COVID-19 FAQs

References

1. Diagnosis-related claims
2. RCPA urges individuals to attend important medical appointments. 10 April 2020.
3. Experts worried people delaying medical tests due to coronavirus will create 'tidal wave' of diagnoses. 14 May 2020.
4. Telemedicine benefits: For patients and professionals. Retrieved 20 May 2020.

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