Study Finds Phone and Online GP Consultations Put Patients at Risk

A doctor wearing protective equipment is seen unloading a patient outside St Thomas's Hospital, in London on April 7, 2020. (Peter Summers/Getty Images)

Remote GP consultations—on the phone or via an online call—put patients at risk and can lead to missed or inaccurate diagnoses, a study has warned.

Conducted by health scientists at the University of Oxford and other UK universities, the study was published in BMJ Quality and Safety. It analysed 12 general practices across England, Scotland and Wales and looked at data from 95 UK safety incidents between 2020 and 2023 (including during the pandemic).

It found that while safety incidents are “extremely rare” in remote primary care, some cases had resulted in deaths or serious harm.

Diagnosing patients remotely, the GPs risked underestimating the severity or urgency of a condition and providing an inadequate follow-up or a delayed referral.

This created an extra layer of risk for patients with complex pre-existing conditions, cardiac emergencies and generalised symptoms.

“Several safety incidents involved clinicians assuming that a diagnosis made on a remote consultation was definitive rather than provisional. Especially when subsequent consultations were remote, such errors could become ingrained, leading to diagnostic overshadowing and missed or delayed diagnosis,” the study said.

In one case, a 70-year-old woman who experienced sudden breathlessness called her GP and was told that the doctor would call her back. The receptionist got distracted by another patient in the waiting room and didn’t see through the emergency call-back. The woman’s condition got worse, and she died at home that afternoon.

Another example, brought forward by the study, described the case of a 16-year-old girl, who was diagnosed with glandular fever by a doctor on the phone. The doctor spoke to the patient’s older sister, but when the parents arrived home and took their daughter to the emergency department, it emerged she had sepsis. The girl died in the hospital.

The NHS recognises the pitfalls of remote consultations, which include missed opportunities to pick up on subtle cues during a face-to-face consultation and exclusion of patients who don’t have access to a phone or a computer.

However, the NHS also recognises that remote consulting allows patients who live rural or remote areas to get fast care and medical advice. It also saves patients’ time and reduces waiting times for GP appointments.

Shift to Remote Appointments

The shift toward remotely provided health care took place with the onset of the COVID-19 pandemic.

The number of face-to-face GP appointments plummeted during the first wave between February and April 2020. At the same time, the number of telephone or video/online consultations rose from 15 percent in February to 48 percent in April, decreasing slightly to 36 percent in October.

The study reported that by mid-2021, remote encounters had begun to be “depicted as potentially unsafe” because they had been linked to cases where patients were harmed. This included avoidable deaths and missed cancers.

A case of a missed diagnosis, reported in the study, was that of a 40-year-old woman, six weeks after a caesarean section, who contacted her GP. She complained of shortness of breath, increased heart rate and dry cough. The patient was advised to get a COVID-19 test.

After she collapsed and died at home the following day, a post mortem examination revealed a large pulmonary embolus. After the GP reviewed the case, they concluded that a face-to-face appointment could have resulted in a better check of the patient’s vitals and a more accurate diagnosis.

Authors of the study suggested that while remote triage and care could serve as a partial solution to the health care system pressures, the question of safety remained a critical one.

Faced with the widespread expansion of remote triage in primary care, the system needs to re-examine where the risks lie, the study concluded.

Latest NHS data showed that in September, 70.7 percent of all GP appointments were carried out face to face.