Increased telehealth access boosts convenience but may increase strain on general practitioners

When technology makes doctors more accessible, it can lead to lower quality for patients and increased pressure on already stressed doctors, says Magnus Wanderås. Wanderås has worked as a general practitioner himself and completed a doctorate on the topic at the University of Agder (UiA).

It has become easier to contact your GP. With just a few keystrokes, you can start an e-consultation where you can discuss what’s on your mind. You can also ask your doctor for a video or phone appointment if you prefer not to visit the doctor’s office.

This development accelerated during the COVID-19 pandemic and has stabilized at a high level.

“One in five consultations in Norwegian general practice is now digital, which means either via phone, video or a written e-consultation,” says Wanderås.

In his doctoral thesis, he interviewed 24 GPs about how they perceive that remote consultations have changed general practitioner service.

Remote consultations are doctor’s appointments via video or telephone, or written requests initiated by the patient, for example through Helsenorge (the official website providing information and access to health services for residents of Norway).

Follow-up appointments needed

Such remote consultations are faster than in-person visits, and they make it possible for general practitioners to see more patients. At least in theory. It doesn’t help that nearly 1 in 5 people who have digital consultations still need an in-person appointment afterwards to resolve the issue.

“Before COVID, there was hope that remote consultations could ease some of the pressure on GPs, but it is likely that instead, they have led to considerable double usage of doctor’s appointments,” says Wanderås.

Asking about throat lozenges

Increased accessibility can lead to some contacting the doctor for things they perhaps shouldn’t seek medical advice about.

“A GP in the study mentioned a patient who sent an e-consultation to ask which throat lozenge the doctor would recommend for a cold,” says Wanderås.

At the same time, it is not easy for general practitioners to distinguish between serious and less serious inquiries in their inbox. Several describe checking e-consultations late at night to ensure there are no life-threatening conditions hidden among them.

“It’s like having a direct line to the GP, and it’s like asking already tired and conscientious GPs to become burned out,” says one of the doctors in the study.

Doorknob questions

Another of the doctors interviewed says, “Most of what we do involves people skills. And we get these skills when we interact with people. These interactions make up perhaps 90% of everything we do. Medicine is only a small part of it.”

“Some things can be handled digitally, and that’s perfectly fine. But the more we move to digital platforms, the less room there is for doing good medical work,” says Wanderås.

It’s about physical examinations, nonverbal communication and what the researcher calls “doorknob questions”—the important issues patients often bring up right at the end of the appointment. Several GPs noted that some patients reveal the real reason for their visit as they are about to leave.

“That is when they could raise concerns about, for example, alcohol problems, after initially visiting the doctor for a sore elbow. This space disappears with digital consultations,” says Wanderås.

The day before the interview with Wanderås, the government proposed several measures (in Norwegian) to increase the accessibility of GPs, among them an obligation to offer video consultations.

Wanderås is skeptical of such an obligation.

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

“This is a field where it is difficult to have definitive opinions. My interviews with 24 doctors are by no means enough to draw conclusions. There are probably GPs who think that digital consultations work perfectly,” he says.

Still, he reminds us that new technology must be used wisely.

“Innovation is not always the same as progress. If we see that the technology is not having the effect we hope for, the wisest course may be to take a step back.”